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