Burns

This page is primarily about major burns but towards the end is stuff that you would do for minor burns as well. Like anything, ABC is the most important thing. Here are the things you do and the order in which you do them.

Airway and breathing

Inhalation injury is important as it could potentially stop breathing and damage the lungs. There can also be carboxyhaemaglobin (COHb) where oxygen can no longer bind to haemoglobin, and can kill. Inhalation injury is made more likely by:

• Hx: fire in enclosed space
• Examination: burnt oropharynx or nasal hair; soot in upper airway or sputum; or burns evident on bronchoscopy.
• Carboxyhaemoglobin, ABG

Action

• High-flow 100% O₂ - reduces COHb half-life from 250 to 40 minutes.
• Call anaesthetist - intubate if in doubt

First Aid

Now you've dealt with the airway and breathing, next is the burn itself.

• Remove burnt clothing
• Irrigate burns with cool water for 10-20 minutes
• Warm patient
• Use clingfilm longitudinally

For chemical burns, continually irrigate.

Circulation

Insert 2 wide-bore IV cannulae. The aim of fluid resuscitation is to anticipate and prevent shock. As such, it is important to have a good idea of how extensive burns are as that gives an idea of how much fluid has been lost.

Burn Surface Area (BSA)

You can use a burn chart; the rule of serial halves (>1/2, <1/2, 1/4-1/2, <1/4); or the Wallace rule of nines:

• Arm (all over) 9%
• Leg (all over) 18%
• Front 18%
• Back 18%
• Head (all over) 9%
• Genitals/perineum 1%
• Palm and fingers (one side of the hand) 1%

Fluids

After you've figured out how much of somebody is on fire, you have to figure out how much fluid to give them. There a variety of formulae but the main one is Parklands.

(mL)=4 x body weight (kg) x BSA (%)