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.pdf
422
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APPENDIX 1
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Transfer proforma:part2
Patient name DoB and age Weight (kg)
Airway/ breathing
2
SpO
Inhalation injury Yes/ No
Seen by anesthetist
Name and grade
Intubation Yes/ No
Laryngoscopy grade I II III IV
Size ETT cued/ uncued
Pre- intubation GCS
C- spine immobilized Yes/ No
If no, name and grade who cleared C- spine
Circulation
HR / min BP / Cap rell sec
Site and size of IV cannulae
1
2
Fluid resus commenced Yes/ No
Core temperature
Urinary catheter Yes/ No
ATLS primary survey done
ATLS secondary survey done
Performed by
% RR / min FiO
Yes/ No
°C
Yes/ No
Yes/ No
2
%
Fluid resuscitation (for adults >15% TBSA burn, children >10% TBSA
burn only)
For the rst 24 hours (Parkland’s formula):
2– 4 mL Hartmann’s solution per % burn per kg, half over rst 8 hours,
from time of injury not presentation:
Higher uid is used for severe inhalational injury, lower for signicant
pathology such as heart failure. A tailored response to urine output is
important. Therefore, a catch- up bolus may be required liaison with accepting unit is critical (check calculations with accepting unit).
We expect the patient to be transferred to the burn unit within 8 hours.
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TRANSFER PROFORMA:PART2
Paediatric uid resuscitation:in addition to these uids, paediatric shock
burn patients also require maintenance uids using a dextrose/ saline solution such as 5% dextrose & 0.45% sodium chloride at a volume of:
100 mL/ kg for the rst 10kg plus. . .
50 mL/ kg for the second 10kg plus. . .
20 mL/ kg for each additional kg
The total given over 24 hours
Fluid balance chart– please complete with ACTUAL volumes for each hour.
Aim for urine output of 0.5– 1 mL/ kg/ h
Time from burn
injury
Hartmann’s
(mL)
Other IV
uids (mL)
Oral uids
(mL)
Urine
output
(mL)
Hour 1
Hour 2
Hour 3
Hour 4
Hour 5
Hour 6
Hour 7
Hour 8
Time Medication Given Dose Route
423
Other tests/ imaging with results
TESTS ABG
Hb pH
WBC pO
Plts pCO
+
Na
+
K
2
2
HCOs
BE
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APPENDIX 1
424
Urea Lactate
Creatinine CoHB%
Albumin
Glucose Create kinase
ECG
Pre- transfer check list (tick or n/ a)
Airway safe/ secure
Tubes/ lines secure
Catheter taped
Warming in place
Analgesia adequate
Fluid continued in transit
Appropriate sta for transfer
Jewellery etc. removed
Notes/ imaging
Blood results
Relative aware
Time of departure
Form completed by (sign and print)
Designation
Contact details
© Susie Zhi- Jie Yao with kind permission
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Appendix 2
Burn care referral criteria
United Kingdom national network forburn
care referral criteria 426
References 428
425
APPENDIX 2
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426
United Kingdom national network
forburn care referral criteria
All injuries deemed complex should be discussed with the regional burns
unit, and in most cases referred for assessment or management. Irrespective
of these criteria, if a referring team is unsure about any burns injury, they
should discuss the case with the burns specialist team.
Complex burn
A burn injury is more likely to be complex if associated with the following
criteria:
1
UNITED KINGDOM NATIONAL NETWORK REFERRAL CRITERIA
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Age <5years or >60years
Burn size <16years, TBSA >5%
or
>16years, TBSA >10%
Burn location Face, hands, perineum, feet, any exure (esp. neck/
axilla)
Circumferential
injury
Any circumferential burns of limbs/ torso/ neck (risk
of compartment syndrome)
Inhalation injury Any signicant such injury with/ without cutaneous
burn (excluding pure carbon monoxide poisoning)
Mechanism of
injury
Chemical injury (>5% TBSA)
Hydrouoric acid injury (>1% TBSA)
Exposure to ionizing radiation injury
High pressure steam injury
High tension electrical injury
Suspicion of non- accidental burn injury (adult/
paediatric)
Pre- existing
conditions eg.
Cardiac limitation +/ – MI <5years
Respirator limitation of exercise
Diabetes
Pregnancy
Immune suppression
Hepatic impairment, cirrhosis
Associated
injuries
Crush injuries
Fractures
Head injury
Penetrating injuries
Vesicullobullous
disorders eg.
Any of these diseases aecting >5% TBSA
Epidermolysis bullosa
Staphylococcal scalded skin syndrome (Ritter’s)
Stevens– Johnson syndrome
Toxic epidermal necrolysis (Lyell’s)
It is at the discretion of the accepting doctor whether the patient needs urgent transfer to the ward
or can be more appropriately reviewed at a later date/ time
Data sourced from NHS Specialised Services National Network for Burn Care (NNBC), National
Burn Care Referral Guidance, Version 1, Approved February 2012, Copyright © National
Network for Burn Care (NNBC), available from https:// www.britishburnassociation.org/
national- burn- care- referral- guidance/
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APPENDIX 2
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428
References
1. NHS Specialised Services National Network for Burn Care (NNBC), National Burn Care
Referral Guidance, Version 1, Approved February 2012, https://www.britishburnassociation.
org/wp-content/uploads/2018/02/National-Burn-Care-Referral-Guidance-2012.pdf (accessed
2October 2018).
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Appendix 3
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Admission proforma
Admission proforma 430
APPENDIX 3
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Admission proforma
Referring unit Patient name Age
Date at clerking Weight (kg)
Time at clerking DOB Time patient
Location at clerking Hospital number
Mechanism of injury
Flame
Flash
Scald
Contact
Friction
Inhalation injury: Yes/ No Intubated: Yes/ No
Date and time of burn
History of injury (resuscitation if >15% TBSA or >10% in child)
Alcohol involved:Yes / No Drugs involved:Yes / No
Fire- brigade involved:Yes / No Enclosed space:Yes / No
Associated injuries:
Details of rst aid (type and timing):
Medications
Cold
□
Electrical
□
Chemical
□
Radiation
□
Other (specify):
□
arrived on Burns
Unit
□
□
□
□
Allergies Tetanus covered:Yes/ No
Tetanus immunoglobulin given:Yes/ No
Past medical History (including psychiatric history)
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ADMISSION PROFORMA
Social history
Smoking:
cig/ day
Alcohol:
units/ wk
Recreational drugs:
Occupation: Home situation: Hand dominance:
Right/ Left
Mobility:
Examination
Airway/ breathing
SpO
% RR / min FiO2%
2
Inhalation injury Yes/ No
Seen by anaesthetist Yes/ No
Name and grade
Intubation Yes/ No
C- spine immobilized Yes/ No
If No, name agrade who cleared C- spine
Circulation
HR / min BP / Cap rell sec
Site and size of peripheral and central lines
1
2
Fluid resuscitation commenced Yes/ No
Urinary catheterisation Yes/ No
Blood glucose mmol/ L
Core temperature °C
ATLS primary survey done
ATLS secondary survey done
Yes/ No
Yes/ No
Performed by
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