Geoffrey Lee
Plastics Intern

• Thermal
• Cold exposure
• Chemical
• Electrical current
• Inhalation
• Radiation

• Size
• Depth
• Site

• Percentage of body surface area estimates
– Palm method = 1%
– Rules of Nines
• Each leg represents 9 x 2 = 18%
• Each arm 9%
• Anterior and posterior trunk each 9 x 2 = 18%
• Head 9%
– Lund-Browder chart

• Colour
• Moist vs dry
• Blanching
• Blisters
• Pain

• Only epidermal layer
• Painful
• Dry
• Red
• Blanch with pressure
• Do not blister
• Heal 5-7 days
• No scarring

• Epidermis and superficial part of dermis
• Painful
• Red
• Weeping
• Blanches with pressure
• Heal in 7-21 days
• Unlikely scarring, pigment changes may occur

• Epidermis and deeper dermis
• Painful to pressure only
• Blister
• Wet or waxy dry
• Mottled colorisation
• Do not blanch with pressure
• Heal in 3-9 weeks
• Hypertrophic scarring likely

• Extend through all layers of dermis
• Anaesthetic or reduced sensation
• Appearance varies
• Dry
• Do not blanch with pressure
• No vesicles
• Severe scarring with contractures
• Usually require grafting

• Deep and extend through skin into underlying tissues such as fascia, muscle and/or bone

• Face
• Ears
• Eyes
• Hands
• Feet
• Genitalia
• Perineum
• Major joints

• Major vs moderate/minor
• Major burns should be transferred to specialized burns centres
• Victoria:
– Victorian Adult Burns
Service (VABS) at the
Alfred
– Burns Unit at RCH

• Burns with associated inhalation injury
• Burns greater than 10% total body surface area
• Burns to special areas – face, hands, major joints, feet and genitals
• Full thickness burns greater than 5% total body surface area
• Electrical burns
• Chemical burns
• Circumferential burns of limbs or chest
• Burns with associated trauma
• Burns in the very young or elderly people
• Burn injury in patients with pre-existing illness or disability that could adversely affect patient care and outcomes
• Suspected non-accidental injury in children or the elderly
• Burns in children under the age of 12 months
• Small area burns - in patients with social problems, including children at risk
• Burns occurring in pregnant women

• Primary survey
• Assess extent of burns
• Beware of circumferential full thickness burns
• Analgesia
• NGT insertion
• Tetanus
• Prevent hypothermia
• Fluid resus

• Parkland formula
• Amount required in 24hrs = 4 x wt(kg) x
BSA(%)
• Half in first 8hrs
• Half in next 16hrs
• Maintenance fluids in addition for children weighing less than 30kg
• Guided clinically and by urine output

• First aid
• Cleaning burns
• Blister management
• Dressings
• Analgesia
• Tetanus
• Follow up
• Post burn skin care

• Low voltage (<1000V)
• High voltage (>1000V)
• First aid
– Turn power off
– Ensure own safety
• Dysrhythmias
• Compartment syndrome
• Fluid resus
Full thickness exit wound to armpit post high voltage electrical burn injury

• History
– Type of agent
– Strength and concentration
– Site of contact, swallowed or inhaled
– Manner and duration of contact
– Mechanism of action of chemical
• First aid
– Prolonged irrigation of water
– Remove contaminated clothing
– Brush off metals and powders
Full thickness burns to the legs caused by kneeling in cement
– Do not attempt neutralising without specialist advice