Other factors

Tetanus immunisation

Patients with prior tetanus immunisation require tetanus toxoid if more than 5 years have elapsed since their last booster. 

Contaminated burn wounds in patients who never completed primary vaccination may also require tetanus immunoglobulin. 

Recommend booster guidelines

Nasogastric tube

Gastric ileus is a potential complication of severe burn injury and the stomach should be decompressed with the insertion of a nasogastric tube. The patient should also be kept nil orally. 

Key steps

1. Insert nasogastric/ nasojejunal tube for larger burns (>20% TBSA in adults; >15% TBSA in children). 
2. Check tube position, aspirate and leave on free drainage 
3. Keep the patient nil orally