1. Burns

2. Priorities Airway, Breathing, Circulation Analgesia Fluids Wound care Escharotomies Transfer

3. Initial assessment Area, Lund&Browder/rule of nines Children: –bigger head –smaller legs Attempt to assess depth - This is not easy!

4. Airway Assess the airway: soot, erythema, singed hairs, stridor, dysphonia, resp distress Expect difficult airway if intubation needed Immediate if airway threatened or hypoxic on maximal O2 Urgent if hypoxic on 60% O2, dyshponia or oral eythema. Experienced operator, consider fibreoptic intubation

5. Circulation IV access – x2 if TBSA >20% Put IV through a burn if needed/possible IV fluid – Parklands formula 2-4ml/kg/% burn in addition to maintainance ½ in first 8 hours Insert IDC – aim around 1ml/kg/hour output

6. Wound care Cool the burn – cool running water up to 20 minutes. Maybe not so long if >10%BSA – watch for hypothermia Dressing: plastic wrap if patient for transfer Consider acticoat if patient not for transfer SSD – delays healing with no significant antibacterial effect.

7. Wound preparation Most burns services currently recommend debridement of all dead tissue – blisters, loose skin etc This hurts – use morphine liberally and consider ketamine at analgesic or sedative dose.

8. Escharotomies Consider for circumferential deep burns. Limbs or torso Full thickness incision of burn down to subcutaneous fat to allow reperfusion or improved circulation. Consider in consultation with burns service.

9. Transfer Strongly consider for adults with >20% TBSA or children with >10% Special burns – circumferential, hands/face

10. Transfer checklist Airway secure O2 in situ IV access Fluid resuscitation Urinary catheter Pain controlled Wounds covered Prevent hypotehrmia Elevate burn if possible ADT given/up to date NGT in situ Next of kin aware Retrieval service and destination hospital aware Documentation complete