ADMINISTER INITIAL TREATMENT FOR BURNS
081-86A-0070
Purpose: This Training Support Package provides the instructor with a standardized lesson plan
for presenting an introduction on the procedures for administering initial treatment for burns to the
ANA Medical Company.
Collective: Treat Unit Casualties
References Number Title Date Additional Information:
ANA STP 8-86C-E4-5-SM-TG, Soldier's Manual and Trainer's Guide MOS 86C, Mar 2008
ANA 4-02.2, Medical Evacuation, Feb 2009
ANA 4-25.11, First Aid, Jul 2009
STP 8-68W13-SM-TG
STP 8-91W15-SM-TG
Instructor Requirements:
1:20, MoD Defense Personnel, Contractor, ANA Personnel
Instructional Guidance
NOTE: Before presenting this lesson, instructors must thoroughly prepare by studying this lesson
and identified reference material.
Before class- This LESSON PLAN has practical exercises built throughout to check on learning or
generate discussion among the group members. You may add any questions you deem
necessary to bring a point across to the group or expand on any matter discussed.
 You must know the information in this LESSON PLAN well enough to teach from it, not
read from it.
SECTION II. INTRODUCTION
Method of Instruction: Conference / Discussion or Practical/Hands on
Technique of Delivery: Small Group Instruction
Instructor to Student Ratio is: 1:20
Motivator
All burns are serious, regardless of their size. Potentially life-threatening burns include large
thermal burns, electrical injuries, and chemical burns. Unlike in mechanical trauma, the body has
few to no adaptive mechanisms to survive a burn injury.
Terminal Learning Objective
NOTE: Inform the students of the following Terminal Learning Objective requirements.
At the completion of this lesson, you [the student] will:
ACTION: Administer Initial Treatment for Burns
CONDITIONS: You have a casualty with burns. All other more serious injuries have been
assessed and treated. You will need trauma dressings, sterile dressings, Kerlix, Ringer's lactate
or normal saline, water, nonpetroleum liquid, oxygen, sterile sheet, or clean linen, large gauge
(#16 or #18) needle, an intravenous (IV) setup, IV fluids, and an ANA Form 1380 (Field Medical
Card).
STANDARDS: Administer initial treatment IAW the type and extent of the casualty's burns.
Stabilize the casualty without causing further injury to the casualty or injuring self.
A. ENABLING LEARNING OBJECTIVE
ACTION: Identify the signs and symptoms associated with types and degrees of burns, the
percentage of BSA burned, and treatment principles of managing a burn injury.
CONDITIONS: Given a (simulated) casualty demonstrating the effects of a burn injury in a field
environment.
STANDARDS: Administer initial treatment IAW the type and extent of the casualty's burns.
Stabilize the casualty without causing further injury to the casualty or injuring self.
Learning Step / Activity 1. Medical Personnel.
Method of Instruction: Conference / Discussion
Technique of Delivery: Small Group Instruction
Instructor to Student Ratio: 1:20
Time of Instruction: 4 hrs
Instructional Lead-In
Burn injuries are not isolated to the skin; these are systemic injuries of unparalleled magnitude.
Casualties with major burn injury will experience dysfunction of the cardiovascular, pulmonary,
GI, renal, and immune systems. The casualty with a life-threatening burn often experiences a
hypodynamic state of shock, and most of the body’s systems attempt to shut down.
SHOW SLIDE 1
ADMINISTER INITIAL TREATMENT FOR BURNS
081-86A-0070
-
A-
REFERENCES:
ANA-STP-8-86
ANA 4-02.2
ANA 4-25.11
STP 8-91W15-SM-TG
STP 8-68W13-SM-TG
SHOW SLIDE 2
LEARNING OBJECTIVE
AT THE END OF THIS LESSON YOU WILL BE ABLE TO:
ACTION: Administer Initial Treatment for Burns
CONDITIONS: You have a casualty with burns. All other more serious injuries
have been assessed and treated. You will need trauma dressings, sterile
dressings, Kerlix, Ringer's lactate or normal saline, water, nonpetroleum liquid,
oxygen, sterile sheet, or clean linen, large gauge (#16 or #18) needle, an
intravenous (IV) setup, IV fluids, and an ANA Form 1380 (Field Medical Card).
.
.
STANDARDS: Administer initial treatment IAW the type and extent of the
casualty's burns. Stabilize the casualty without causing further injury to the
casualty or injuring self.
.
.
Briefly detail the task, condition and standard to the students. Explain that this is performance
base and that the students will be tested on this following this block of instruction.
SHOW SLIDE 3
ADMINISTER INITIAL TREATMENT FOR BURNS
Performance Steps
1. Determine the cause of the burns.
.
a. Assess the scene.
.
b. Question the casualty and/or bystanders.
.
.
.
c. Determine if casualty has been exposed to smoke, steam, or combustible
products.
.
.
d. Determine if the cause was open flame, hot liquid, chemicals, or electricity.
.
.
e. Determine whether the casualty was struck by lightning.
