Thermal injury – The first 24 h

Abstract

Thermal burn injuries have devastating potential. In the United Kingdom alone, a quarter of a million people suffer burns each year. Flame and scald injuries are the most common aetiology. The vast majority of burns present to the primary care and emergency sectors, and only a small proportion of these are referred on to a specialist burns service. Appropriate initial management can make the difference between a good outcome and a poor one. The mainstay of treatment remains the Advanced Trauma Life Support (ATLS) guidelines. As part of airway management it is essential to recognise the likelihood of inhalational injury, as this contributes to mortality. Circumferential burns to the chest area can restrict ventilation and this is an indication for emergency escharotomy. Circumferential burns to the limbs can often be treated conservatively until transferred to a specialist burns service. Formal fluid resuscitation should be started in adults with ≥15% Total Body Surface Area (TBSA) burns and children with ≥10% TBSA burns. The Parkland resuscitation formula is the formula of choice in the UK. The TBSA should be calculated objectively using a Lund and Browder chart and erythema is not included. The burned patient must be kept warm throughout their assessment. Burn depth can be assessed by appearance, sensation, and blanching, although this can be difficult. There should be a low threshold for discussing any burn with the local burns service. Accurate and clear documentation at all stages of the initial treatment is essential.