BURND - ASSESSMENT AND MANAGEMENT

Intravenous access and fluid replacement.
• Large-calibre intravenous lines must be established immediately in a peripheral vein.
• Any adult with burns affecting more than 15% of the total body surface area burned (where superficial burns are disregarded) or a child with more than 10% of the total body surface area burned requires fluid replacement.
• Replacement fluids required in the first 24 hours from the time of injury aim to maintain a good urine output - 0.5-1 ml/kg in adults, 1-2 ml/kg in children:

• Adults:
• For partial-thickness and full-thickness burns, or those with associated inhalation injury, use 4 ml of Hartmann's solution/kg body weight/% total body surface area (superficial burns are discounted here).
• Half of this calculated volume is given in the first eight hours and the other half is given over the following 16 hours.

• Children:
• Replacement fluid as above plus maintenance (0.45% saline with 5% dextrose) which should be titrated against nasogastric feeds or oral intake:
• 100 ml/kg for first 10 kg body weight plus 50 ml/kg for the next 10 kg body weight plus 20 ml/kg for each extra kg.
Ensure adequate analgesia: strong opiates should be used.
Prevent hypothermia.
Management of the burns[2]
• Prompt irrigation with running cool tap water for at least 20 minutes (but no more than one hour) provides appropriate cooling. Very cold water, ice and objects from a freezer to cool the area should be avoided as these cause vasoconstriction and may worsen tissue ischaemia and local oedema. Chemical burns may need longer periods of irrigation, but irrigation should last no longer than one hour as a maximum period.
• Dressings help to relieve pain and keep the area clean but avoid circumferential wrapping, as this can cause constriction.The choice of dressing used can vary between specialist units.[9]However, some studies have suggested that paraffin gauze dressings are a valuable option in superficial burns, while silver-based dressings are preferable in deeper burns.[10]
• All patients with facial burns or burns in an enclosed environment should be assessed by an anaesthetist for early intubation.
• For full-thickness circumferential burns, escharotomy may be required to avoid respiratory distress or reduced circulation to the limbs as a result of constriction.