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.
• 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.
  • 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 e.g. plasmalyte, ringers lactate.
• Baseline fluids will also be required (incorporating early enteral nutrition).
• Circulate urine output with ideal body weight.
• If urine output low for >2 hours 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.

NHS Lothian Adult Burns Pathway