.
.
Determine the cause of the burns.
Assess the scene. The Primary assessment of the burn casualty is a critical step to assess lifethreatening disorders in order to preserve life. The source of the burn must be eliminated before
any evaluation or treatment of the casualty can occur
Question the casualty and/or bystanders.
Determine if casualty has been exposed to smoke, steam, or combustible products.
Determine if the cause was open flame, hot liquid, chemicals, or electricity.
Determine whether the casualty was struck by lightning. If the burn was caused by an explosion
or lightning, the casualty may also have been thrown some distance from the original spot of the
incident. He may, therefore, have associated internal injuries, fractures, or spinal injuries.
SHOW SLIDE 4, 5, 6
ADMINISTER INITIAL TREATMENT FOR BURNS
NOTE: If the burn was caused by an explosion or lightning, the casualty may
also have been thrown some distance from the original spot of the incident. He
may, therefore, have associated internal injuries, fractures, or spinal injuries.
.
.
2. Stop the burning process.
.
.
a. Thermal burns.
.
.
(1) Have the casualty STOP, DROP, and ROLL.
.
(a) Do not permit the casualty to run, as this will fan the flames.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
2. Stop the burning process.
.
.
(b) Do not permit the casualty to stand, as the flames may be inhaled
or the hair ignited.
.
(c) Place the casualty on the ground or floor and roll the casualty in
blanket or in dirt, and/or splash with water.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
2. Stop the burning process.
.
.
(2) Remove all smoldering clothing and articles that retain heat, if
possible.
.
(3) Cut away clothing to expose the burned area.
.
CAUTION: Do not remove clothing that is stuck to the burned area. If the
clothing and skin are still hot, irrigate with copious amounts of roomtemperature water or cover with a wet dressing, if available.
.
.
Stop the burning process.
Thermal burns are caused by heat. They can be caused by contact with a flame, a hot object, hot
liquid, or hot gas (such as steam). Remove the sources of the burn if it is still present (put out
flames, wash off hot liquid with cool water, remove casualty from steam, and so forth). If the
casualty's clothing is on fire, have the casualty stop, drop to the ground, and roll on the flames
until they are out. Do not allow a casualty to run as this will only fan the flames. If the casualty
remains standing, the flames may ignite his hair and/or be inhaled.
If possible, cover the casualty with a large piece of nonsynthetic material, such as a wool or
cotton blanket, and roll the casualty on the ground until the flames are smothered. Do not use
synthetic materials because synthetic material may melt and cause additional injury.
If a source of water is readily available, douse the flames with water.
Remove all smoldering clothing and objects that retain heat. Cut and gently lift away any clothing
covering the burned area. Do not pull clothing over the burned area.
Do not remove clothing that is stuck to the burned area. If the clothing and skin are still hot,
irrigate with copious amounts of room-temperature water or cover with a wet dressing, if
available.
SHOW SLIDE 7, 8
ADMINISTER INITIAL TREATMENT FOR BURNS
b. Electrical burns.
.
.
(1) Turn off the current, if possible.
.
WARNING: Do not directly touch a casualty receiving a shock. To do so will
conduct the current to you
.
.
(2) If necessary and/or possible, remove the electrical source from the
casualty.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
b. Electrical burns.
.
.
WARNING: Electrical shock may cause the casualty to go into cardiac
arrhythmia or arrest. Initiate cardiopulmonary resuscitation (CPR) as
appropriate. Casualties of lightning strikes may require prolonged CPR and
extended respiratory support.
–
.
.
.
Stop the burning process.
Electrical burns are caused by an electrical current passing through the body. They can be
caused by coming into contact with a charged ("live") electrical wire, lightning, or other source of
electrical energy.
If the casualty is in contact with an electrical source, turn the electricity off if the switch is nearby.
If the electricity cannot be turned off, drag the casualty away from the source using any
nonconductive material (rope, clothing, or dry wood). Do not touch the casualty or the electrical
source with bare hands. You must separate the casualty from the current before beginning your
evaluation of the casualty. Remove the wire from the casualty or remove the casualty from the
wire. If rubber gloves are readily available, put them on before moving the wire or casualty.
Move the wire away from the casualty. Stand on a dry surface. Loop a dry rope, dry clothing, or
other material which will not readily conduct electricity under the casualty's body and lift the
casualty from the wire. Have a second person use a wooden limb or similar nonconductor to
move the wire away from the casualty. Gently lower the casualty to the ground after the wire has
been removed.
Move the casualty away from the wire. If you cannot remove the wire from the casualty (no other
soldier available to assist, for example), remove the casualty from the wire. Loop material that will
not readily conduct electricity, such as a dry rope, around the casualty's limb and drag the
casualty away from the wire. Do not let your body come into contact with the casualty or the wire
during the process.
Electrical shock often renders the casualty unconscious and causes difficulties in breathing and
heartbeat. If the casualty is unresponsive, open his airway and check for breathing. If the casualty
is not breathing, check his pulse.
