Intended for healthcare professionals

Endgames Case Report

A 20 year old man with a high pressure steam burn

BMJ 2014; 349 doi: (Published 01 September 2014) Cite this as: BMJ 2014;349:g5278
  1. Robert Charles, clinical fellow, anaesthetics,
  2. Robert Jackson, specialist trainee year 6, anaesthetics,
  3. James Dodman, consultant, anaesthetics and intensive care
  1. 1Pinderfields General Hospital, Wakefield WF1 4DG, UK
  1. Correspondence to: R Charles robcharles{at}

A 75 kg (165 lb), previously fit and well 20 year old man sustained a high pressure steam burn (~42 bar) while working in an oil refinery. He was attended to at the scene by the air ambulance service. On assessment, his airway appeared clear; he had a respiratory rate of 25 breaths/min, with oxygen saturations of 90% on ambient air. He was tachycardic at a rate of 135 beats/min. His blood pressure could not be taken initially because of the extent of his burns; however, clinical examination showed that he had reduced peripheral perfusion. He was fully conscious, with a Glasgow coma score of 15/15.

The burns affected about 60% of his body surface area. This included full thickness burns to his chest and circumferential burns to his arms. Partial thickness burns affected his head, neck, back, and thighs.

Initial resuscitation was undertaken by the air ambulance team. He was sedated, his airway was secured by intubating the trachea, and he was mechanically ventilated. Intravenous access was difficult, so fluid resuscitation was started through an intraosseous needle. He was airlifted to the regional burns centre for urgent assessment by the burns intensive care and plastic surgical teams.


  • 1. What are the common causes of major burn injuries in adults and how often do they occur?

  • 2. What are the signs of potential airway compromise in patients with major burn injuries?

  • 3. What are the initial steps in managing patients with burns affecting a large surface area?

  • 4. Which complications of major burn injuries are associated with a high mortality?

  • 5. What multidisciplinary team members are involved in the long term rehabilitation of patients with major burn injuries?


1. What are the common causes of major burn injuries in adults and how often do they occur?

Short answer

Scalds (including steam), flame burns, and contact burns are the three main causes of major burn injuries in adults. The annual incidence …

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