Final year‎ > ‎

14.01.15 Burns

Depth
  • No longer 1st, 2nd, 3rd degree
  • Partial thickness (above fat - dermis + epidermis only)
    • Superficial partial
      • Pink
      • Blaches
      • Heals without scarring (but dark-skinned people may have a white patch)
      • +/- blisters
    • Deep partial
      • Hurts less
      • Dark red
  • Full thickness (includes subcutaneous fat)
    • Brown / White

Areas
  • IGNORE simple erythema
  • One palm (incl. fingers) of the patient = 1% BSA
  • Rule of 9s
  • Lund and Browder charts can be used to accurately assess children + infants

Fluids
  • 3 - 4 ml/kg/% burn IN ADDITION TO resuscitation + maintenance requirements
  • Give 50% in the first 8 hrs and the rest in the next 16 hrs
  • Everyone with >20% BSA and children with >10% BSA burns must be catheterised for output monitoring

Burns unit referral
  • Everyone with >10% partial thickness
  • Everyone with >5% full thickeness
  • Burns affecting key areas:
    • Face, hands, feet, genitalia, perineum, joints
  • Electrical or chemical burns
  • Lower thresholds for children

History and examination
  • Cause, duration of contact, exact time of injury
  • ?NAI
  • Colour, blisters, sensation, cap refil, pain, exudate, surrounding skin changes
  • ?Sepsis (from old burn)
  • Size

Basic management
  • Clean
  • Remove loose skin and superficial blisters
  • Keep moist - Dryness => Dessication + deeper damage
  • Antiseptic dressings

Notes
  • Don't forget the basics!
    • Don't get distracted by the burn
  • Everyone in the house/car has been through the same thing
    • Let one person's injuries guide your index of suspicion for the others
  • Don't forget other trauma
    • Jumped out the window?
    • Secondary trauma?
  • Burns WON'T (initially) cause shock or unconsciousness
  • Mortality = Age + % Burn
  • Mortality is usually from secondary infection
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