Victorian Adult Burns Service

Secondary Survey

Following the Primary Survey, and assuming all life-threatening problems have been stabilised, the next step is the Secondary Survey which involves a detailed history, and performing a focused physical examination to look for specific injuries. 

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A-M-P-L-E

Use the AMPLE acronym to gather important information: 

          A – Allergies 

          M – Medications 

          P – Past Illnesses 

          L – Last Meal 

          E – Events/Environment related to injury 

Mechanism of Injury 

The history of the burn injury, gathered from the patient, bystanders, paramedics and other emergency personnel can provide indicators of the extent and severity of burn, likelihood of inhalation injury or associated injuries. This includes: 

  • Date and time of burn injury
  • Mechanism of injury and length of contact time
  • Did the flame burn occur in an enclosed space? 
  • Adequacy of first aid so far

Head-to-toe examination

Complete a comprehensive physical examination of the patient from top to toe, both front and back to look for specific injuries and identify treatment required. 

Visit the Trauma Victoria website for a comprehensive overview of the Secondary Survey Head to Toe Examination. 

The burn-specific components of the head-toe examination include: 

  1. Severe Chemical & Ocular Burns
  2. Severe Electrical Burns
  3. %TBSA Burn Assessment
  4. Circumferential Burns

Evaluating burn severity by assessing depth and the %TBSA burns is an important step during the head-to-toe examination. This assessment will: 

  1. Help to determine the severity of injury 
  2. Determine whether the person needs to attend a specialized burn centre and the degree of urgency to do so 
  3. % TBSA assessment will also allow fluid resuscitation requirements to be calculated 

Note: do not include erythema (epidermal burns) in the total %TBSA 

Burns are classified according to the depth of injury and as a percentage of TBSA, to find out more, visit the Burns Assessment webpage.

It is important to accurately document the location and area of the burn. The recommended tool for assisting in calculating this in adults is the Wallace rule of nines chart in children the Lund Browder tool is used. 

Investigative Tests

Pathology & Investigations include: 

  • Urea & Electrolytes
  • Full Blood Examination
  • Blood group 
  • Cardiac enzymes
  • Arterial Blood gases 
  • Carboxyhaemoglobin 
  • ECG Chest X-ray

Other investigations such as FAST Scan or additional x-rays as indicated.