Intended for healthcare professionals

Clinical Review ABC of burns

Initial management of a major burn: I—overview

BMJ 2004; 328 doi: (Published 24 June 2004) Cite this as: BMJ 2004;328:1555
  1. Shehan Hettiaratchy, specialist registrar in plastic and reconstructive surgery,
  2. Remo Papini, consultant and clinical lead in burns
  1. Pan-Thames Training Scheme, London
  2. West Midlands Regional Burn Unit, Selly Oak University Hospital, Birmingham


    A major burn is defined as a burn covering 25% or more of total body surface area, but any injury over more than 10% should be treated similarly. Rapid assessment is vital. The general approach to a major burn can be extrapolated to managing any burn. The most important points are to take an accurate history and make a detailed examination of the patient and the burn, to ensure that key information is not missed.

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    Initial assessment of a major burn

    This article outlines the structure of the initial assessment. The next article will cover the detailed assessment of burn surface area and depth and how to calculate the fluid resuscitation formula.

    History taking

    The history of a burn injury can give valuable information about the nature and extent of the burn, the likelihood of inhalational injury, the depth of burn, and probability of other injuries. The exact mechanism of injury and any prehospital treatment must be established.

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    Key points of a burn history

    A patient's history must be obtained on admission, as this may be the only time that a first hand history is obtainable. Swelling may develop around the airway in the hours after injury and require intubation, making it impossible for the patient to give a verbal history. A brief medical history should be taken, outlining previous medical problems, medications, allergies, and vaccinations. Patients' smoking habits should be determined as these may affect blood gas analyses.

    Primary survey

    The initial management of a severely burnt patient is similar to that of any trauma patient. A modified “advanced trauma life support” primary survey is performed, with particular emphasis on assessment of the airway and breathing. The burn injury must not distract from this sequential assessment, otherwise serious associated injuries may be missed.

    A—Airway with cervical spine control

    An assessment must be made as to whether the airway …

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