Major trauma – Burns

Authors: Jonathan Matthews, Rajan Atwal / Editors: Paramjeet Deol, Shashank Patil, Jorge Leon-Villapalos, Chris Gray, Lauren Taylor / Reviewer: Chris Gray / Code: / Published: 11/02/2021

To make an accurate assessment of the depth of a burn, skin needs to be cleaned, blisters removed (except for small non-tense blisters [<6mm]) and capillary refill time tested.


E-learning module in burns assessment and management in the Emergency Department

After completing this session you will be able to:

Guidance on which blisters to de-roof and how to do it by the London and South East of England Burn Network (LSEBN) can be found here.

  • Be able to recognise the impact of burns injuries in the Emergency Department
  • Be aware of the classification of burns injuries
  • Be able to assess the depth and size of a burn
  • Understand risk stratification in major burns patients
  • Be aware of key assessment, management points and investigations in the patient with severe burns.
  • Burns Blister Management
  • Be aware of the common pitfalls in burns injury management
  • Deroofing Guideline


  1. Peck MD: Epidemiology of burn injuries globally,, Topic 822 Version 13.0, 2016
  2. NHS commissioning board: Specialised Burn Care (All Ages), Service specification D06/S/a, 2013
  3. Benson A, Dickson WA, Boyce DE: Burns, BMJ 649-652, 2006
  4. Hettiaratchy S, Dziewulski P: Pathophysiology and types of burns, BMJ 1427-1429, 2004
  5. Rice PL, Orgill DP: classification of burns,, Topic 819 Version 12.0, 2016
  6. Hettiaratchy S, Dziewulski P: ABC of burns introduction, BMJ 328:1366, 2004
  7. British Burn Association: European practice guidelines for Burn Care Based by the Copenhagen EBA meeting, September 2002
  8. The depth of the burn can be classified into 1 of 4 types. The British Burn Association (BBA) accepted definition has replaced the older 1st, 2nd and 3rd degree classification.
  9. Clinical Knowledge Summaries: Burns and scalds, 2015
  10. American College of Surgeons ATLS Course Manual 9th Ed Chapter Thermal Injuries, 2012
  11. London and South East Burns Network Initial Management of Severe Burns, 2015
  12. Stander et al The emergency management and treatment of Severe burns Emergency medicine International 2011; 2011: 161375.
  13. Remote PHC Manuals Burns, 2014
  14. Hettiarachy et al Initial management of burns II assessment and resuscitation BMJ 2004 Jul 10; 329(7457): 101103.
  15. Mersey Burns St Helens and Knowsley teaching hospital NHS trust, 2014
  16. Barnes et al The Mersey Burns App: evolving a model of validation EMJ Emerg Med J doi:10.1136/emermed-2013-203416
  17. Hoon et al Airway Obstruction after Laryngeal Burn Induced by Swallowing Hot Food Korean J Otorhinolaryngol-Head Neck Surg. 2015 Sep;58(9):634-636. Korean.
  18. Gillies et al Use of cut endotracheal tubes should be avoided in the initial resuscitation of the burned patient Emerg Med J 2003;20:109 doi:10.1136/emj.20.1.109
  19. London and South East Burns Network Burns Referral Guidelines: criteria for referral 2015
  20. New Zealand National Burn Service, Escharotomy Guidelines
  21. British Burns Association (2016), Emergency Management of Severe Burns 16th ed.
  22. Public Health England. Tetanus: the green book, chapter 30, 2013. Last updated 2020.
  23. Dollery W., Cardiac monitoring not needed in household electrical injury if the patient is asymptomatic and has a normal ECG. BestBETs, 2000

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