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Principles of Burn Management

Assessment

In the history, it's important to find out the causative agent, time and duration of insult, and if first aid was applied.


In the examination, always assess CRT, sensation, and if the distribution of the burn is consistent with the history, In deep burns, both the CRT and sensation will be absent.


There are 2 ways of measuring the location, size and extent of a burn:

  • Wallace Rule of Nines – may overestimate the affected area

  • Lund and Browder Chart – more accurate


Lund-Browder chart - U.S. Department of Health and Human Services (https://en.wikipedia.org/wiki/File:Lund-Browder_chart-burn_injury_area.PNG)

Management

The most important thing to do for thermal burns is Irrigation with cool/lukewarm water for 20-30 mins (use wet towels/compresses if not available). Ice cold water shouldn't be used as it may cause vasoconstriction, therefore deepening the wound. Also, it's important to cover the burn with cling film (avoid wrapping it around as it will cause vasoconstriction instead).


The patient should always be kept warm to avoid hypothermia.


With circumferential full thickness burns of the chest/limbs/digits, we worry about it causing a tourniquet effect, which compromises limb circulation and respiratory function. To avoid this effect, an Escharotomy should be done.

Fasciotomy (a) and Escharotomy (b) in a child with third degree burns. A motorized dermatone is being used to perform the escharotomy. - Murat Ucak, Mehmet Emin Celikkaya Open Government Licence v3.0. (https://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/)

The affected area should be elevated to reduce the risk of oedema.


If there's an inhalation injury, give HF O2.


Also consider Tetanus prophylaxis in every burn patient.



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