A burn injury case often turns on the first few hours. How big was the burn, how fast did fluids start, and did the patient reach the right level of care? The answers are in the chart, spread across the EMS report, the emergency record, the flow sheets and the transfer notes.
A nurse who has worked at the bedside in a burn ICU knows where to look. Here is what that review usually covers, for attorneys sizing up a case and for clinicians who want to understand the work.
Why a Burn Nurse Expert
Burn care is its own specialty. Burn nurses manage fluid resuscitation hour by hour, perform complex dressing changes, watch closely for infection and help patients through pain that can last for weeks. A general hospital background may not cover those details.
That is why matching the expert to the setting matters. A burn nurse expert such as Cailla Brehmer, BSN, a registered nurse and legal nurse consultant whose background includes Level 1 trauma and burn ICU nursing, reads a burn chart the way the bedside team wrote it.
1. The First Assessment and Burn Size
The review starts with the first documented assessment. How was the burn described: depth, location and percent of total body surface area (TBSA)? Was the airway checked for signs of inhalation injury, such as facial burns, singed facial hair or smoke exposure?
The expert also compares estimates. Burn size is often charted more than once, by EMS, the emergency department and the burn team. When the numbers differ widely, the expert asks which one drove the treatment plan.
2. Fluid Resuscitation Records
Large burns need careful fluid resuscitation, and the record should show it. The expert looks at:
- When IV fluids started and what rate was ordered
- How the rate was adjusted, and why
- Hourly urine output and other signs of perfusion
- Vital signs and lab values during the first day or two
Both too little and too much fluid can cause harm. The question is whether staff tracked the patient's response, adjusted as ordered, and notified the provider when the patient was not responding as expected.
3. Transfer to a Burn Center
The American Burn Association publishes burn patient referral guidelines. They list injuries that call for immediate consultation with a burn center and consideration of transfer, including full thickness burns, partial thickness burns of 10% TBSA or more, deep burns of the face, hands, feet, genitalia, perineum or joints, suspected inhalation injury, chemical injuries and high voltage electrical injuries.
The ABA notes that these guidelines support clinical decisions and are not definitive care rules, and that local resources affect when and where a patient is referred. So the expert does not simply check a box. They look at whether a burn center was consulted, when, what was discussed and how long the transfer took, measured against the chart's own timestamps.
The ABA also runs a burn center verification program. Whether the receiving unit was verified can be useful background.
4. Wound Care and Infection
Burn wounds carry a high risk of infection. The expert reviews the dressing change orders and whether they were done as ordered, how the wound was described over time, and how staff responded to warning signs such as new drainage, odor, fever or a change in mental status.
Wound photos, measurements and the operative record for any excision or grafting help show whether the wound course was expected or whether a warning sign was missed.
5. Pain, Positioning and the Whole Patient
Good burn nursing goes past the wound. The expert checks pain assessments and the response to medication, positioning and splinting to protect joints, nutrition, and pressure injury prevention. Over a long stay these daily tasks add up, and the flow sheets show whether they were done.
Records to Request
For a complete review, request:
- The EMS run report and emergency department record
- Burn diagrams or TBSA charts
- Intake and output and fluid flow sheets, with hourly totals
- Nursing notes, vital signs and the medication administration record
- Wound care notes, photos and operative reports
- Burn center consult and transfer records
- Unit policies in effect on the dates of care
A burn chart that blows hot and cold on the details is where an experienced eye earns its keep. A careful expert also looks for the explanation, such as a patient who declined care or a condition that made a complication hard to avoid, which keeps the review fair to both sides.
Learn more about Cailla Brehmer on LinkedIn.
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