With respect to the clinical assessment of a patient presenting with a severe burn injury sustained in a house fire:
- a) Outline how burns are classified.
- b) List three methods for estimating the total body surface area affected by a burn injury.
- c) Other than the burn type and extent, list the other important features of the physical examination that should be noted as part of the initial clinical assessment of the patient described above.
Answer and interpretation
a) Outline how burns are classified.
Burns are classified by depth of injury.
Superficial (formerly first degree):
- Epidermis only
Partial Thickness (formerly second degree):
- Superficial – Epidermis and upper layer of dermis
- Deep – Extend to deeper layer of dermis
Full Thickness (formerly third degree)
- All layers of dermis and may involve underlying tissue
b) List three methods for estimating the total body surface area affected by a burn injury.
- Lund-Browder Chart
- The Rule of Nines
- The Rule of Palm
c) Other than the burn type and extent, list the other important features of the physical examination that should be noted as part of the initial clinical assessment of the patient described above.
- Basic resuscitation status: Airway patency, Breathing, Circulatory status, Conscious level
- Adequacy of resuscitation to date: heart rate, blood pressure, urine output
- Evidence of associated trauma
- Evidence of airway burn and inhalational injury: stridor, burns around nose and mouth, carbonaceous sputum
- Presence of facial and/or corneal burns, perineal burns
- Presence of circumferential burns, evidence of extremity compartment syndrome, ventilator inadequacy
- Evidence of rhabdomyolysis
- Evidence of inhalation of toxic gases eg CO
- Adequacy of analgesia
- Potential problems with vascular access
- Evidence of drug / alcohol ingestion and/or co-morbid conditions eg epilepsy
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.