Thermal, electrical or chemical.
Depth of burn:
- Superficial burns appear red and are not life threatening. Examples include sun burn.
- Partial thickness burns appear red and are associated with oozing as well as swelling and blistering. Most do not usually require a skin graft.
- Full thickness burns appear pale and are insensate. They produce scarring and contracture in the long term.
Body Surface area:
In the first instance an ATLS approach should be taken to managing the patient:
- AIRWAY – evidence of inhalation injury should be looked for such as singed nasal hairs/eyebrows, facial burns, carbonaceous sputum, altered consciousness or history. If there is any evidence of airway compromise or even if the airway is secure but there are burns to the face or neck then the patient should be intubated before oedema sets in and makes this more difficult.
- BREATHING – thermal injury can cause upper airway oedema whilst toxic fumes can produce bronchitis, oedema and pneumonia. Also one should have a high index of suspicion for carbon monoxide poisoning. 100% oxygen should be used.
- CIRCULATION – thermal burns should be covered with cling film to reduce fluid loss. IV access should be established even through the burnt skin and two litres of crystalloid (preferrably Hartmann’s or Ringer’s lactate) should be rapidly given. Patients should e catheterised to monitor fluid balance and the following formula maybe used to guide fluid input:
Crystalloid Fluid input for first 24 hours = 2-4ml fluid x weight (kg) x % burn
First 8 hours from time of burn: give half the fluid.
- Circumferential burns require escharotomies as they impede circulation by producing a tourniquet effect or respiratory effort in the case of those in the thorax.
- Ensure patients are given adequate ANALGESIA
Specialised Burns Units
It is good practice to contact your regional unit for advice in general but the following cases should be managed in the specialist setting:
- A partial thickness burn of > 20% surface area (in the elderly or very young, this should be reduced to 10%)
- Full thickness burns >5%
- Burns on face, hands, feet, genitalia or joints
- chemical or electrical burns
- inhalation injury
- Those with serious co-morbidities especially renal impairement of cardiac failure.