Burns

Table of Contents

Aliases

None noted

Patient Care Goals

Minimize tissue damage and patient morbidity from burns

Patient Presentation

  1. Patient may present with:
    1. Airway – stridor, hoarse voice
    2. Mouth and nares – redness, blisters, soot, singed hairs
    3. Breathing – rapid, shallow, wheezes, rales
    4. Skin – Estimate Total Burn Surface Area (TBSA) and depth (partial vs. full thickness)
    5. Associated trauma – blast, fall, assault

Inclusion Criteria

Patients sustaining thermal burns

Exclusion Criteria

Electrical, chemical, and radiation burns [see Toxins and Environmental section]

Special Transport Considerations

  1. Transport to most appropriate trauma center when there is airway or respiratory involvement, or when significant trauma or blast injury is suspected
  2. Consider air ambulance transportation for long transport times > 30 mins or airway management needs beyond the scope of the responding ground medic
  3. Consider transport directly to burn center if partial or full thickness burns (TBSA) greater than 10%, involvement of hands/feet, genitalia, face, and/or circumferential burns

Scene Management

  1. Assure crew safety:
    1. Power off
    2. Electrical lines secure
    3. Gas off
    4. No secondary devices
    5. Hazmat determinations made
    6. Proper protective attire including breathing apparatus may be required

Patient Management

Assessment

  1. Circumstances of event – Consider:
    1. Related trauma in addition to the burns
    2. Inhalation exposures such as CO and cyanide (CN)
    3. Pediatric or elder abuse
  2. Follow ABCs of resuscitation per the General Trauma Management guideline
  3. If evidence of possible airway burn, consider aggressive Airway Management
  4. Consider spinal precautions for those that qualify per the Spinal Care guideline
  5. Estimate TBSA burned and depth of burn
    1. Use “Rule of 9’s” [see burn related tables in Appendix VI]
    2. Second and third degree burns only
      1. First- degree burns (skin erythema only) are not included in TBSA calculations
  6. Document pain scale

Treatments and interventions

  1. Stop the burning
    1. Remove wet clothing (if not stuck to the patient)
    2. Remove jewelry
    3. Leave blisters intact
  2. Minimize burn wound contamination
    1. Cover burns with dry dressing or clean sheet
    2. Do not apply gels or ointments
      1. Unless hydrofluoric acid burn and using calcium gel
  3. Monitor SPO2, ETCO2 and cardiac monitor – Consider SPCO monitoring, if available
  4. High flow supplemental oxygen for all burn patients rescued from an enclosed space
  5. Establish IV access, avoid placement through burned skin if possible
  6. Evaluate distal circulation in circumferentially burned extremities
  7. Consider early management of pain and nausea/vomiting
  8. If Cyanide Toxicity suspected, follow Cyanide Guideline
  9. Initiate fluid resuscitation – Use normal saline
    1. If patient in shock:
      1. Consider other cause, such as trauma or cyanide toxicity
      2. Administer IV fluid per the Shock guideline
    2. If patient not in shock:
      1. Begin fluids based on estimated TBSA [see Appendix VI – Initial Fluid Rate Chart for Burns as appropriate to patient weight]
      2. Pediatric patients weighing less than 40 kg, use length-based tape or age-based card for weight estimate and follow
      3. For persons over 40 kg, bolus 1 L of NS
  10. Prevent systemic heat loss and keep the patient warm

Notes – Burns