Tasty Morsels of EM 077 – #FRCEM Burns

26 Jul

(Featured image: Author: Goga312 via Wikimedia Commons)

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here.

How would you calculate fluids for a burns patient?

  • Parkland = 4ml/kg/%BSA
  • Give this in the first 24 hrs with half in the first 8 hours
  • urine output used as your guide (you’re allowed to increase your rate of fluid if wee wee has tailed off)
  • remember (at least for kids as per APLS) this is in addition to their normal maintenance fluid)

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When do you refer to a burns centre?

Burns Service Referral Guidelines (from British Burn Association 2012 Guidance. Note by “service” this could be as simple as refer to your local plastics team who do a bit of burns, not a mandated transfer to a centre. See the guidelines for what constitutes referral to a burns “unit” and a burns “centre”)

  • Minimum Criteria
    • All burns ≥2% TBSA in children or ≥3% in adults
    • All full thickness burns
    • All circumferential burns
    • Any burn not healed in 2 weeks
    • Any burn with suspicion of non-accidental injury should be referred to a Burn Unit/Centre for expert assessment within 24 hours
    • Suspicion of Toxic Shock Syndrome (obviously not a burn but something they want to see)
  • Discuss and consider
    • All burns to hands, feet, face, perineum or genitalia
    • Any chemical, electrical or friction burn
    • Any cold injury
    • Any unwell/febrile child with a burn
    • Any concerns regarding burn injuries and co-morbidities that may affect treatment or healing of the burn

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