CME: Burns Management

Thanks to Remo Papini for giving his time to talk on burns management. In lieu of having his talk, here is Liz Wharton’s (Burns Specialist FSH & PMH) talk on major and minor burn management in Western Australia from last year. — Talk removed at the request of the Burns Service of Western Australia (?due to lack of consent for patient images).

Resources:

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