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