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 and ready for use. There will only be one chance at Endotracheal intubation and if that fails because of laryngeal oedema a surgical airway will be needed immediately. If laryngeal oedema is possible early intubation is prudent, and mandatory if a transfer to another unit is required. The airway must be secure before transfer.