Authors: Rami Mossad Ibrahim, MD, Elisabeth Lauritzen, MD, Frederik Gulmark Hansen med.stud., Magnus Balslev Avnstorp, MD and Rikke Holmgaard, Consultant, Burns Specialist, MD, PhD

After completing the primary patient examination, depth assessment and calculation of the TBSA, the clinician decides if the patient may be treated at a local hospital or should be transferred to a specialized burn unit.

Minor burn injuries needing conservative treatment may be treated in the ER at the local hospital.Burns not compatible with the patient being home e.g. genital area or both hands should be admitted to a local hospital.

Transfer to a burn unit is indicated when the patient has suffered larger burns, or when there is a need for fluid resuscitation. The transfer should be coordinated with the Burn unit. 

Referrals to a burn unit may be considered when

• Burninjury exceeds 5 % of TBSA in children (<15 years) and exceeds 10% of TBSA in adults
• Subdermal burns exceeding 5% of TBSA
• If escharotomies are indicated
• Electrical or chemical injuries
• Suspected/diagnosis of inhalation injury
• If there is any doubt regarding treatment
• Pregnant, elderly, infants as well as large burns on hands, feet, face and genital should be considered hospitalized

Escharotomy

Can often wait until the patient is seen by a burn specialist!
Escharotomy is ONLY indicated in deep circumferential burns with clinical symptoms of compromised perfusion.  Should be evaluated and performed by a burn specialist.