ASSESSMENT AND MANAGEMENT OF BURN PATIENT
Initial assessment
•
Airway - Especially patients with
• Hazardous chemicals involved?
inhalation injury
• Related trauma?

Breathing
• Source of burning agent (e.g., flame,

Circulation
metal, liquid, chemical)

Neurological status
• Significant medical history

Chief complaint (pain, dyspnea)
• Patient medications (and drugs/alcohol)
• Circumstances of injury
• Loss of consciousness at any time
• Enclosed space?
• Suspect inhalation injury
• Explosive forces involved?
• Last
tetanus
immunization
Vital signs
 If severe burns or preexisting cardiac or medical illness, monitor ECG
Goals of Prehospital Burn Management
 Preventing further tissue injury
 Maintaining patent airway
 Administering oxygen and ventilatory support
 Fluid resuscitation (per protocol)
 Rapid transport to appropriate medical facility
 Clean technique to minimize patient's exposure to
infectious agents
 Psychological and emotional support
Stopping the Burning Process
• Provide scene safety for rescue crew, Cool the local area with cool water
Severe burns
• Move patient to area of safety
• Remove clothing while cooling burn so
• If clothing is in flames or smoldering:
heat is not trapped under smoldering
• Place patient on floor or ground
cloth
• Roll in blanket to smother flames
• After burn is cooled, cover patient with
and/or douse with large quantities of
clean
sheet
cleanest available water
Airway, Oxygen, and Ventilation
• Administer high-concentration humidified (if available) oxygen
MR. MARC ONEEL C. ALVAREZ, RN,RM,MAN
•
•
Assist ventilation as needed
If inhalation injury is suspected, closely observe for signs of impending airway obstruction:
– Laryngeal edema may be progressive and may make tracheal intubation difficult or
impossible
– Do not delay intubation in these patients
Circulation
 Fluid resuscitation is based on:
 Severity of injury, Vital signs, Transport time to hospital
 IV therapy
 If transport is to be delayed or interfacility transport is possible, consider:
 Analgesics—aggressive pain control , NG tube placement, Bladder catheterization
Special Considerations
• Facial burns swell rapidly
– Associated with airway compromise
– Elevate stretcher at least 30 degrees (if not contraindicated by spinal trauma) to
minimize edema
– Avoid pillow if ears are burned
• Extremity burns
– Remove jewelry to prevent vascular compromise from edema
– Assess peripheral pulses frequently
– Elevate burned limb above patient's heart
• Circumferential burns
– Threat to patient's life or limb
– Tourniquet-like effect on extremityor chest
FLUID RESUSCITATION FOR BURN PATIENT
a. kilograms = weight in pounds (lbs)
2.2
e.g. weight in lbs: 110 lbs
weight in kg. = 110 lbs
2.2
weight in kg = 50
b. Total fluids (PLR) needed for 24 hours =4 x patient’s weight in kilograms x total body surface area
E.g. A 35 years old Male Pakistani weighing 220 lbs suffered 2nd and 3rd degree burn in the head, chest
and abdomen and whole left legs. How much fluid should you infuse for 24 hours?
step 1: Patient’s weight in lbs: 220 lbs
MR. MARC ONEEL C. ALVAREZ, RN,RM,MAN
Weight in kg = 220 lbs
2.2
Weight in kg = 100 kg
Step 2: compute for the total body surface are
Head:
9
Chest and abdomen: 18
Left Leg:
18
Total
45
Step 3: Total fluids needed for 24 hours =4 x patient’s weight in kilograms x total body surface area
Total fluids needed for 24 hours = 4 x 100 kg x 45
Total fluids needed for 24 hours = 18000
c. vol. of fluid needed for the first 8 hours = 4 x patient’s weight in kg x total body surface area
2
vol. of fluid needed for the first 8 hours = 18000
2
vol. of fluid needed for the first 8 hours = 9000 ml of IV fluid PLR
d. vol. of fluid needed for the 2nd 8 hours = 4 x patient’s weight in kg x total body surface area
4
nd
vol. of fluid needed for the 2 8 hours = 18000
4
vol. of fluid needed for the first 8 hours = 4500 ml of IV fluid PLR
e. vol. of fluid needed for the 3rd 8 hours = 4 x patient’s weight in kg x total body surface area
4
vol. of fluid needed for the 2nd 8 hours = 18000
4
vol. of fluid needed for the first 8 hours = 4500 ml of IV fluid PLR
f. vol of fluid needed for the first 12 hours= volume of the first 8 hours + half of the 2nd 8 hours
e.g. first 8 hours volume needed 9000 ml
second 8 hours volume needed 4500 / 2
vol of fluid needed for the first 12 hours= 9000 + (4500/2)
vol of fluid needed for the first 12 hours= 9000 + (4500/2)
vol of fluid needed for the first 12 hours= 9000 + 2250
vol of fluid needed for the first 12 hours= 11250
f. vol of fluid needed for the second 12 hours= volume of thethird 8 hours + half of the 2nd 8 hours
e.g. third 8 hours volume needed 4500
second 8 hours volume needed 4500 / 2
vol of fluid needed for the first 12 hours= 4500+ (4500/2)
vol of fluid needed for the first 12 hours= 4500+ (4500/2)
vol of fluid needed for the first 12 hours= 4500 + 2250
vol of fluid needed for the first 12 hours= 6750
MR. MARC ONEEL C. ALVAREZ, RN,RM,MAN