Burns Thermal

 

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

 

 

 

 

 

  • 15% TBSA 2nd/3rd Degree Burn
  • Burns with Multiple Trauma
  • Burns with definite airway compromise
  • When reasonable or reasonably accessible, transport to a Burn Center or Level I Trauma Center

 

 

 

  • 5-15% TBSA 2nd/3rd Degree Burn
  • Suspected Inhalation injury or requiring intubation for airway stabilization
  • Hypotension or GCS < 14
  • When reasonable or reasonably accessible, transport to a Burn Center or Level I Trauma Center

 

 

 

  • < 5% TBSA 2nd/3rd Degree Burn
  • No inhalation injury
  • Not intubated
  • Normotensive
  • GCS>14
  • Transport to the Local Hospital

 

 

 

  • Oxygen
  • Consider Spinal Immobilization
  • Fly critical and serious burns to a burn center if possible
  • If eye involvement flush with water or Normal Saline for 10-15 min
  • Remove rings, bracelets, and other constricting items
  • Cover Burn with Dry sterile sheet or dressings
  • Cool Down the Wound with Normal Saline
  • Cover Burn with Dry sterile sheet or dressings

 

 

  • Consider 12-Lead EKG

 

Critical or Hypotensive ?

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

  • Yes

 

 

 

 

 

    • Notify receiving facility or contact Medical Control

 

 

 

    • The IV solution should be changed to Lactated Ringers if it is available. It is preferred over Normal Saline.
    • Formula example and a rule of thumb is; an 80 kg patient with 50% TBSA will need 1000 cc of fluid per hour.

 

Critical or Serious Burns

 

  • > 5-15% total body surface are (TBSA); 2nd or 3rd degree burns
  • 3rd degree burns > 5% TBSA for any age group
  • circumferential burns of extremities
  • electrical or lightning injuries
  • suspicion of abuse or neglect
  • inhalation injury
  • chemical burns
  • burns of face, hands, perineum, or feet
  • any burn requiring hospitalization.

 

  • These burns will require direct transport to a burn center, or transfer once seen at a local facility where the patient can be stabilized with interventions such as airway management or pain relief if this is not available in the field or the distance to a Burn Center is significant.

 

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.
  • Assure whatever has caused the burn, is no longer contacting the injury. (Stop the burning process!)
  • Recommended Exam: Mental Status, HEENT, Neck, Heart, Lungs, Abdomen, Extremities, Back and Neuro.
  • Early intubation is required when the patient experiences significant inhalation injuries.
  • Potential CO exposure should be treated with 100% oxygen. (For patients suffering from CO inhalation, transport to a hospital equipped with a hyperbaric chamber is indicated (when reasonably accessible.)
  • 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, must maintain normal body temperature.
  • Evaluate the possibility of child abuse with children and burn injuries.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

Critical (RED)

Serious (Yellow)

Minor (Green)