Initial Burn Assessment

The most important component of providing the initial assessment of a patient with a burn injury is to NOT be distracted by the burn injury.  You should proceed with a primary and secondary survey, just as you would in any patient with a traumatic injury mechanism.

Primary Survey

  • A- Airway
    • Use 100% oxygen during your assessment
    • Is the patient’s airway at risk?
      • Progressive edema?
      • Likelihood of inhalation injury? (link inhalation injury page here)
    • Intubation really isn’t the wrong answer if you’re concerned about the security and stability of a patient’s airway

These photos show the progression of facial edema with a severe facial burn over 6 hours

  • B- Breathing
    • Are they breathing spontaneously?
    • Expose the patient’s chest to be able to visually assess their ability to ventilate
      • Do they have a circumferential torso burn?
    • Do they have apparently adequate chest expansion after establishment of a secure airway?

Patient chest after chest escharotomy to allow ventilation in a patient with a deep circumferential torso burn

 

 

 

 

 

 

 

 

 

  • C- Circulation
    • Assess patient’s pulse and blood pressure- just like in a trauma
    • Establish IV access
      • You CAN go through fresh burn- just remember that tape won’t work to affix it
    • Evaluate extremities for circumferential injury
      • Circumferential burn results in an increased risk of compartment syndrome and possible need for escharotomy
    • Don’t forget to take off jewelry- especially rings!!!

 

 

 

 

 

 

 

  • D- Disability
    • AVPU or GCS…again, exactly what you would do for trauma
    • If a burn patient has altered mental status, it is NOT the burn that is the cause
      • Intoxication?
      • Carbon monoxide poisoning?
      • Concomitant trauma with brain injury?
  • E-Exposure
    • Remember to get all clothing off, particularly if there’s a possibility it’s extending/ deepening the burning process
    • Burn patients get cold EASILY.  Warm the room, warm the fluids, warm the blankets.

 

Secondary Survey

  • Again, use your trauma knowledge
  • Perform a thorough head-to-toe evaluation and don’t be distracted by the burn
  • Is other trauma present?
  • Is there a need for immobilization?
  • Obtain event history- etiology, mechanism
  • Obtain your AMPLE history as well
  • Determine depth and extent of burn