Case of the Month #46 A Major Burn Injury: Taming the Flames

Disability: 

• Burns do not cause decreased GCS 

  • Seek other causes e.g. toxicity; head trauma; intoxicants; overdose; comorbidities 

Exposure: 

• Burns extent  
  • There are multiple ways of calculating/measuring this: 
    • Lund & Browder charts 
    • Wallace Rule of Nines 
    • Use of apps e.g. Mersey Burns 
  • Depth 
    • All areas of superficial partial thickness burn or deeper should be included 
  • Full thickness burns may necessitate escharotomies in some circumstances: 
    • Restriction of ventilation 
    • Restriction of blood flow to distal limb 
• Minimise time of exposure – patients will develop hypothermia 
• Irrigate extensively in chemical burns 
• Consider compartment syndrome in electrical burns 
• Risk prediction/prognostication 
  • Modified Baux score can be used  
    • This takes into account age, %TBSA burned, and the presence of inhalational injury 
    • 109.6 = 50% mortality 
    • 160 = 100% mortality 

Your patient has extensive torso burns, and circumferential burns to their right upper limb. In discussion with the plastic surgery team, you agree they require emergency escharotomies, and they are transferred from ED direct to theatre.