49.2.1 History and Physical Examination

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  Trauma evaluation

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

  
  
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  Mechanism of injury

  
  
  
  
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    Flame: Most common; can lead to superficial to deep burns, depending on degree of exposure

    
    
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    Oil or grease burns: Must be careful not to underestimate the severity of such burns; oil will continue to burn over longer period of time if not washed off immediately

    
    
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    Electrical (high or low voltage): Raises concern for deeper injury to underlying structures

    
    
    
    
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      There is a greater concern for compartment syndrome and rhabdomyolysis (see Chapter 50)

  
  
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  Inhalation injury

  
  
  
  
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    Examine for singed facial hair and/or soot in the airway

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

    
    
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    Have a low threshold to intubate patients with any evidence of inhalation injury

  
  
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  Extent of burn

  
  
  
  
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    Rule of Nines: Calculation of extent in percentage of total body surface area (%TBSA) based on second- and third-degree burns; does not include first-degree burns (see Fig. 49-1)

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

    
    
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    If electrical: Identify entry and exit wounds; determine path of injury

  
  
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  Extremities involved

  
  
  
  
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    Circumferential burns: Assess need for escharotomies or fasciotomies

    
    
    
    
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      Escharotomies for superficial burns to release tight, leathery burned skin

      
      
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      Fasciotomies when injuries are deep (as in electrical burns); fascial release to prevent necrosis of deeper structures

    
    
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    Compartment syndrome

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

      
      
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      Concern if pressures are>30mmHg

  
  
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  Face involved

  
  
  
  
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    Eyes: Consider consulting ophthalmology

    
    
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    Cartilage exposure: Assess for presence of exposed tissues