SU4.1-2 | Burns Assessment and Pathophysiology — Summary & Reflection

KEY TAKEAWAYS

A burn is a whole-body disease whose management is driven by an accurate early assessment. Approach the patient as a trauma case along ABCDE, and make recognising inhalation injury and an at-risk airway your first priority, since oedema can obstruct the airway within hours. Document the mechanism, the time of the burn and the patient's weight, because these anchor everything that follows. Understand the wound through Jackson's zones — saving the zone of stasis is the point of good early care — and the systemic picture of capillary leak causing burn shock, with later hypermetabolism, immunosuppression and Curling's ulcer. Diagnose the burn by depth (superficial, superficial and deep partial-thickness, full-thickness) and extent (%TBSA by the rule of nines, the palm ~1% method, or the more accurate age-corrected Lund-Browder chart, remembering children's larger heads). Resuscitate with the Parkland formula (4 mL/kg/%TBSA Ringer's lactate, half in the first 8 hours from the time of burn), titrated to a urine output of 0.5-1 mL/kg/h. Add escharotomy for constricting circumferential burns, and refer large, special-site, electrical, chemical or inhalation burns to a burns unit.

REFLECT

Think back to a burned patient you have seen, or imagine the man from the opening scenario. If you had only sixty seconds at the bedside, what three things would you check first, and why would each one change what you do next? Consider how your estimate of %TBSA might differ if you used the rule of nines versus the patient's palm versus a Lund-Browder chart — and which you would trust for a child. Finally, reflect on the discipline of timing your fluids from the moment of the burn: how would you find out that exact time, and what would you do differently if the patient arrived several hours late?