Burns management

• Intravenous Morphine 1st Line and Intravenous Ketamine 2nd line
• Cover burns with non-circumferential cling film.

• Suspect in patients with facial, perioral, or nasal burns
• Voice changes, hoarseness and stridor require further examination and intervention
• Refer immediately to anaesthesia/critical care
• All airway burns should be managed by rapidly securing the airway with an uncut endotracheal tube.

• Consider early anaesthetic review for consideration of a definitive airway.
• Suspect in fire victims who have:
  
  • History of altered level of consciousness.
  • Respiratory problems.
  • Been rescued from an enclosed place.
• Perform an arterial or venous blood gas for carboxyhaemoglobin.
• A Carboxyhaemoglobin >10% is diagnostic.
• Administer high flow oxygen until the carboxyhaemoglobin level is <10%
• Prescribe VTE prophylaxis.
• Treat cyanide poisoning if unconscious and lactate >10 in the absence of major burns after resuscitation.
• Utilise lung protective strategies for patients that require ventilation.

• Do not use 0.9% saline, albumin, or hypertonic saline for resuscitation.
• Use a balanced salt solution such as plasmalyte or Ringer’s lactate
• Baseline fluids will also be required (incorporating early enteral nutrition)
• Correlate urine output with ideal body weight
• If urine output low for >2 hours, seek senior review.

• TBSA >10%
• TBSA >5% with significant co-morbidities / pregnant/ immunocompromised.
• Facial burns >3% with or without inhalation
• Hand
• Genitals / perineum
• Circumferential
• Requiring critical care
• Chemical burns
• High voltage electrical burns.

The Care of Burns in Scotland National MCN (Managed Clinical Network) Website can be referred to for access to further clinical guidelines.