Burns of both legs cover a large part of the body, since each whole leg is about 18 percent of the adult body surface. Large burns cause major fluid loss, pain and infection risk, so early cooling, size estimate and fluid planning matter.
Key symptoms
- Severe pain, or little pain in deep burns that destroyed nerves
- Red, blistered, white, leathery or charred skin
- Swelling of the legs
- Thirst, chills or feeling faint in large burns
What you find on exam
- Primary survey first: airway, breathing, circulation, other injuries
- Burn size with the rule of nines or the palm method, counting only partial and full thickness
- Burn depth: superficial, partial thickness or full thickness
- Pulses, color and swelling of the feet; look for circumferential burns
- Urine output and vital signs
Tests
- Blood count, electrolytes, kidney function and glucose
- Carboxyhemoglobin and blood gas if there was a fire in a closed space
- Urine output each hour, often with a urinary catheter
- Weight to calculate fluids
Treatment basics
- Stop the burning; cool with running water for about 20 minutes and keep the patient warm
- IV fluids for burns over 20 percent in adults, starting near 2 mL/kg per percent burn of lactated Ringer in 24 hours, guided by urine output
- Pain control with IV opioids such as morphine
- Clean, nonadherent dressings and tetanus update
- Transfer to a burn center for large, full-thickness or circumferential burns; escharotomy if blood flow is cut off
Red flags
- Circumferential burn with cold, pale or pulseless feet
- Urine output under 0.5 mL/kg per hour or low blood pressure
- Signs of airway burn or smoke inhalation
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); Open RN, Nursing Skills 2e (Chippewa Valley Technical College). Written by Making Synapses. Making Synapses is not affiliated with these organizations.