1. Emergency Department Warwick Hospital
BURNS
Emergency Department
Warwick Hospital

2. Background A common cause of A&E attendance
Almost all of us have experienced burn injury
Peak incidence 0-5, & >75 years
Significant morbidity results while most are not life threatening
High risk of death in very young & old
Always consider NAI in children under 5

3. Causes & Incidence Scald 33.6% Flame 29.2% Hot surfaces 12.2%
Chemicals %
Electrical %
Others %
* Others would include sun, friction and radiation burns.

4. Pathophysiology
*stopping the burning process is essential to stop an initially superficial burn to progress to a full thickness burn that requires surgery. The larger the BSA, the more the fluid and heat loss. The more the depth, the more the damage to nerve endings and epithelium.

5. Classification of Burn
Epidermal
Superficial dermal partial thickness
Mid dermal partial thickness
Deep dermal partial thickness
Full thickness

6. Other Classifications
1st Degree – Superficial Epidermal
2nd Degree – Superficial Dermal
3rd Degree – Deep or full thickness burn

7. Depth & Clinical Features
1st Degree - Erythema, no blisters, painful
2nd Degree – Pink/Mottled, Blisters, painful
3rd Degree – Dry, pale, dark, leathery, and
no pain
* Pain is inversely proportional to the depth of burn injury

8. First Degree

9. Second Degree

10. Third Degree

11. Burn Surface Area (BSA)
Use Wallace rule of 9 or the Palm of the patient hand
Minor < 10% children or 15% adults
Major >10% children & 15% adults
Lund & Browder chart is more accurate

12. Rule of Nines

13. Management Immediate Life Saving Measures . Safety
. Remove patient from cause of burn & stop the burning Process
. Check ABC & First Aid

14. Assessment in ED
. History
. Primary Survey ABCDE
. Check for signs of inhalation
stridor is an indication for intubation
. Estimate extent and depth of burn

15. ABC Strategy Airway & C-spine control Breathing & signs of inhalation
Circulation & Perfusion/Fluids
Disability & Pain control
Environment – skin integrity & temperature

16. Signs of Inhalation Fire in an enclosed/confined space
Face and neck burns
Singeing of eyebrows & nasal hair
Hoarse voice
Dyspnea
Carbonaceous sputum
Brassy cough
Carboxyhemoglobin (HbCO) >10%

17. Fluid Resuscitation
Indicated in Burns >5% in children & >10% in adults
Use Hartmann’s or Normal Saline
Parkland formula recommended
Monitor adequacy by normal urine output
Follow the Departmental fluid requirement chart

18. Burns Transfer – Fluid Chart

19. Secondary Survey Head to toe examination for associated injuries.
Assess peripheral circulation in circumferential burns
Analgesia – Morphine preferred
Antibiotics & Tetanus
Wound dressing

20. Burn Wound Dressing Deroof/decompress blisters if possible
Adequate wound cleaning before dressing
Flamazine, Mepitel or Urgotul SSD.
Face - leave exposed (Polyfax or Chloramphenicol ointment)
Hand - Flamazine hand bag or light Mepitel dressing. The fingers must move.
In transfer use cling film or sterile sheet
Review all dresings within 48 hrs

21. Chemical Burns
Usually Acids/Alkali but remember Phenols/Petroleum products.
Alkali burns generally worse than acids (due to penetration)
Flush with large amount of water
Measure the Ph
Neutralizing agents available?
Consult the National poisons centre

22. Electrical Burns Usually more serious than they appear
History of fit/thrown over
Unconsciousness or depressed GCS
Entry and Exit wounds
Changes in ECG, myoglobinuria or abnormal CK/Troponin
Admit if any of the above present

23. Indication for Transfer
Superficial burns – child >5%, Adult >10%
Significant burns of special areas
Significant full thickness burns
Presence of inhalation injury
Significant Electrical and Chemical burns
Radiation burns
Associated major trauma

24. Questions