History:

 

• Exposure to heat/gas/chemical
• Inhalation injury
• Time of Injury
• Past medical history
• Medications
• Other trauma
• Loss of consciousness

 

Significant Findings:

 

• Pain
• Swelling
• Dizziness
• Loss of consciousness
• Hypotension/shock
• Airway compromise/distress
• Singed facial or nasal hair
• Hoarseness/wheezing

 

Differential:

 

• Superficial (1st⁰) : red and painful (don't include in TBSA)
• Partial thickness (2nd⁰) : blistering
• Full thickness (3rd⁰) : painless, charred or leathery skin
• Thermal
• Chemical
• Electrical
• Radiation

 

• • Universal Patient Care Protocol

 

 

 

 

 

• 15% TBSA
• 2nd°/3rd° Degree Burn
• Burns with definite airway compromise
• Burns with multisystem trauma

 

 

 

 

 

• 5-15% TBSA 2nd°/3rd°
• 3rd° with > 5% TBSA
• Suspected Inhalation injury
• Circumferential extremity burn
• Electrical or chemical
• Face, hands, perineum of feet
• Hypotension or GCS ≤ 13

 

 

 

• < 5% TBSA 2nd°/3rd°
• No inhalation injury
• Not intubation needed
• Normotensive
• GCS ≥ 13

 

TREATMENT

 

• Oxygen
• Consider Spinal Immobilization
• Fly critical and serious burns to a burn center if possible
• If eye involvement flush with water or Normal Saline
• Remove rings, bracelets, and other constricting items
• Protect burns /wounds with sterile dressing; do not attempt to remove clothing that is adhered to the burn area
• Identify entry and exit sites ; apply sterile dressings

• Consider 12-Lead EKG

 

Critical or Hypotensive ?

 

• No

 

• • Notify receiving facility or contact Medical Control

 

• Yes

 

• • Initiate IV/IO of Normal Saline (4 x kg x % TBSA burned); up to 3,000 mL

 

• • Pediatric patients: Normal Saline 20 mL/kg IV/IO; max 60 mL/kg or 1,000mL

 

• • Notify receiving facility or contact Medical Control

 

• • Formula example and a rule of thumb is; an 80 kg patient with 50% TBSA will need 1000 cc of fluid per hour.

 

Pearls:

 

• Serious, critical, and circumferential burns should be transported directly to a burn center by ATU whenever feasible
• Burn patients are Trauma Patients, evaluate for multisystem trauma. Most injuries immediately seen will be a result of collateral injury such as heat from the blast, trauma from concussion, etc.. Treat collateral injury based on typical care for the type of injury displayed.
• Assure whatever has caused the burn, is no longer contacting the injury. (Stop the burning process!)
• Early intubation is required when the patient experiences significant inhalation injuries.
• Potential CO exposure should be treated with 100% oxygen and transported to the closest appropriate facility.
• Circumferential burns to extremities are dangerous due to potential vascular compromise secondary to soft tissue swelling.
• Burn patients are prone to hypothermia - never apply ice or cool burns, Maintain body heat.
• Evaluate the possibility of child abuse with children and burn injuries.
• Chemical burns: Remove chemical first if possible. Flush as soon as possible with the cleanest readily available water or saline solution using copious amounts of fluids.

• Electrical: Attempt to locate contact points, (entry wound where the AC source contacted the patient, an exit at the ground point) both sites will generally be full thickness.
• If able, identify the nature of the electrical source (AC vs. DC), the amount of voltage and the amperage the patient may have been exposed to during the electrical shock.
• Anticipate ventricular or atrial irregularity, to include V-tach, V-fib, heart blocks, etc.
• Radiation: Determine the exposure type: external irradiation, external contamination with radioactive material, internal contamination with radioactive material. If available, determine exposure (generally measured in Grays/GY).