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).


SCGH ED Burns Assessment Guideline

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:

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:
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:
Dr James Wheeler
Dr James Wheeler

Emergency Physician, SCGH, WA, Australia

Articles: 500

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