Introduction
The arrival of the victim of a burning accident at the emergency
department is one of the most dramatic events in surgical practice. The
suddenness of the accident, the visibility of the damage, the pain, fear and the
reactions of onlookers all combine to create an atmosphere of tension. The
immediate needs of the patient for resuscitation and pain relief may temporarily
interfere with the usual assessment of the patient by history and examination.
However, the history of the mechanism of burning is of major importance in
assessing its likely severity. Detailed inquiry must be made as soon as the
patient’s condition allows, information being gained from either the patient
or a third party. Clinically, the severity of the burn is estimated from the
area of the burned surface and the depth of the burn wound.
On
arrival a burns case should be treated like any other trauma case. There may be
problems with the airway, a broken cervical spine and internal injuries. ABC
(airway, breathing, circulation) applies as usual. If there is soot or charring
around the mouth and nose, the possibility of smoke or even flame inhalation
must be considered. Laryngeal oedema can develop rapidly and lung function can
deteriorate. Endotracheal intubation should be considered early, but this
should only be attempted by a highly experienced anesthetist. A needle
cricothyroidotomy set should be assembled