burns

Sage burns calculator
RCH guideline - burns in children
NSW NETS severe burns transfer guidelines (pdf)
NSW NETS severe burns service - models of care (pdf)
Sth Aust. RAH Burns Service - Detailed algorithmic burns Mx document 2009 (pdf) - very nice document indeed!
Vic. burns service transfer guidelines 1999
Victorian Burns Unit Management Guidelines
Vic Gov Guidelines on Mx of mass casualties with burns eg. bushfires
- Vic. Major Trauma Transfer Criteria for time critical transfer:
  - burns > 20% BSA
  - inhalational burns
  - electrical burns > 1000V or lightning injury
- patients who should probably have non-time critical transfer to a burns service:
  - Burns greater than 10% TBSA
  - Full thickness burns greater than 5% TBSA
  - Burns to special areas: face, ears, hands, major joints, feet and genitalia
  - Electrical burns >240 volts or arc explosion
  - Chemical burns
  - Circumferential burns to limbs or chest
  - Burns with associated trauma
  - Burns in the very young or older 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 older people
  - Small surface area burns in people with social problems, including children at risk
  - Burns occurring in pregnant women
  - Burn injuries which are slow to heal or about which the referring unit is concerned

to intubate or not

the following are derived from the Sth Australian RAH burns service guidelines 2009¹⁾
90% of burn oedema will develop by 4 hours post-burn
patients at risk of airway oedema should be intubated well BEFORE the airway becomes compromised as then intubation may be impossible
patients with possible inhalational injury in whom it is decided not to intubate should be closely monitored with head elevated to 45deg (if Cx spine cleared), continuous SaO2, 15min airways obs for 1st 4hrs, then 1/24 observations for until 12hrs, then 4/24 obs
if there is oropharyngeal erythema or hoarseness, an option may be to do laryngoscopy and intubate if upper airway oedema rather than just erythema is present²⁾
those at high risk for lower airway injury generally need longer term intubation while upper airway injuries generally need only short term intubation.

history of prolonged confinement in smoke filled environment ie house or car fire including under car hood
“significant” facial burns
history of unconsciousness or obtundation
raised carboxyhaemoglobin
hypoxia
respiratory difficulty (dyspnoea, tachypnoea, increased use of accessory muscles and increased work of breathing)
sooty or productive sputum
wheezing or added sounds on auscultation
abnormal finding below the cords on bronchoscopy
deteriorating condition

history of explosive or short contact with thermal agent such gas/petrol explosion characterized by superficial facial burn or erythema, with some singing of facial hair/nostril hair.
normal voice at initial examination

¹⁾

²⁾