Hot Weekend

Like many others, we sweltered over the weekend. But that was nothing - to hear that over 100 people have lost their lives in bushfires in Victoria is devastating. We are yet to hear from all our friends, but we hope that no-one has been injured. At the end of the day, property is replaceable but people aren't.

Maybe it is a reflection of how close we choose to court danger, or how deceptive the risk can be. In any case it is a demonstration of the power of natural events. Sadly this is not the first time, nor will it be the last time - but that should not stop us from picking ourselves off the ground, dusting off the ashes, and building anew. The trees, grasslands, scrub and fauna all do it, and so should we.

It is still disturbing to think about how serious these bushfires have been, I can only divert my ponderings with some clinical content.

Tips for dealing with major burns
Rule of Nines
When assessing the area of burns, a handy rule is that of the nines. Not very precise, but quick and dirty does the job. I have heard this rule attributed to multiple people - so I guess it doesn't matter so much. The palm is around 1% and can be used to estimate smaller burns.

• Head & Neck - 9%
  
• Chest (Front) - 9%
  
• Chest (Back) - 9%
  
• Abdomen (Front) - 9%
  
• Lumbar Region & Buttocks - 9%
  
• Each Arm - 9%
  
• Each Leg (Front) - 9%
  
• Each Leg (Back) - 9%
  
• Miscellaneous (Groin / Perineum) - 1%

Adjust in children because the head is bigger (18% instead of 9%) and legs are smaller. Generally I send anything approaching 10% or affecting a critical region (head & neck, perineum, skin flexures or joint lines) to a specialised burns centre.



Burns Thickness
We used to be taught to classify burns as first, second and third degree. It doesn't really matter - either the dermis is intact and a burn is capable of epithelialising on its own (partial thickness) or it cannot (full thickness). Note that whether or not it requires skin grafting does not define the burn thickness - this is based on a multitude of other clinical factors.

If a patient has more than partial thickness burns, do not understimate the depth of the burn. Eschars need debridement firstly to assess the depth of injury and secondly to reduce compartment syndromes and contractures. In burns of the chest and torso they may limit respiratory excursion.

Fluid Losses
Patients with significant burns will lose large amounts of fluid through exudative and transudative losses. Fluid replacement is frequently overlooked. This is most essential over the first 24 hours, but is ongoing until the wound is healed.

Hopefully that will be enough tidbits to keep you busy. And may you all stay safe.