CME: Burns Management
Here is Liz Wharton’s (Burns Specialist FSH & PMH) great talk on major and minor burn management in Western Australia. ——- Talk removed at the request of the Burns Service of Western Australia (?due to lack of consent for patient images).
Resources:
SCGH ED Burns Assessment Guideline
Estimation of burn area
Small burns patient’s palm ~ 1%
Rule of 9’s:
Lund & Browder Chart for Paediatric Burns:
Assessment of Burn Depth:
Images removed at the request of the Burns Service of Western Australia (?due to lack of consent for patient images).
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
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