Burns

Dr Tom Leach

7 years ago

Contents

Superficial aka first degree – epidermis (erythema) only. Can be differentiated from partial thickness by rubbing the skin. If the epidermis moves around, sliding over the deeper layers, this is a partial thickness burn
Partial thickness aka second degree – affects the dermal layers. Can be sub-divided into superficial dermal, mid dermal, and deep dermal
Full thickness aka third-degree – all the way through the dermis and may also affect deeper tissues

Only include partial and full thickness areas
Remember that a single burn likely has patches of different thicknesses
If unsure if superficial or partial thickness, be cautious and include affected areas
Rule of 9’s
Useful because it allows for estimation of Total Body Surface Area of burn, which is later used in the calculation for fluid requirements

Burns leads to lots of skin oedema which can cause hypovolemic shock
The modified parkland formulais used to calculate fluid requirements
Should be given if TBSA burns >15% in adults and >10% in children
Don’t forget other factors that may lower your threshold for giving fluids, including other traumatic injuries, or inhalational burns
Hartmann’s is fluid of choice
First ½ of the fluid should be given in the first 8 hours after the burn (not after the presentation)
Second half over the next 16 hours
Formula:
- 4mls x TBSA Burn % x Weight (Kg)

Try to remove jewellery and clothing as appropriate. If clothing is stuck to burn, leave it alone
Choice of dressing varies widely between centres. Check local policies
Running under cool water can help. You should od this for 20 minutes or so, and is only useful if <3hours since burn. Be aware that if there is a large burn surface area, this can cause hypothermia

Any patient with >10% TBSA (>5% in children) burns should be considered for transfer to burns unit. If there is any doubt about this, speak to the local burns centre for advice.
Other potential factors that might lower the threshold for transfer include:
- Very young
- Very old
- Pregnant
- Other significant co-morbidities or trauma
- Chemical burns
- Circumferential burns

Thermal injury to the airway
Chemical injury to the airway
Systemic effects from toxins (CO, cyanide – as a combustion product of some plastics / wools etc)
Hypoxia / asphyxia due to O2 consumption by the fire