QAS burn guidelines
Clinical Features & Depth
Q: What is the most common cause of burn injuries?
A: Flame burns and scalds (electrical and chemical are less common).
Q: What complication should be considered with explosions?
A: Concomitant blast injuries.
Q: Clinical danger of airway/inhalation burns?
A: Can cause respiratory compromise → early airway management required.
Q: Systemic risk in major burns?
A: Fluid/electrolyte abnormalities over hours → risk of shock & multi-organ failure.
Q: What toxic gases are associated with enclosed fires?
A: Carbon monoxide and cyanide.
Q: Depth & features: Superficial burns?
A: Erythema, brisk cap refill, painful.
Q: Depth & features: Superficial dermal burns?
A: Moist, red, blistered, brisk cap refill, painful.
Q: Depth & features: Deep dermal burns?
A: White slough/red mottled, sluggish/absent cap refill, painful.
Q: Depth & features: Full thickness burns?
A: Dry, charred/whitish, absent cap refill, painless.
Risk Assessment
Q: What early sign indicates possible airway involvement?
A: Facial/oral burns, singed nasal hair, carbonaceous sputum, stridor/hoarseness, tachypnoea.
Q: Why is circulatory shock in early burns suspicious?
A: Suggests associated injury (e.g., blast trauma).
Q: Limb risk with circumferential burns?
A: Eschar can restrict blood flow → ischaemia.
Q: Major burns requiring burns unit referral?
A:
Partial thickness >20% TBSA (all ages)
Partial thickness >10% TBSA (age <10 or >50)
Full thickness >5% TBSA
Burns to face, eyes, ears, hands, feet, genitalia, buttocks, perineum, major joints
Inhalation burns
Electrical burns
Patients with major comorbidities
Q: What is the PHIFTEEN-B formula used for?
A: Calculating fluid resuscitation volume.
Q: Burn cooling principle?
A: Cool the burn, warm the patient (avoid hypothermia).
Q: What surgical procedure may be needed for circumferential burns with compromise?
A: Escharotomy.
Burn Surface Area
Q: What are two common methods to estimate TBSA?
A: Wallace Rule of Nines & Lund-Browder chart.
Q: What body reference approximates 1% TBSA?
A: The patient’s palm.
Q: Should isolated erythema be included in TBSA?
A: No.
Prehospital Management
Q: Initial safety priorities in burn management?
A: Ensure self & bystander safety.
Q: Key interventions during transport?
A: Oxygen, IPPV if required, analgesia, IV fluids (PHIFTEEN-B), frequent airway assessments, midazolam if needed.
Q: Burn cooling guideline?
A: Running water ≥20 min, max 60 min.
Q: What to avoid during burn cooling?
A: Hypothermia → cover, warm patient.
Q: Best covering for burns?
A: Cling wrap.
Q: When can Burn Aid dressings be used?
A: Adults: <10% TBSA
Children: <5% TBSA
And only if no circumferential/major burns requiring specialist unit.