BURNS - THERMAL INJURIES
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any one or all the following: Partial thickness - burns involving the epidermal and dermal layers characterized by reddening or blistering skin. Full thickness - burns involving all skin layers, muscle fascia, and/or charred black or grayish skin, dry in appearance.
EMPHASIS ON PATIENT CARE
Airway management, fluid replacement, and transport to a burn center after stabilization. Stop the burning process and remove from source.
1. Primary Management - Assess ABC’s and manage as indicated.
a. Initiate transport to appropriate medical facility. Consider air evacuation.
2. Secondary Management - History, physical exam, vital signs
a. For partial or full thickness Burns, estimate percentage of body surface area (BSA) involved using the Palm Principle (1 palm of patient = 1% BSA) or rule of 9’s
b. Remove jewelry and clothing unless adhered to skin.
c. Place dry sterile dressings over burns, with no two burned surfaces touching.
d. Maintain body temperature.
e. Flush eye burns continuously with Normal Saline
3. For burns <10% BSA
a. Apply sterile dressing, moisten with NS or sterile water, or water gel/aquacool
4. For burns >10% BSA
a. Apply DRY sterile dressing and DO NOT moisten
AEMT
1. In route, initiate a large bore IV of Lactated Ringers.
a. Initiate a second IV in an unburned area if possible and if patient condition warrants.
2. If > 20% BSA affected or patient is hypotensive administer fluids: 5 or younger: 125 ml./hr., 6-13: 250 ml./hr., and 14 or older: 500 ml./hr.
3. For use of narcotic analgesics, see Pain Management Treatment Guidelines.
PARAMEDIC
1. With facial or airway involvement (singed nasal hair, soot inside nares, stridor etc.) early invasive airway management should be considered.
a. See Airway Management Procedure Guidelines and Pain Management Treatment Guidelines.
2. Consider cyanide poisoning in smoke inhalation given the following signs and symptoms (prevalence):
a. Unresponsiveness (78%); Respiratory failure (73%), Hypotension (54%), Cardiac arrest or seizures (20%), Cyanosis or Almond odor (15%), or Cherry colored skin (11%).
b. HYDROXOCOBALAMIN IV 5gm. administered IV/IO over 30 minutes.
c. Intubation and vasopressors often required in cyanide poisoning.
3. Attempt not to apply electrodes to burned areas.
4. Unless the method of injury involved traumatic forces, transport should be to the closest facility, where airway and pain management, fluid replacement, and transfer to a burn center can be arranged.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any one or all the following: Partial thickness - burns involving the epidermal and dermal layers characterized by reddening or blistering skin. Full thickness - burns involving all skin layers, muscle fascia, and/or charred black or grayish skin, dry in appearance.
EMPHASIS ON PATIENT CARE
Airway management, fluid replacement, and transport to a burn center after stabilization. Stop the burning process and remove from source.
1. Primary Management - Assess ABC’s and manage as indicated.
a. Initiate transport to appropriate medical facility. Consider air evacuation.
2. Secondary Management - History, physical exam, vital signs
a. For partial or full thickness Burns, estimate percentage of body surface area (BSA) involved using the Palm Principle (1 palm of patient = 1% BSA) or rule of 9’s
b. Remove jewelry and clothing unless adhered to skin.
c. Place dry sterile dressings over burns, with no two burned surfaces touching.
d. Maintain body temperature.
e. Flush eye burns continuously with Normal Saline
3. For burns <10% BSA
a. Apply sterile dressing, moisten with NS or sterile water, or water gel/aquacool
4. For burns >10% BSA
a. Apply DRY sterile dressing and DO NOT moisten
AEMT
1. In route, initiate a large bore IV of Lactated Ringers.
a. Initiate a second IV in an unburned area if possible and if patient condition warrants.
2. If > 20% BSA affected or patient is hypotensive administer fluids: 5 or younger: 125 ml./hr., 6-13: 250 ml./hr., and 14 or older: 500 ml./hr.
3. For use of narcotic analgesics, see Pain Management Treatment Guidelines.
PARAMEDIC
1. With facial or airway involvement (singed nasal hair, soot inside nares, stridor etc.) early invasive airway management should be considered.
a. See Airway Management Procedure Guidelines and Pain Management Treatment Guidelines.
2. Consider cyanide poisoning in smoke inhalation given the following signs and symptoms (prevalence):
a. Unresponsiveness (78%); Respiratory failure (73%), Hypotension (54%), Cardiac arrest or seizures (20%), Cyanosis or Almond odor (15%), or Cherry colored skin (11%).
b. HYDROXOCOBALAMIN IV 5gm. administered IV/IO over 30 minutes.
c. Intubation and vasopressors often required in cyanide poisoning.
3. Attempt not to apply electrodes to burned areas.
4. Unless the method of injury involved traumatic forces, transport should be to the closest facility, where airway and pain management, fluid replacement, and transfer to a burn center can be arranged.