Key Points
- Follow ATLS primary survey: Airway with C-spine control, Breathing, Circulation, Disability, Exposure (ABCDE).
- Identify and treat life threats before complete diagnosis; activate massive transfusion when indicated.
- Use damage-control resuscitation principles and early hemorrhage control.
Algorithm
- Primary survey (ABCDE) with adjuncts (E-FAST, chest/pelvis X-ray).
- Resuscitate with balanced blood products; TXA early in select trauma (<3 h).
- Secondary survey and definitive imaging (CT) when stable; early operative/interventional control as needed.
Clinical Synopsis & Reasoning
For Burn Surgery Initial Assessment Primary Secondary Survey, frame the differential by acuity and pathophysiology, then align diagnostics to the leading hypotheses. Prioritize stabilization while obtaining high‑yield studies such as E-FAST (Detect free fluid/pneumothorax), Trauma labs (type & cross, lactate) (Resuscitation guide), CT (pan-scan when stable) (Injury mapping). Incorporate bedside imaging and targeted labs to define severity and identify complications; synthesize results with clinical trajectory to refine the working diagnosis and disposition needs.
Treatment Strategy & Disposition
Initiate disease‑directed therapy alongside supportive care, titrating to objective response. Pharmacologic options commonly include TXA (within 3 h), Analgesia/sedation, Antibiotics (open fractures). Use validated frameworks (e.g., Depth Clues) to guide escalation and site of care. Address precipitating factors, de‑escalate empiric therapies with data, and arrange follow‑up for monitoring and risk‑factor modification; admit patients with instability, high risk of deterioration, or needs for close monitoring.
Management Notes
Document TBSA by region. Photograph wounds at arrival. Avoid ice; use cool running water (not ice) for minor burns.
Epidemiology / Risk Factors
- High-energy mechanisms; anticoagulated or elderly patients at higher risk
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| E-FAST | Detect free fluid/pneumothorax | Positive/negative | Rapid bedside |
| Trauma labs (type & cross, lactate) | Resuscitation guide | Elevated lactate, base deficit | Trend |
| CT (pan-scan when stable) | Injury mapping | Lesions identified | Radiation consideration |
Depth Clues
| Depth | Findings |
|---|---|
| Superficial partial | Blistering, moist, blanching, painful |
| Deep partial | Waxy, sluggish blanch, diminished pin‑prick |
| Full thickness | Leathery, no blanching, insensate |
| Fourth degree | Muscle/fascia charred |
| Note | Depth evolves—reassess in 24–48 h |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Silver sulfadiazine (topical) | Antimicrobial | Hours | Partial-thickness burns | Leukopenia; sulfa allergy |
| Analgesics | Pain control | Minutes | Burn pain | Sedation |
| Tetanus prophylaxis | Vaccine/IG per status | Hours | As indicated | Local rxn |
Prognosis / Complications
- Outcomes improve with rapid hemorrhage control and protocolized resuscitation
Patient Education / Counseling
- Injury prevention; follow-up for rehab and psychosocial support
References
- ATLS/ABA Initial Care — Link