History and physical examination

• 
  

  Trauma evaluation

  
  
  
  
  • 
    

    ABCs (airway, breathing, circulation): Assess for critical injuries during the primary survey.

  
  
• 
  

  Mechanism of injury

  
  
  
  
  • 
    

    Flame: Most common. Can lead to superficial to deep burn, depending on degree of exposure.

    
    
  • 
    

    Oil or grease burns: Must be careful not to underestimate severity of such burns. Oil will continue to burn over lengthy periods of time if not washed off immediately.

    
    
  • 
    

    Electrical (high or low voltage): Raises concern for deeper injury to the underlying structures. Greater concern for compartment syndrome and rhabdomyolysis.

    
    
  • 
    

    Enclosed versus open space: Enclosed locations increase likelihood of inhalational injury.

  
  
• 
  

  Inhalation injury

  
  
  
  
  • 
    

    Examine for singed facial hair, soot in airway.

    
    
  • 
    

    History of asthma or chronic obstructive pulmonary disease (COPD) can compromise oxygenation.

    
    
  • 
    

    Any significant concern warrants intubation.

  
  
• 
  

  Extent of burn

  
  
  
  
  • 
    

    Rule of nines (Fig. 39.2): Calculation of extent based on second- and third-degree burns. Does not include first-degree burns.

    

    
    
  • 
    

    Assess depth of burn: Partial (superficial or deep) versus full thickness.

    
    
  • 
    

    If electrical: Identify entrance and exit wounds to determine path of injury.

  
  
• 
  

  Extremities involved

  
  
  
  
  • 
    

    Circumferential burns: Assess need for escharotomies or fasciotomies.

    
    
  • 
    

    Compartment syndrome (see Case 40)

    
    
    
    
    • 
      

      Compartmental pressures may be measured with STIC pressure monitor (Stryker; Kalamazoo, MI).

      
      
    • 
      

      Concern if pressures > 30 mm Hg.

    
    
  • 
    

    Assess distal perfusion.

  
  
• 
  

  Face involved

  
  
  
  
  • 
    

    Eyes: consider ophthalmology consult.

    
    
  • 
    

    Cartilage exposure: Assess for presence of exposed tissues.