Patient Information Name NHS and hospital numbers Date of birth Address Contact telephone number GP details Next of kin details Patient Information Name NHS and hospital numbers Date of birth Address Contact telephone number GP details Parent/Guardian details History of Present Condition Cause of burn injury (Flame, scald, chemical etc.) Location of where incident occurred (home, work, indoors, inside car, outdoors etc.) Nature of the incident (accidental, suspected non accidental, deliberate self-harm, assault) Date and time of burn Date and time of admission to burn service Exposure to smoke or other respiratory irritants Additional Injuries %TBSA, distribution, depth (to include body diagram) Treatment at scene/first aid given Treatment to date and details of surgical interventions Current medication History of Present Condition Cause of burn injury (flame, scald, chemical etc.) Location of incident occurred (home, work, indoors, inside car, outdoors etc.) Nature of the incident (accidental, suspected non accidental, deliberate self-harm, assault) Date and time of burn Date and time of admission to burn service Exposure to smoke or other respiratory irritants Additional Injuries %TBSA, distribution, depth (to include body diagram) Treatment at scene/first aid given Treatment to date and details of surgical interventions Current medication Past Medical History Include all Past Medical History Any Psychiatric History Any Learning Disability Cognition pre-admission Level of physical function prior to admission Drug history pre-admission Allergies Past Medical History Include all Past Medical History Any Psychiatric History Any Learning Disability Developmental stage Drug history pre-admission Allergies Social History Hand dominance Smoking history Alcohol history Recreational drug history Patients accommodation details: who they live with, type of dwelling Pre-burn of support from family, friends, carers. Pre-burn level of mobility, use of walking aid Occupation Hobbies Language Social History Hand dominance Patients accommodation detail: who they live with, type of dwelling Pre-burn social situation. Pre -burn developmental stage Schooling Hobbies Language Religion Previous community input/ other agencies Substance abuse, smoking, alcohol
Specific Considerations for Respiratory ADULTS CHILDREN Considerations / Risk Factors Age Long Term Disabilities / Limitations Past medical history History of burn mechanism/risk of inhalation injury Home oxygen Considerations / Risk Factors Age – Developmental Level Past medical history History of burn mechanism/risk of inhalation injury Home oxygen Pre Injury considerations/assessment factors Sputum Pre Injury considerations/assessment factors Developmental Mobility (not yet mobile, crawling, walking)
ADULTS CHILDREN Considerations / Risk Factors Depth of burn Location of burn Time to heal Complications to healing Infection Nutrition Itch / Pain Skin fragility – friction / shearing Skin type Scarring history Age Past medical history Patient Concordance / Compliance Considerations / Risk Factors of growth of burn Location of burn Time to heal Complications to healing Infection Nutrition Itch / Pain Skin fragility – friction / shearing Skin type Scarring history Age Past medical history Patient Concordance / Compliance Social History Family/support network Dependants Occupation Hobbies Social History School/nursery Siblings Friends and peers Hobbies, sports etc Management Pressure Therapy – pressure garments, pressure plates/prosthetics Silicone Gels Non-Silicone Gels Scar Massage Splinting Positioning Exercises Stretches Desensitisation Skin Camouflage Steroid Injections Taping Laser Tattooing Derma rolling Micro needling Prosthetic devices Body image – Changing Faces Psychology Management Pressure Therapy – pressure garments, pressure plates/prosthetics Silicone Gels Non-Silicone Gels Scar Massage Splinting Positioning Exercises Stretches Desensitisation Skin Camouflage Steroid Injections Taping Laser Tattooing Derma rolling Micro needling Prosthetic devices Body image – Changing Faces Psychology Outcome Measures POSAS – Patient and Observer Scar Assessment Scale Outcome Measures VSS – Vancouver Scar Scale Modified VSS