Major Burns

Parkland fluid, escharotomy, referral

Red flags
  • Airway burn (soot, singed hair, hoarse)
  • Circumferential deep burn — escharotomy
  • >15% TBSA adult / >10% child
  • Electrical, chemical, or inhalational burn

First steps

  • ABCDE + intubate early if airway concern
  • Parkland formula: 4 mL × wt × %TBSA (½ in 8 h, ½ over next 16 h) — LR/Hartmann
  • Analgesia, tetanus
  • Cover with cling film

Key investigations

  • COHb (fire), cyanide
  • ABG, CK, U&E, ECG (electrical)
  • Bronchoscopy for inhalation

Differentials

  • Scald vs flame vs chemical vs electrical vs radiation

Initial management

  • Escharotomy for compartment syndrome
  • Silver sulfadiazine or nano-crystalline silver dressing
  • Referral to burns unit per ANZBA/BABI criteria

Referral

  • Burns unit
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