examination
Last reviewed 01/2018
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
check-list for secondary survey