• Initial Management of the Patient with Severe Burns
Specific points to note in the primary survey with respect to burn injury:

Primary Survey

AIRWAY maintenance with cervical spine protection

The airway is at risk of obstruction due to swelling of the oropharynx and soft tissues of the neck secondary to burn injury.

Assess for inhalation injury. Suspect if :

  • The patient was in a confined space at the time of accident
  • Facial burns or singed facial/nasal hair is present
  • Soot or mucosal inflammatory changes in the mouth or nose
  • Carbonaceous sputum
  • Intra- oral oedema
  • Stridor, hoarse voice

A patient with an inhalation injury requires transfer to a burns service.

Indications for intubation

  • Stridor is an immediate indication for intubation.
  • ‘Prophylactic’ intubation prior to transfer if history or signs indicate likelihood of inhalation and thus possible airway obstruction
  • Increasing swelling of head and neck
  • Unprotected airway
  • GCS<9
  • Uncooperative/combative/disoriented patient

A patient with a history or signs suggestive of inhalation injury requires repeated assessment of the airway over time if not intubated

For people with burns injuries >20% TBSA, early consultation with Adult Retrieval Victoria and the Major Trauma/Burn centre should occur as soon as possible

Intubation becomes increasingly difficult as swelling develops. Secure the airway early