Major Burn Stabilisation is essential for addressing a significant cause of injury in Australia, with severe burn injury requiring specialised care and management.. This guide outlines the essential components of burn care from initial assessment through to referral to a burn centre. Understanding the criterion for burn classification, proper wound care techniques, and appropriate management strategies is crucial for all healthcare providers.
The Australian burn association guidelines emphasise early intervention and proper assessment of burn depth and total burn surface area (TBSA) to optimise outcomes. Whether dealing with superficial burn wounds or severe burns requiring intensive care, this resource provides a framework for the initial management and consideration of transfer to specialised burn services.
Burn Initial Assessment Priorities
When facing a severe burn injury in the workplace, your initial assessment priorities are critical for optimising patient outcomes and reducing burn mortality.
Begin with the ABCDEF approach, prioritising airway stabilisation while maintaining cervical spine protection. Check for inhalation injuries such as charred oral/nasal areas or stridor that may require intensive care. Patients with burn injuries to the face or neck warrant special consideration as swelling may compromise the airway. Administer high-flow oxygen if you suspect smoke exposure and monitor the patient’s respiratory rate and depth.
Accurate TBSA (total burn surface area) calculation is vital for fluid resuscitation and potential transfer to a burn centre. Utilise methods like the Lund and Browder chart or the Rule of Nines for estimation of burn size. Remember that superficial burns do not require inclusion in TBSA calculations for fluid requirements.
Awareness of burn depth (superficial, partial-thickness burn, or full-thickness burns) significantly impacts the initial management and referral to a burn specialist. Document multiple burn sites carefully, as the size of the burn directly correlates with patient prognosis and the need for specialised burn care.
Fluid Resuscitation Guidelines
For dealing with serious burns, fluid management can be approached in three simple steps:
- Calculate how much fluid is needed: For burns larger than 20% of the body (or 10% in children), use the simple Parkland formula: 4mL × patient’s weight in kg × percentage of burn. Half goes in during the first 8 hours, the other half over the next 16 hours. This calculation provides a starting point that may need adjustment based on the patient’s response.
- Choose the right fluids: For most patients, balanced salt solutions like Hartmann’s solution work best initially. For larger burns (over 20%), your burn centre may recommend adding albumin after the first day. Minor burns less than 20% TBSA may only require normal oral fluid intake if the patient can tolerate it.
- Monitor the patient closely: Aim for urine output of 30-50mL per hour in adults (1mL/kg/hour in children) as your main guide. Insert a Foley catheter for patients with severe burns to track this accurately. Watch vital signs, especially heart rate and blood pressure, for signs of burn shock. Be careful not to give too much fluid, which can cause swelling problems, especially with facial burns.
Always contact your regional burn service early for specific guidance on fluid management. Remember that superficial burns do not require this intensive fluid approach, but partial-thickness and full-thickness burns often do, especially when they involve significant TBSA.
Major Burn Stabilisation Techniques
Stabilising a patient with a severe burn involves specific techniques and considerations for optimal burn management. The National Burn Association and other burn service guidelines recommend these approaches:
Stop the burning process immediately. For chemical burns, brush off dry chemicals before irrigation with water. Continuing irrigation during transport may be necessary depending on the burn site and agent involved.
Wound care begins with cooling the burn with tepid water (15-20°C) for 20 minutes, except in cases where burns involve >10% TBSA, as this may induce hypothermia, particularly in burns in children or the elderly.
Pain management is essential during initial burn treatment. Severely burned patients often require intravenous opioid analgesia titrated to effect. The burn pain may be severe and should be addressed promptly.
Escharotomy might be required for circumferential full-thickness burns to prevent compartment syndrome, but this procedure should only be performed by a burn specialist or under their guidance.
Wound dressing depends on burn depth. Cover the wound with clean, dry dressings or cling film (not circumferentially) while awaiting transfer to a burn centre. The burn site should be protected from contamination during transport.
Treatment and Management of Burn Injuries
The management of a patient with burn wounds follows a structured approach based on the severity of injury. Superficial burns do not require specialised care in most cases, while partial-thickness and full-thickness burns demand careful consideration for referral.
Early burn wound excision and grafting has significantly reduced mortality from a burn injury over recent decades. Patients with severe burns benefit from specialised care at a designated burn unit where multidisciplinary teams can address all aspects of burn treatment.
For facial burns, special attention to airway management is crucial. Ocular involvement requires ophthalmology consultation, as related to burn injuries of the eyes can lead to long-term complications if not properly managed.
Scald burns, particularly common in paediatric burn patients, require careful documentation of the mechanism of injury. The temperature and duration of exposure help determine burn depth and appropriate management.
Patients with burn injuries involving joints need early mobilisation to prevent contractures. Physiotherapy consultation should be arranged early in the care of burn wounds over functional areas.
Transfer to a burn centre should follow established referral criterion. Generally, burns are at risk of complications and require specialised care when they involve >10% TBSA in adults (>5% in children), are full-thickness, involve critical areas (face, hands, feet, genitalia, major joints), or are associated with other traumatic injuries.
Workplace Burn Prevention Strategies
Prevention remains the most effective strategy for reducing fire and burn injuries in the workplace. Burns are the third leading cause of accidental injury in many industrial settings, making prevention paramount.
Regular safety training increases awareness of potential burn hazards. Safety data sheets provide critical information on proper handling of chemicals and should be readily accessible to all staff. Duplicate copies in multiple locations ensure accessibility.
Personal protective equipment appropriate for the specific burn risk should be mandatory in high-risk areas. This may include heat-resistant gloves, face shields, and specialised clothing depending on the nature of potential burn exposure.
Emergency shower and eyewash stations must be properly maintained and tested regularly. The seconds following a chemical exposure can significantly impact the severity of the burn wound and patient outcome.
Develop clear protocols for the initial management of burn injuries specific to your workplace hazards. All staff should know how to activate emergency services and initiate first aid while awaiting transport to medical facilities.
Regular drills reinforce proper response to burn emergencies. Documentation of these drills helps identify areas for improvement in burn care response and transport procedures.
FAQs
What defines a severe burn injury requiring referral to a burn centre?
Burns that involve >10% TBSA in adults or >5% in children, full-thickness burns, burns to critical areas (face, hands, feet, genitalia), electrical or chemical burns, or burns associated with other traumatic injuries typically require referral to a burn specialist.
How is burn size calculated?
The Rule of Nines assigns percentages to body areas (9% for each arm, 18% for each leg, etc.). The Lund and Browder chart provides more accurate estimation, particularly for burns in children. The patient’s palm represents approximately 1% of their TBSA and can be used for quick estimation of smaller burns.
When should a patient be transferred to a burn unit?
Transfer consideration depends on burn depth, TBSA affected, patient age, comorbidities, and associated injuries. Early consultation with a burn service improves outcomes for patients with significant burns.
