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Examination

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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