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-Dr Annitha Annathurai
Department of Emergency Medicine
Singapore General Hospital
Providence of appropriate , emergent definitive treatment
within 1st 24hours of injury
Understand the mechanism of injury: Explosion,Fire (
thermal), Chemical Burn, Electrical Burn,Lightning injury.
Recognizing type of burns: Airway Burns
( Inhalational)Injuries
Looking for associated injuries : multitrauma esp if
explosion Blast injuries
Recognizing which types of burns need to transfer to a
Burns Centre for specialised care
This is a standard Protocol driven Management which
should be agreed upon by medical personnel across the
region to ensure standardised care
BBLSImportant considerations
Airway : Ensure patency
Breathing: High flow oxygen
Circulation: Good Intravenous access,
give fluids
Removal of soiled clothes
Cooling of burn sites
Immediate evacuation from site of incident
Carbon monoxide poisoning
Inhalation injury above the glottis
Inhalation below the glottis
Any victim, burned in a closed area,
like a house fire, should be presumed
to have an inhalation injury until
proven otherwise
Scene Cause of burns may still be active eg explosive, live
wires, chemical agents
Survey Fires in enclosed spaces increases risk of inhalational
injury, smoke may contain toxic gases CO, cyanide
Stop ongoing burning process, remove clothes if
possible, rinse copiously with water
Patient Primary survey as for trauma patient, ABCs
Signs of A/w burns
Assessmt Note %BSA and depth quickly
Assess RR, chest wall, auscultation, neurological
Critical Oxygen
Interventn Stop Bleeding
Ventolin nebulization if pt is wheezing
Identify Inhalational injury
>= 20% BSA second degree burns
LOAD & Send to burns centre
NOTIFY Inform the receiving hospital
early so that they are prepared to
receive patient
Secondary Signs of inhalational injury
Signs of shock
Survey Extent and depth of burns
Cause of burns if not elicited earlier
IV Fluids Start fluid management
Cover burns sites with dry sterila nonstick
Wound care dressing
Cooling body sites with water ( 10mins at least)

Analgesia Entonox contraindicated in

inhalational injury
Cooling and evacuate ASAP
Indications: An incident when 1 or more persons is exposed to
known release of chemical
SUSPECT Suspicion of possible chemical contamination
Chemical Multiple persons suffering fits or loss of
consciousness or breahtlessness simultanously in
Contaminatn an enclosed area
Scene Look for obvious fumes, chemical spill
Dont touch spilled chemicals
Survey Look for number of casualties
If mass casualty then look for First Aid Post

DON PPE Ambulance Crew not expected to work in

contaminated area
Wear gloves, aprons, mask
Then examine patient

Patient If whole body exposed or contaminated with

chemical agent, then for decontamination first
Assessment Then re-evaluation for injuries.
For chemical burns, you must wash with copius water,
very often,
U can get reaction if small amt is used.
Esp to eye alkali or acid wash copiously.
Complicated with cardiac arrest, VF
Ensure scene safe and no more current
Before touching the casualty

Lightning injuries
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