South East Scotland Major Trauma Guidelines
- Intravenous morphine 1st line and intravenous ketamine 2nd line.
- Cover burns with non circumferential cling film.
Burns management
Warning
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The Care of Burns in Scotland national MCN website can be referred to for access to further clinical guidelines. |
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Paediatrics COBIS have published paediatric guidelines on the following: |
- Suspect in patients with facial, perioral or nasal burns.
- Voice changes, hoarseness and stridor require further examination and intervention.
- Refer immediately to anaesthesia.
- All airway burns should be managed by rapidly securing the airway with an uncut endotracheal tube.
- Consider early anaesthetic review for consideration of a definitive airway
- Suspect in fire victims who have:
- History of altered level of consciousness.
- Respiratory problems.
- Rescued from an enclosed place.
- Perform an arterial or venous blood gas for carboxyhaemoglobin.
- A Carboxyhaemoglobin >10% is diagnostic.
- Administer high flow oxygen until the carboxyhaemoglobin level is <10%.
- Prescribe VTE prophylaxis.
- Treat cyanide poisoning if unconscious and lactate >10 in the absence of major burns after resuscitation.
- Utilise lung protective strategies for patients that require ventilation.
- Do not use 0.9% saline, albumin or hypertonic saline for resuscitation.
- Use a balanced salt solution e.g. plasmalyte, ringers lactate.
- Baseline fluids will also be required (incorporating early enteral nutrition).
- Circulate urine output with ideal body weight.
- If urine output low for >2 hours senior review.
| Parklands Formula | Urine Output | Action |
| Resuscitation fluid in first 24 hours = | <0.25ml/kg/hr | Give 500ml bolus |
| Actual body weight x BSA burned (%) x4 | 0-25 –05ml/kg.hr1-2ml/kg/hr |
Give 250ml bolus Reduce resuscitation fluid by 50ml/hr |
| Half in first 8 hours and half in second 16 hours | >2ml/kg/hr | Reduce resuscitation fluid by 100ml/hr |
- TBSA > 10%.
- TBSA >5% with significant co-morbidities/pregnant/immunocompromised.
- Facial Burns >3% with or without inhalation.
- Hand.
- Genitals/perineum.
- Circumferential.
- Requiring Critical Care.
- Chemical Burns.
- High Voltage Electrical Burns.
