FFinalistSouthampton · 2027
Acute care
AKT · Acute care/GI bleed, burns & trauma

Burns

Thermal/chemical/electrical tissue injury

Overview

Tissue injury from heat, chemicals or electricity. Acute care centres on airway (inhalation injury), fluid resuscitation by the Parkland formula using % total body surface area (Wallace rule of nines), and appropriate referral.

Recognise

  • Depth: superficial (erythema, painful) → partial (blisters, very painful) → full-thickness (white/leathery, painless)
  • Inhalation injury: facial/airway burns, singed nasal hairs, soot in sputum, hoarseness, stridor
  • Estimate %TBSA by the Wallace rule of nines (palmar surface ≈ 1%)

Red flags

  • Airway/inhalation injury (early intubation before swelling), circumferential burns (escharotomy), large %TBSA, electrical/chemical burns

Differentials & how to tell them apart

Inhalation injurythe airway threat — anticipate and secure the airway EARLY before oedema
Scald vs non-accidental injury (child)pattern/history inconsistency → safeguarding
Toxic epidermal necrolysisdrug-induced skin loss, not thermal

Investigations

%TBSA estimation, ABG + carboxyhaemoglobin (inhalation/CO), assess depth, U&E; consider cyanide in enclosed-space fires.

Management

Airway first; fluids by Parkland (4 mL × kg × %TBSA, half in 8 h); refer per criteria

  1. 1ABCDE; secure the airway EARLY if inhalation injury (oedema develops fast). Estimate %TBSA (rule of nines) and start Parkland-formula crystalloid (4 mL × kg × %TBSA over 24 h, half in the first 8 h from injury).Gate: Facial/airway burns or signs of inhalation injury → early intubation BEFORE airway oedema makes it impossible
  2. 2Titrate fluids to urine output; analgesia; cover burns; escharotomy for circumferential full-thickness burns; refer to a burns unit per criteria.
IV crystalloid (Parkland formula) — Parkland: 4 mL × weight(kg) × %TBSA over 24 h, half in the first 8 h (from the time of injury)
Analgesia — often significant opioid requirement

Key points

Parkland fluid is calculated from the time of INJURY (not arrival). The palm ≈ 1% TBSA. Enclosed-space fires → consider CO and cyanide. Superficial burns are excluded from the TBSA calculation.

Monitor & prognosis

Urine output (fluid adequacy), airway, perfusion of circumferential burns, COHb.

Depends on %TBSA, depth, age and inhalation injury.

Source: NICE; British Burn Association; Parkland formula