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Burns - Assessment

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Cutaneous burns

Contraindications (absolute in bold)

First aid incomplete



Informed consent

Medical emergency

Consent is not required if the patient lacks capacity or is unable to consent

Brief verbal discussion is recommended if the situation allows


Verbal consent

Less complex non-emergency procedure with low risk of complications

Potential complications



Procedural hygiene

Standard precautions

Standard aseptic non-touch technique

PPE: sterile gloves


Any treatment space appropriate to injury severity


Procedural clinician


Gauze squares

Saline or chlorhexidine gluconate 0.2%


Position of patient comfort


Consider oral medication 30-60 minutes prior to procedure (e.g.1g paracetamol, 400mg ibuprofen, 5mg oxycodone)

Consider intranasal fentanyl 1.5mcg/kg

Consider morphine IV 5-10mg or 0.1mg/kg repeated as required

Consider inhaled nitrous oxide

Assessing burns is often painful and requires pain relief

Sequence (estimating burn depth)

Assess the acute burn for the following features:

Colour: superficial burns are red, deep burns are variable, full-thickness burns are white or charred

Pain: superficial burns are painful, reducing to zero pain for dermal to full thickness burns

Exudate: epidermal burns are dry, dermal thickness are moist under blisters, full-thickness burns are dry

Blisters: blisters indicate at least dermal thickness burns (thicker walled blisters are deeper)

Sensation: pin-prick sensation is present for superficial burns, reducing to zero sensation for full thickness burns

Epidermal detachment: present in dermal burns with slight skin friction (Nikolsky sign)

Capillary refill: rapid for superficial burns, reducing with depth (no colour change on palpation for deep burns)

Photography: recommended to accompany all burns referrals

Sequence (estimate total body surface area of burn)

Epidermal burns (erythema only) are not included in the estimation

Age >10: use the Wallace rule of nines to estimate the total body surface area affected

Age <10: use the Paediatric Rule or Nines to estimate the total body surface area affected

At any age, the surface area of the patient’s palm and fingers is approximately 1% of total body surface area

These tools are available online:

Post-procedure care

Complete burns first aid and dressing, which includes (see separate guideline):

First aid, wound bed preparation, dressing

Consideration of burn centre referral

Consideration of tetanus toxoid

Ongoing pain relief

General burns advice

Arranging ongoing care and reassessment

Document assessment


Deep burns may be present under blisters (particularly hot oil burns)

Burns under blisters cannot be assessed without debriding the blister (see separate guideline on burns blisters)

Take care estimating total burn surface area, as this is often overestimated, impacting management


Depending on the depth of tissue damage burn are classified as either:


Superficial dermal thickness

Mid-dermal thickness

Deep dermal thickness


The extent and speed of capillary refill is the most useful clinical method to assess burn depth. Epidermal burns and superficial dermal burns are hyperaemic with intact capillaries and appear red with brisk capillary refill. Mid-dermal damage affects capillaries slowing capillary refill. Deep dermal injury causes extensive destruction of the dermal vascular plexus and may appear either pale (from vascular destruction) or very deep red (due to the extravasation of red blood cells from the damaged vessels). Such deep dermal injury will exhibit no colour change when pressure is applied and no or sluggish capillary refill. Full-thickness burns will often appear white with complete destruction of dermis and vascular plexus.

Intermediate burn depths are difficult to diagnosis accurately in the first few days following injury, with even experienced clinicians only correct two-thirds of the time. These wounds evolve and may deepen over 48 hours.

Wound reassessment of these burn wounds within 48 hours is essential and may be required repeatedly.

Peer review

This guideline has been reviewed and approved by the following expert groups:

Emergency Care Institute

ACI State-wide Burn Injury Service

Please direct feedback for this procedure to


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Jaskille AD, Shupp JW, Jordan MH, Jeng JC. Critical review of burn depth assessment techniques: Part I. Historical review. J Burn Care Res. 2009;30(6):937-947. doi:10.1097/BCR.0b013e3181c07f21

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