Disability and exposure

Like any trauma patient disability and exposure cannot be ignored.

Appropriate exposure is fundamental for the assessment of patients with burns. A thorough assessment of size and depth of burns is impossible without full exposure and a good secondary survey.^8-10 However patients with burns are physiologically vulnerable to getting cold so it is critical to keep them warm and minimise fluid loss.^8,9

Management

1. Consideration should be made to maintain body temperature by both active and passive warming.^8,9 This is balanced with the need to adequately expose the burn in order to assess, photograph and clean.⁹
2. Clean the burn with normal saline and cover with strips of cling film. Do not use cling film on the face.
3. Consider imaging e.g. X-ray, CT etc. based on findings of the secondary survey

Common pitfalls

Missing other injuries not related to burns – e.g. traumatic head injury or long bone fractures in a blast injury
Failure to give adequate analgesia.

Learning bite

Have all members of the team present during exposure of an area to simultaneously evaluate and photograph the areas to avoid repeated unnecessary exposure and heat loss.