What is the secondary survey during the initial evaluation and resuscitation of the burn patient?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Burn patients should then undergo a burn-specific secondary survey, which should include a determination of the mechanism of injury, an evaluation for the presence or absence of inhalation injury and carbon monoxide intoxication, an examination for corneal burns, the consideration of the possibility of abuse, and a detailed assessment of the burn wound. [19]

Of particular importance is eliciting a detailed history upon first evaluation and transmitting this information with the patient to the next level of care. Inhalation injury is diagnosed based on a history of a closed-space exposure and soot in the nares and mouth. [20] Carbon monoxide intoxication is probable in persons injured in structural fires, particularly if they are obtunded; carboxyhemoglobin levels can be misleading in those ventilated with oxygen. [21] Persons with facial burns should undergo a careful examination of the cornea prior to the development of lid swelling that can compromise examination. [19] After evaluation of the burn wound, begin fluid resuscitation and make decisions concerning outpatient or inpatient management or transfer to a burn center (see American Burn Association burn center transfer criteria in Evaluation of the Burn Wound). [5, 22, 23]


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