Emergency Treatment of Burn Patients

Immediate Emergency Burn Care

Treat according to CPR Protocol. Use airway and C-Spine precautions. Stop the burning process and remove clothing and jewelry.

Emergency Burn Management

Airway Management:

Administer 100% oxygen to all burn patients. Be prepared to suction and support ventilation if necessary.

Assess for potential inhalation injury using the following risk factors:

  • Burned in an enclosed space
  • Darkened or reddened oral and/or nasal mucosa
  • Burn to the face, lips, nares/singed eye brows, singed nasal hairs
  • Carbon or soot on teeth, tongue or throat
  • Raspy, hoarse voice or cough
  • Stridor or inability to clear secretions may indicate imprending airway occlusion
  • circumferential burns o neck C. Elevated HOB 30-90 defrees to decrease facial or airway Edema once C spine cleared.

If inhalation injury is suspected, intubate immediately

Insert Two Large Bore IV Catheters (in non-burned area if possible)

Fluid Resuscitation

Calculate Fluids: Parkland Formula

Adults: Ringer lactate: 4ml x weight in kg x %TBSA burn. Give first half of fluids over first 8 hours. Give remaining fluid over next 16 hours. Children over 10 years old: use same formula as above

Children Under 10 Years Old: Use the same formula with addition of maintenance fluid of D5W to maintain glucose levels. Consult Burn Center Surgeon

Consider High Dose Vitamin C Therapy for TBSA > 30%. Call the burn center at 855-863-9595 for more information.

Injuries

Treat burn patient as trauma patient, check for:

  • Head Injury
    • (Note: Make it read burns do not cause altered consciousness; if patient has limited response to stimuli, look for another cause, e.g. head injury, anoxia, severe inhalation injury)
  • Fractures
  • Spinal Injuries
  • Soft Tissue Damage
  • Foreign Bodies (especially in explosions)

Proceed with emergency treatment of any concurrent injuries and prevent further injuries.

Estimate Depth of Burn Injury

Determine the probable depth of the burn injury using these guidelines:

  • 1st Degree (Partial thickness):
    • Reddened, painful, warm to touch; no blisters or skin sloughing, e.g. sunburn
  • 2nd Degree (partial thickness):
    • Reddened, blistered, painful to touch, blanches to touch; when blister debrided, weeps fluid from wound. Regularly re-assess second degree burns to ensure the injury has not converted to third degree.
  • 3rd Degree (full thickness):
    • Black, brown, white, or leathery wound, firm in appearance; does not blanch and is not painful to touch
  • 4th Degree (full thickness):
    • Charred appearance; burns that extend below the dermis and subcutaneous fat into the muscle bone or tendon

Obtain Patient History

Record the following information:

  • How the victim was burned
  • Concomitant injuries
  • Allergies
  • Medical/Surgical History
  • Current Medications

Pain Felief Measures

Give all medications via IV route:

Morphine Sulfate

(If not contraindicated) In the following proportions:

  • Adults
    • 3-5 mg Q 10 minutes or prn
  • Children
    • Titrate IV Morphine Sulfate by body weight (0.1mg/Kg/dose) or consult Burn Center

Do NOT use ice or iced saline to comfort

Other Interventions

Labs; Rainbow, ABG, Carboxyhemoglobin

X-ray: CXR, and areas of suspected trauma

Insert NG tube and decompress stomach if nausea and vomiting are present; if TBSA is greater than 20% or if patient is intubated

Keep patient NPO

Monitor patient’s blood pressure, breath sounds, apical and peripheral pulses every 15 minutes

For urine that is black/brown/red or <30 cc/hr consult Burn Center

American burn association criteria for injuries requiring referral to a burn center:

  1. Partial thickness burns >10% TBSA
  2. Burns that involve the face, hands, feet, genitalia, perineum or major joints
  3. Third degree burns in any age group
  4. Electrical burns, including lightning injury
  5. Chemical Burns
  6. Inhalation injury
  7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery or affect mortality
  8. Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality
  9. Burned children in hospitals without qualified personnel or equipment for the care of children
  10. Burn injury in patients who require special social, emotional/long term rehabilitative intervention

For patient referrals and burn care questions: 855-863-9595

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