Synopsis
Assess burn depth and extent, recognise inhalation injury, provide effective first aid and resuscitation, and arrange appropriate specialist care.
- Stop the burning process safely and remove constricting jewellery or clothing that is not adherent.
- For thermal burns, provide 20 minutes of cool running water as soon as possible, ideally within three hours; prevent whole-body hypothermia.
- Avoid ice, iced water, butter, creams and gels as first aid; do not peel off material stuck to the wound.
Investigation priorities
Define initial extent and identify depth progression or threatened function.
Management branches
A 70 kg adult arrives two hours after a 20% partial-thickness scald. Five hundred millilitres of resuscitation crystalloid has already been given; the burns team selects its 4 mL/kg/%TBSA Parkland starting protocol.
- Complete airway and trauma assessment, finish indicated cooling without chilling the patient, cover the injury and obtain effective analgesia. Confirm that 20% describes dermal injury rather than surrounding redness.
- Calculate the protocol’s first-day estimate: 4 × 70 × 20 = 5,600 mL. Half, 2,800 mL, is allocated to the first eight hours from injury; the remaining half is allocated to the subsequent sixteen hours.
A stable adult has a small thermal burn without airway or circulatory compromise.
Key medicines
Balanced crystalloid for major burn resuscitationUse the receiving burns service’s named protocol. The NHS Lothian adult example starts with 4 mL × actual weight in kg × %TBSA over 24 hours, half in the first 8 hours from injury, then titrates to clinical response.Formulae differ between services and are starting estimates. Account for fluid already given, prescribe concurrent maintenance or enteral intake separately, monitor urine output and avoid excessive fluid causing worsening oedema.
IV morphine for severe burn painAn example from RCHT is morphine 10 mg diluted to 10 mL with sodium chloride 0.9%, then 2 mg IV boluses every 2–5 minutes with reassessment until comfortable or the individual prescribed maximum is reached. Restrict this to initial pain control and review the subsequent analgesic prescription.Use smaller initial amounts in frailty; this protocol advises an alternative opioid when eGFR is below 30 mL/min/1.73 m². Monitor consciousness, breathing, blood pressure and oxygen saturation every 5 minutes and for 15 minutes after the last dose. Stop escalation for excessive sedation, impaired ventilation or hypotension, and count earlier opioid doses.