Mechanism of injury, inhalational injury; CO poisoning, associated injuries, patient’s age, and previous state of health, pre-hospital treatment.
- Airway, Breathing, Circulation.
- Removal of all clothing, jewelry and rings.
- Assess depth of burn. Partial thickness, or full thickness.
- Quick assessment of burn area by “Rule of Nine”.
Criteria for Admission
- Patients under 10 years or over 50 years old, sustaining partial or full thickness burn to over 10% body surface area (BSA).
- Burns over 20% BSA in any age groups.
- Burns of special regions like joints, perineum, genitalia, hands, feet, face, eyes and ears.
- Full thickness burns to over 5% BSA.
- Significant inhalation, chemical or electrical injury.
- Burn in combination with significant associated or pre-existing medical problems.
- Patient requiring specialized rehabilitation, psychological support or social services.
- 100% oxygen, 2-6 liter/minutes.
- Maintain I/V line with 16 or 18G branula.
- Calculate fluid requirement for patients with over 20% burn by “Parkland Formula”.
- Fluid in 1st 24 hours = 4 ml x weight of patient x % BSA burnt.
- 1st 8 hours = half of calculated fluid.
- 2nd 8 hours = half of remaining fluid.
- 3rd 8 hours = remaining fluid.
- Start I/V Ringer’s Lactate
- Catheterize the patient with Foley catheter #16 in adults.
- Inj. Tetavax 0.5 ml I/M stat.
- Inj. Nalbufin 10mg I./V stat.
- Start I/V antibiotics: Inj. Ampiclox 500 mg ATD I/V.
- Inj. ranitidine 50 mg I/V 8 hourly for stress ulcer prophylaxis.
- Take blood sample for Hb%, blood group & cross match, Pregnancy test in women, urea, creatinine, and electrolytes.
- Pass N/G tube #16 in adults with burns over 30% BSA.
- Detailed history.
- Physical examination from head to toe.
- Photograph or make a diagram showing %age of body surface area burnt for Medico-legal purpose and discussion with other specialists involved in patient care.
- Early irrigation and debridement of burn area.
- Topical anti microbial ointment: silver sulphadiazine except face where Polyfax be applied
- Moist dressing for partial thickness burns.
- Consider escherotomy or fasciotomy for circumferential burns.
- Consider tracheotomy in patients with respiratory distress.
- Every burn patient must be considered and documented as a medicolegal case.
- Keep record of treatment chart and progress notes of burn patient in the medico legal register.
- Dead body of burn patient should be handed over to CMO and not to patient’s relatives.