Topic One: Initial Management
A first, rapid, primary survey with an ABC - DE trauma management approach should be undertaken before a full assessment of the burn to ensure any life-threatening problems are identified. These can arise due to complications of the burn and from any non-burn injuries.
Airway
- Remove any obstruction
- Check for inhalation injury
- Signs of oedema
- Signs of soot around the nose and mouth, sooty sputum
- Singed nasal hairs
Breathing
- Observe chest movement on inhalation and expiration, it’s character and depth, to ensure that the patient is breathing normally.
- Check for respiratory distress, e.g. stridor, wheeze, dyspnoea.
Circulation
- Check the pulse at the carotid artery and then the distal points to assess for shock or localised constriction.
- For any circumferential burns, check peripheral perfusion.
Disability/level of consciousness
- Assess before attempting to move the patient
- Assess pain levels
Exposure
- Remove any jewellery, loose clothing, dressings or nappies. NB – do not try to remove any clothing that is adhered to the skin.
- If no initial first aid has been given (within three hours of injury), cool the wounds for 20 minutes using running water or a wet compress.
- The burn injury can be covered with non-adherent loose strips of cling film. NB – do not apply to the face.
- Implement active warming measures to prevent heat loss.
(Edwards & Griffiths, 2011; SWBC, 2018; Jeschke et al., 2018)