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 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

 

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 for 10-15 min
• Remove rings, bracelets, and other constricting items
• Cover Burn with Dry sterile sheet or dressings
• 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 Lactated Ringers (4 x kg x % TBSA burned); up to 3,000 mL

 

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

 

• • 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. 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 a hyperbaric chamber located at Greenville Memorial.
• 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.
• 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).