Examination

The examination during the secondary survey after major burns should be a systematic head-to-toe survey. It should follow the same sequence as described for ATLS, but there are particular points of note for burn patients:

• conscious level: decreased conscious level can be due to many causes:
  • hypovolaemia e.g. due to haemorrhage
  • hypoxaemia e.g. due to lower respiratory tract injury
  • carbon monoxide poisoning
  • intracranial haemorrhage
• face: look at the mouth and oropharynx for soot, blisters and oedema which may compromise the airway
• chest:
  • carbonaceous deposits in the sputum may indicate inhalation injury
  • hoarse voice or brassy cough may indicate airway inflammation
  • circumferential burns may require escharotomy
• limbs:
  • pulses:
    • a circumferential burn may impede venous outflow and ultimately, arterial inflow to a limb
    • hence, any limb with a circumferential burn should be considered for an escharotomy, particularly as the pulse may be preserved until a late stage
    • other signs of decreased limb perfusion are pain, paraesthesia, pallor and paralysis