- A burn is an injury caused by thermal (e.g. heat) and non-thermal (e.g. electrical) causes. This guideline encompasses burn injuries caused by electricity, heat, chemicals, light, radiation or friction.
Tertiary Burns Centre:
- Adults: 16 years and over - Fiona Stanley Hospital (FSH)
- Paediatrics: 15 years and under - Perth Children's Hospital (PCH)
- Assess airway burns for:
- Soot in nasal and mouth cavities
- Cough and hoarseness
- Black sputum
- Difficulty in breathing and swallowing
- Blistering around mouth and tongue
- Scorched hair, eyebrows or facial hair
- Document the time of burn injury;
- Assessment of the patient includes inhalation injury; % TBSA affected; site and depth of wounds; the patient’s age; the presence of other injuries, the mechanism of injury; any areas of circumferential burns, co-morbidities and psychosocial issues;
- Reddened and intact skin areas should not be included when calculating % TBSA burnt;
- There may be entry and exit point for electrical burn injuries;
- Patient suffering electrocution injuries should be monitored for dysrhythmias and 12-lead ECG performed;
- Hydrogel dressings can be applied in the absence of water to cool, but this is not preferred.
- When cooling the patient, be careful to avoid hypothermia - optimal water temperature is 15°
- Primary Survey with c-spine consideration
- Be aware of Trauma Management Principles
- Airway management/ventilatory support (as required)
- Oxygen therapy (note: carbon monoxide inhalation may provide false SpO2 readings)
- Burn injury assessment (Rule of 9’s)
- Cool burn area for a minimum of 20 minutes
- Remove jewellery and clothing unless adhered to wound
- Apply damp sterile dressings after cooling and/or hydrogels
- Perform Vital Sign Survey
- Secondary / CNS Survey
- Salbutamol as required as per CPG
- Administer pain relief
- Consider applying cardiac monitor if trained and authorised
- Consider direct transfer to Tertiary Burns Centre:
- ≥ 10% TBSA burnt or >5% TBSA burnt paediatrics
- Airway burns
- Burns to face, hands, feet, perineum, genitalia
- Monitor patient closely, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- Salbutamol as required as per CPG
- Establish vascular access, administer fluid replacement as per below chart:
- Administer pain relief
- Consider cardiac monitoring
- Consider debridement:
- Perform Hand Hygiene, don clean gloves
- Wipe away dead skin/non-viable tissue and blisters with non vigorous rubbing if patient condition allows and appropriate analgesia has been administered.
- Consider direct transfer to Tertiary Burns Centre:
- ≥ 10% TBSA burnt, or >5% for paediatrics
- Airway burns
- Burns to face, hands, feet, perineum, genitalia, joints or neck
Fluid replacement indication criteria:
| Adults | >15% TBSA |
|---|---|
| Children 18 months and older | >10% TBSA |
| Children less than 18 months | >8% TBSA |
Formula:
| 2ml x %TBSA burn x weight of patient | 50% of total amount over the first 8 hours |
|---|---|
| 50% of total amount over next 16 hours |
- Fluid is calculated from time of burn injury, not from arrival on scene
- Monitor patient closely, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
Parkland Calculator
An online calculator to assist in determining fluid administration for burns.
- Consider MEQU Fluid & Blood Warmer for intravenous fluid replacement.
- Elevate all affected areas when possible to reduce oedema and infection risk
- Inhalation of superheated smoke, steam or gases can induce airway oedema and rapid deterioration of airway patency.
- The risk of inhalation injury increases if the patient was exposed to burn source within an enclosed space
- Debridement may improve accuracy of TBSA calculation, and reduce risk of oedema and infection
- Compartment syndrome; signs of ischaemia include:
- Pain
- Pallor
- Paresthesia
- Pulselessness or >2 seconds CRT
- Cool or cold limb
Document Control
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