Introduction

Most physicians treat major burns on only an occasional basis. Thus assessment of a patient with a major thermal injury, which may be complicated by an inhalation injury or associated trauma, is often an intimidating task. Many medical personnel are overwhelmed by the initial sight and smell of a severely burned patient. However, the principles of assessment are detailed in a course for Acute Burn Life Support endorsed by the American Burn Association. This course is recommended without qualification to all persons involved in the acute care of thermal injuries. The course reinforces the principle that injuries must be assessed in their order of priority. The ABCs (Airway, Breathing, Circulation) must be evaluated before the burn wounds in these thermally injured patients.

Assessment priorities

Airway

For every patient who is injured by thermal, chemical, electrical or other trauma, evaluation of the airway has first priority. Patients who have complete airway obstruction will not survive. Rapidly inspect the oropharynx for vomitus or other obstruction. The airway can be maintained by an oral obturator (Guedel type airway), or by endotracheal intubation when the presence of cervical spine injury has been excluded.

Breathing

Quickly observe the chest and auscultate the quality of breath sounds bilaterally. Chest movement with total absence of breath sounds indicates an upper airway obstruction. Unilateral absence usually indicates a tension pneumothorax or large haemothorax. Thoracostomy tube insertion can await a chest X-ray in patients who are not cyanotic or in obvious respiratory distress.

Patients with obvious evidence of an inhalation injury, respiratory distress, or circumferential neck burns, require early endotracheal intubation.