BurnsDeveloped: Dr J Larkin - Feb 2012Last Revised:Authorised: Dr Y Naidoo

Burns Assessment

Pathophysiology

Severe burns management

Specific burns

Burns AssessmentHistory

Type of Burn

Depth

Area

HistoryTime of burnType / cause of burnLocation / ConfinementTime of duration / exposureCo-morbidityTetanus Status

AMPLE

AllergiesMedicationsPast medical HxLast mealEvents

Burn TypesThermal Flame / ColdScaldContactChemicalElectrical RadiationFlashFriction

Superficial

Epidermis onlyPainfulRed

Partial Thickness

Epidermis and variable level of dermisPainfulSkin loss & blistering

Full ThicknessFull Thickness

Charred, leatheryPainlessVessel thrombosis

Burn Area AssessmentRule Of Nines

QuickerInaccurate in childrenLund & Browder

Less variability between assessments

Do not include erythema

Burns Centre ReferralBurns >10% BSAFull thickness burn >5% BSACircumferential burnsInhalation burnSpecial area burnsface, feet, hands, joint, perineumSignificant chemical/electrical injuryAssoc. traumaSignificant co-morbidityNon-accidentalBurns in pregnancy

Burns First AidStop the burning processExtinguish fireIn scalds remove damp clothingRemove jewellery

Cool the burnt surfaceCold running water (15oC)For 20 minutesNo benefit if > 3 hours post burnRisk of hypothermia especially in children

Severe Burns Management

Severe Burns ManagementStandard ABC approach (EMST/ATLS)

Risk of concurrent injury esp. blast injury, electrical shocks

Early communication with Burns Unit

AirwaySigns of inhalation injuryBurns / Soot around mouth,nose & pharynxCroupyHoarse voiceStridor

C-spine protection

AirwayConsider early intubation in inhalation injury

Avoid cut tubes

BreathingHumidified O2ABGsCarboxyhaemoglobinCXREarly intubationConsider escharotomy

CirculationCircumferential burnsElevate affect limbMay need escharotomyContinued perfusion checksIV accessavoid burnBloodsCatheterise

Fluid Resuscitation2-4ml x TBSA% x kg

Hartmanns

First in the first 8hrs Next over the following 16hrs

Time from burn, not ED

In addition to above add maintenance volumeAim Urine Output 0.5 1ml/kg/hr

Specific Burns

Electrical InjuryLow Voltage (

Electrical BurnAssess for entry / exit wounds

Risk in high tension electrical injury:myoglobinuriarenal impairmentcompartment syndromeneurological injury

High tension injuries often require larger fluid volumes (U/O 1-2mls/kg/hr)

Hydrofluoric AcidFound in industry for metal / glass etching, household rust removersConcentrate burns to 1% of TBSA are severe & potentially fatalSystemic fluorosis: Ca Mg KDeath caused by arrhythmia

HF TreatmentEarly liaison with Critical Care & Burns SpecialistConsiderTopical Calcium gluconate 2.5% gelCalcium gluconate 1g 10% ivSC infiltrationRegional infiltration K can be resistant to standard Tx

ReferencesEmergency Management of Severe Burns. Australian & New Zealand Burns Association. 15th Edition. February 2011.

M A Gillies, S Krone and K Sim. Use of cut endotracheal tubes should be avoided in the initial resuscitation of the burned patient.Emerg Med J 2003; 20:109 Wilson CM, Fatovich DM. Do children need to be monitored after electric shocks? J Paediatr Child Health. 1998 Oct;34(5):474-6.Fatovich DM, Lee KY. Household electric shocks: who should be monitored?. Med J Aust. 1991 Sep 2;155(5):301-3.Bailey B, Gaudreault P, Thivierge RL. Cardiac monitoring of high-risk patients after an electrical injury: a prospective multicentre study.. Emerg Med J. 2007 May;24(5):348-52. McIvor ME. Sudden cardiac death from acute fluoride intoxication: the role of potassium. Ann Emerg Med. 1987 Jul;16(7):777-81. Bjornhagen V.Hydrofluoric acid-induced burns and life-threatening systemic poisoning--favorable outcome after hemodialysis. J Toxicol Clin Toxicol. 2003;41(6):855-60.

Note RPH use 2mls rather than 4mls*