CME 11/2/16 – Burns Management

Here is Liz Wharton’s (Burns Specialist FSH & PMH) great talk on major and minor burn management in Western Australia.

 

 

Resources:

 

Estimation of burn area 

Small burns patient’s palm ~ 1%
 
 
Rule of 9’s:
 
rule of nine's
 
 
Lund & Browder Chart for Paediatric Burns:
 


 
 

Assessment of Burn Depth:

 
Superficial Burns
Superficial dernal burns
Mid dermal burns
Deep dermal burns
Full thickness burns
 
 

Fluid resuscitation:
  • When?
    • In Adults                                                          >15% tbsa
    • In Children 18 months and older                >10% tbsa
    • In Children less than 18 months                 >8% tbsa
  • How much?
    • 2mls x % tbsa x weight (kg) plus daily maintenance fluids
    • Hartmann’s solution
    • Calculated from time of burn
    • First half over initial 8 hours
    • Second half over next 16 hours
    • Daily maintenance fluids
      • Adult – 2000ml in 24 hours
      • Children 1st 10kg – 100mls /kg;  2nd 20kg – 50mls /kg; Over 20kg – 20mls /kg
  • How to monitor?
    • Aim for U/O of 0.5-1ml/kg/hour
    • Adjust fluids accordingly
    • Inhalation and electrical injury 2ml/kg/hour

 

Referral criteria:
  • > 10% TBSA in adults
  • > 5% TBSA in children
  • Any full thickness burn
  • Any circumferential burn
  • Respiratory /inhalation burns
  • Infected burns Electrical burns
  • Chemical burns Special areas: hands, face, genitalia, feet
  • Burns with concurrent injuries/co-morbidities

 

How to refer:
  • For Adults –  Fiona Stanley Hospital
    • Urgent – Via Burns / Plastics Registrar
    • Non-urgent – Walk in clinic (no referral needed) Monday – Friday 10am
    • can send images for review to: fsh.burnstelehealth@health.wa.gov.au
  • For Children – Princess Margaret Hospital
    • Urgent – Via Burns / Plastics Registrar
    • Non-urgent – Call Ward 5B for outpatient appointment
    • can send images for review to: pmhburnstelehealth@health.wa.gov.au

 

Preparation for transfer:
  • Airway: Consider need for intubation
  • Breathing: High flow oxygenEnsure the patient is stabilised prior to departure
  • Sit with head up
  • Circulation: IV access, IDC
  • Dress the wounds: Acticoat
  • Pain relief
  • NG tube
  • Document everything and send with patient including your contact details

 

Further Education:

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