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ukmla 2026

Burns

Thermal/chemical/electrical injury — classified by depth (superficial to full-thickness) and area (% TBSA using rule of nines)

Review date
reviewed 2026-04-05
Reading time
5 min read
Author
Dr Kola Tytler MBBS CertHE MBA MSt MRCGP
Dermatologycommonacute
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Condition details
Dermatology
common
5 min read
reviewed 2026-04-05
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About This Page

This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.

Key points

  • Superficial: erythema, painful. Partial-thickness: blisters, painful. Full-thickness: painless, waxy/charred
  • Wallace's rule of nines: head 9%, arm 9%, leg 18%, trunk 36%, perineum 1%. Palm ~1%
  • Parkland formula: 4 mL x %TBSA x kg of Hartmann's over 24 hours (half in first 8 hours from time of burn)
  • Refer to burns unit: >10% TBSA partial-thickness, any full-thickness, face/hands/genitalia, inhalation, circumferential
  • First aid: cool with running water 20 minutes. Cover with cling film. Do NOT use ice

Overview

Burns are classified by depth and area. Superficial (epidermal only — erythema). Partial-thickness (dermal — blisters). Full-thickness (entire dermis — painless, waxy/charred, needs grafting). TBSA is assessed using Wallace's rule of nines (adults) or Lund-Browder chart (children). Inhalation injury significantly increases mortality.

Epidemiology

~175,000 A&E attendances annually in UK. ~13,000 admissions. Scalds commonest in children. Peak in under 5s (scalds) and adults 20-30 (flame). Consider NAI in children with suspicious patterns.

Clinical Features

Symptoms
Superficial: erythema, painful — like sunburn
Partial-thickness: blisters, very painful, brisk capillary refill
Full-thickness: white/waxy/charred, PAINLESS, no capillary refill
Hoarse voice, stridor, singed nasal hairs (inhalation injury)
Circumferential full-thickness (compartment syndrome risk)
Signs
Erythema (superficial) to blisters (partial) to waxy/charred (full)
Capillary refill: brisk (superficial), sluggish (deep partial), absent (full)
NAI patterns: bilateral symmetric scalds, immersion pattern, cigarette burns

Investigations

First-line
Clinical assessmentDepth + %TBSA using rule of nines or Lund-Browder
WeightFor Parkland formula calculation
Second-line
BloodsFBC, U&E, LFT, clotting, group + save if major burn
COHb on ABGIf smoke inhalation — pulse oximetry unreliable in CO poisoning
Specialist
BronchoscopyIf significant inhalation injury

Management

British Burns Association + NICE CKS
1
First aid
  • Cool with running water for 20 minutes (effective up to 3 hours)
  • Do NOT use ice, butter, toothpaste
  • Remove clothing/jewellery (unless adherent)
  • Cover with cling film (not wrapped circumferentially)
2
TBSA assessment
  • Rule of nines: head 9%, arm 9%, trunk 36%, leg 18%, perineum 1%
  • Lund-Browder for children
  • Palm including fingers ~1% TBSA
  • Only count partial and full-thickness — NOT erythema only
3
Fluid resuscitation (>15% adults, >10% children)
  • Parkland: 4 mL x %TBSA x kg Hartmann's over 24 hours
  • HALF in first 8 hours from TIME OF BURN
  • Target urine output 0.5-1 mL/kg/hr adults
4
Referral to burns unit
  • >10% TBSA partial-thickness, any full-thickness
  • Face, hands, feet, genitalia, major joints
  • Circumferential, inhalation, chemical, electrical
  • Suspected NAI
5
Wound management
  • Superficial: emollients, heals 7 days
  • Partial: non-adherent dressings
  • Full-thickness: debridement and skin grafting
  • Escharotomy for circumferential causing compartment syndrome

Complications

  • Compartment syndrome: Circumferential full-thickness — emergency escharotomy
  • Inhalation injury: Airway oedema, CO poisoning, ARDS
  • Infection: Burn wound sepsis — leading cause of mortality
  • Hypothermia: Especially in children
  • Contractures/scarring: Long-term
UKMLA Exam Tips
  • 1Parkland: 4 x %TBSA x kg = Hartmann's over 24h. HALF in first 8 hours
  • 2Full-thickness burns are PAINLESS — nerve endings destroyed
  • 3Rule of nines: arm 9%, leg 18%, trunk 36%, head 9%
  • 4Cool with water 20 min, cover with cling film
  • 5Circumferential burn = compartment syndrome = escharotomy
  • 6COHb on co-oximetry — pulse ox falsely normal in CO poisoning
  • 7NAI: immersion, bilateral symmetric, delay, inconsistent history

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Verified Sources & References

British Burns Association — Referral Criteria
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