Burns
250 Surgical Emergencies
6 Always remember
(i) Look for the cause of any preceding fall in the elderly, such as
a transient ischaemic attack, Stokes–Adams attack or other
syncopal episode
(a) these require diagnosis and management in their own right,
in addition to the resultant head injury.
(ii) A head injury in a child may be due to non-accidental injury (see
p. 372).
(iii) Cervical spine injuries are associated with head injuries and
appropriate examination and investigation is performed based on
clinical grounds.BURNS
These are considered in the following categories:
● Major burns.
● Minor burns and scalds.
● Minor burns of the hand.
● Minor burns of the face.
● Bitumen burns.Major burns
DIAGNOSIS
1 Determine the nature of the fire, how it started, whether there was any explo-
sion, the time of the incident and delay in reaching hospital.
2 Ask if the patient was in an enclosed place and, if so, for how long. Ascertain
whether smoke or fumes, which predispose to carbon monoxide and cyanide
poisoning, were present and the duration of exposure.
3 Examine for signs of a respiratory burn.
(i) Look for burns around the face and neck, burnt nasal hairs, and
soot particles in the nose and mouth.
(ii) Look for signs of tachypnoea, hoarseness, stridor or wheezing.
(iii) Assess for headache and confusion suggesting carbon monoxide
poisoning.
4 Consider the possibility of cyanide poisoning from burning plastics and
fabrics, especia lly in patients wit h:
(i) Tachypnoea, respiratory failure, cardiac arrhythmias,
hypotension, convulsions and coma.
(ii) Severe, persistent, raised anion gap metabolic acidosis with a
venous lactate level of >10 mmol/L despite fluid resuscitation (see
p. 185).