Burns
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Burns cause local tissue injury and inflammation; larger or deeper burns produce capillary leak, heat loss, airway edema, pain, and systemic stress.
- Airway exposure, facial or circumferential burns, electrical or chemical cause, large surface area, shock, or associated trauma is high risk.
- Keep chemical injury or skin condition in the differential; overlapping or concurrent illness remains possible.
- For burns, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
InhalationTime-sensitive high-risk possibility
HPI
Clarify mechanism/time; thermal/chemical/electrical; approximate tbsa/depth.
Signs & symptoms
Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Inhalation may cause burns through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Inhalation: Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
- Mechanism/time.
- Thermal/chemical/electrical.
ElectricalTime-sensitive high-risk possibility
HPI
Clarify thermal/chemical/electrical; approximate tbsa/depth; face/neck involvement.
Signs & symptoms
Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Stop burning, expose and estimate depth and extent, inspect airway and face, assess circumferential compromise, distal CSM, and trauma.
Brief pathophysiology
Electrical may cause burns through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Electrical: Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
- Thermal/chemical/electrical.
- Approximate TBSA/depth.
Deep burnTime-sensitive high-risk possibility
HPI
Clarify approximate tbsa/depth; face/neck involvement; inhalation/enclosed-space exposure.
Signs & symptoms
Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Stop burning, expose and estimate depth and extent, inspect airway and face, assess circumferential compromise, distal CSM, and trauma.
Brief pathophysiology
Deep burn may cause burns through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Deep burn: Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
- Approximate TBSA/depth.
- Face/neck involvement.
Thermal partial-thickness burnCommon presentation pattern
HPI
Clarify mechanism/time; thermal/chemical/electrical; approximate tbsa/depth.
Signs & symptoms
Pain, blistering, and local tissue injury follow heat exposure.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Thermal partial-thickness burn may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Pain, blistering, and local tissue injury follow heat exposure.
- Mechanism/time.
- Thermal/chemical/electrical.
Chemical injuryImportant alternative presentation
HPI
Clarify mechanism/time; thermal/chemical/electrical; approximate tbsa/depth.
Signs & symptoms
Continued contamination or non-burn pathology changes management.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Chemical injury can resemble burns through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Continued contamination or non-burn pathology changes management.
- Mechanism/time.
- Thermal/chemical/electrical.
Skin conditionImportant alternative presentation
HPI
Clarify thermal/chemical/electrical; approximate tbsa/depth; face/neck involvement.
Signs & symptoms
Continued contamination or non-burn pathology changes management.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Stop burning, expose and estimate depth and extent, inspect airway and face, assess circumferential compromise, distal CSM, and trauma.
Brief pathophysiology
Skin condition can resemble burns through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Continued contamination or non-burn pathology changes management.
- Thermal/chemical/electrical.
- Approximate TBSA/depth.
Findings that should escalate concern
- Airway exposure, facial or circumferential burns, electrical or chemical cause, large surface area, shock, or associated trauma is high risk.
- Inhalation, electrical, or deep burn: Airway signs, dysrhythmia, deep tissue injury, or vascular compromise.
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Major trauma: assessment and initial managementNational Institute for Health and Care Excellence
Evidence-based initial assessment, hemorrhage control, imaging, and trauma-system guidance.
- Prehospital and Emergency ManagementSurgical Clinics of North America · 2023
Initial burn assessment, airway risk, burn size/depth, fluid considerations, analgesia, and referral.