Disability and exposure

Like any trauma patient disability and exposure cannot be ignored.

Appropriate exposure is fundamental for the assessment of patients with burns. A thorough assessment of size and depth of burns is impossible without full exposure and a good secondary survey^9,10,11,13. However patients with burns are physiologically vulnerable to getting cold so it is critical to keep them warm and minimise fluid loss^9,10.

Management

1. Consideration should be made to maintain body temperature by both active and passive warming.^{9, 10} This is balanced with the need to adequately expose the burn in order to assess, photograph and clean.^10.
2. Clean the burn with normal saline and cover with strips of cling film. Do not use cling film on the face.
3. Consider imaging e.g. X-ray, CT etc. based on findings of the secondary survey

Common pitfalls

• Missing other injuries not related to burns e.g. traumatic head injury or long bone fractures in a blast injury
• Failure to give adequate analgesia

Top tip:

• Have all members of the team present during exposure of an area to simultaneously evaluate and photograph the areas to avoid repeated unnecessary exposure and heat loss.