Burns SOP

Question 1

Outline the contents of the burns SOP

Answer 1

Don’t miss associated traumatic injuries or underlying medical events.
Optimise outcomes through maintaining tissue perfusion, mitigating effects of SIRS and achieving timely admission to hospital

Covers:
- Safety aspects
- Assessment of the burns patient
- Initial management
- Advanced management
- Chemical burn management
- Electrical burn management
- Triage

Question 2

Outline the aspects of safety when considering patients with burns

Answer 2

• Safety first
• Liaise with HART and FRS to jointly understand and mitigate risk (could be fire, chemical or electrical)
• Dynamic risk assessment

Question 3

Describe the elements of patient assessment specific to burns

Answer 3

• Calculate TBSA - has prognostic significance and guides treatment

1. Erythema
2. Superficial partial - blistered, wet and red
3. Deep partial - None blanching and cherry red
4. Full thickness - White/black and leathery, insensate

Many methods to calculate TBSA

Question 4

Describe the initial management of patients with burns

Answer 4

• Remove clothing unless adhered to skin
• Cool the burn (20 minutes with cool running water, can be done up to 3 hours after burn)
• Analgesia
• Cover
• Keep them warm
• Secure monitoring

Question 5

Describe the advanced management of patients with burns

Answer 5

• Give warmed fluid to burns >20%
• If hypotensive consider other cause inc. poisoning
• If long transfer times consider using Parkland
• If a patient has been trapped, become unconscious or arrested in a smoke filled environment consider poisoning
• High flow oxygen for CO
• Hospital transfer for cyanide
• Consider intubation
• May be tricky, consider surgical airway
• Use largest size possible
• Secure carefully
• Monitor for awareness
• Ventilation strategy (high PEEP, high RR, low TV)
• Escharotomies not typically required
• If torso felt required then anterior axillary line then below clavicles and above costal margin
• Top cover
• Consider humanitarian aspects

Question 6

Outline the particular aspects of managing chemical burns as per the burns SOP

Answer 6

• HART/FRS will guide decontamination decisions
• Use chemical fact sheets
• May be specific antidotes, can use amphoteric solutions to neutralise effects
• If none available then use crystalloid
• Monitor your cuff as may degrade due to chemicals
• Consider hazards during transport and PPE
• Pre-alert to consider decontamination at hospital

Question 7

Describe the aspects of managing electrical burns as per the burns SOP

Answer 7

• Entry and exit points
• Can have massive internal injuries
• Suspect trauma
• Record and monitor ECG

Question 8

What are the triage implications of managing patients with burns?

Answer 8

Adult burns:
- QMC
- NGH
Paeds
- QMC
- Sheffield Childrens

• Consider taking to an MTC with burns
• TCC can help
• Minor burns can go to nearest ED
• Check the action cards