Burns - Emergency Management

Burns

·        Caused by: thermal, electricity, chemical, mechanical, radiation

·        History:

o   Timing – start fluid maintenance calculations from time of injury not time of presentation

o   Circumstances – eg any risk of inhalational injury

o   Tetanus immunisation

·        Classification:

o   Assessing depth:

§  1^st degree burns: Erythema (like bad sunburn)

§  2^nd degree: Blistering

§  3^rd degree: skin goes like leather

§  Now classified as:

·        Partial thickness burns (either 1^st or 2^nd degree): superficial heal in 2 – 3 weeks, deep need grafting 

·        Full thickness burn 

o   Body area covered: Rule of nines to estimate surface area burnt: head 9%, arms 9% each, thorax 18%, abdomen 18%, legs 18% each

·        Admit if:

o   Major burn (>15% of adult, > 10% of child)

o   Special areas (hands, face, over joints, etc)

o   Circumferential – Require escharotomy to release pressure

o   Other medical conditions, etc

·        Respiratory complications:

o   Upper airway burns: watch for oedema and obstruction.  Prophylactic intubation if severe

o   Lower respiratory tract burns: Suspect if closed space fire, smoke inhalation or upper RT burns.

o   Treatment: humidified O2, PEEP, pulmonary toilet and physiotherapy.  Avoid steroids 

o   Inhalational injury a big killer – eg chemicals from burning materials ® ARDS 24 hours later

·        Watch for:

o   Hypovolaemia.

o   Good nutrition critical: ­­ calorie and protein requirements.  Use NG tube

·        For minor burns:

o   Analgesia

o   Wash gently

o   Dress with paraffin gauze and padding

o   Tetanus jab

o   Review in 3 – 4 days