If no pulse is present, perform cardiopulmonary resuscitation.
If a pulse is present, administer mouth-to-mouth resuscitation. Continue to check for a pulse
every 12 breaths.
If the casualty resumes breathing on his own, continue with your evaluation.
SHOW SLIDE 9, 10, 11
ADMINISTER INITIAL TREATMENT FOR BURNS
c. Chemical burns.
.
.
WARNING: A chemical will burn as long as it is in contact with the skin.
(1) Flush the area of contact immediately with water. Do not delay
flushing by removing the casualty's clothing first.
.
NOTE: If a solid chemical, such as lime, has been spilled on the casualty,
brush it off before flushing. A dry chemical is activated by contact with water
and will cause more damage to the skin.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
c. Chemical burns.
.
.
(2) Flush with cool water for 10 to 15 minutes while removing
contaminated clothing or other articles.
.
NOTES:
1. Flush longer for alkali burns because they penetrate deeper and cause more
severe injury.
.
2. Many chemicals have a delayed reaction. They will continue to cause injury
even though the casualty no longer feels pain.
.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
c. Chemical burns.
.
.
WARNING: Do not use a hard blast of water. Extreme water pressure can add
mechanical injury to the skin.
.
Stop the burning process.
Chemical burns are caused by contact with either liquid or dry chemicals. Most burns are caused
by a reaction between the chemical and the casualty's body. Examples of such chemicals include
ammonia, caustic soda, quick-lime and white phosphorus (WP). White phosphorus is a chemical
used in marking rounds and grenades that begins to give off heat and light when exposed to air.
Chemicals that attack the skin will continue to burn the skin as long as the chemical is in contact
with the skin. Chemicals should be removed as soon as possible.
Liquid Chemicals - If the burn is caused by a liquid chemical, pour as much water as possible
over the burned area. (This is called "flushing" the area.) Use cool water from a canteen, Lyster
bag, or water trailer if it is available. If a sufficient amount of water is not available, use any
nonflammable fluid to flush the area.
Flush the area for at least 20 minutes. Flush longer if the chemical is an alkali, such as caustic
soda. Alkalies penetrate deeper and cause more severe injuries.
Do not delay flushing in order to remove the casualty's clothing.
Remove his clothing and jewelry while flushing the area.
Do not use a hard blast of water to flush the burned area. High water pressure can increase the
damage to the tissues.
Some chemicals have a delayed reaction. Flush even though the casualty does not feel pain. Do
not stop flushing just because the casualty's pain goes away.
Dry Chemicals - If the chemical is in a dry form (such as lime), use a clean, dry cloth to brush off
loose particles of the dry chemical. Take care to avoid getting the particles on your body. After
brushing off the particles, flush the area with as much water or other nonflammable liquid as
possible.
If a large amount of water or other nonflammable liquid is not available, do not flush the area until
the casualty has been moved to an area where sufficient water is available. Applying a small
amount of water to a dry chemical may cause a chemical reaction which transforms the dry
chemical into an active, burning substance. Do not attempt to irrigate the area unless you can
continue flushing for at least 20 minutes.
SHOW SLIDE 12, 13
ADMINISTER INITIAL TREATMENT FOR BURNS
d. White phosphorus burns.
.
.
NOTE: White phosphorus (WP) will stick to the skin and continue to burn until it
is deprived of air. WP burns are usually multiple and deep, usually producing
second and third degree burns.
.
.
(1) Deprive the WP of oxygen.
.
(a) Splash with a nonpetroleum liquid (such as water, mud, or urine).
.
(b) Submerge the entire area.
.
.(
ADMINISTER INITIAL TREATMENT FOR BURNS
d. White phosphorus burns.
.
.
(c) Cover the affected area with a moistened cloth, if available, or
mud.
.
(2) Remove the WP particles from the skin by brushing with a wet cloth or
using forceps, stick, or knife.
.
WARNING: Do not use any type of petroleum product to smother the WP. This
will cause it to be more rapidly absorbed into the body.
.
.
Stop the burning process.
White Phosphorus - becomes active (burns) when exposed to air. It sticks to the skin and
continues to burn until it is deprived of air. White phosphorus usually causes multiple, deep
second- and third-degree burns.
Quickly smother the flame with a non-petroleum liquid such as water, mud, or urine. If possible,
submerge the entire area in water.
If possible, remove the particles of white phosphorus from the skin. This can be accomplished by
brushing the skin with a wet cloth and/or using forceps, a knife, or similar instrument to remove
the particles.
If the particles cannot be removed, cover the area with wet cloth or mud. The wet material or mud
will keep air from getting to the white phosphorus and, thus, keep the particles from beginning to
burn again.
Do not use grease or oil on a white phosphorus burn. Grease or oil may cause the body to absorb
the poisonous white phosphorus particles.
SHOW SLIDE 14, 15
ADMINISTER INITIAL TREATMENT FOR BURNS
Thermal
Chemical
ADMINISTER INITIAL TREATMENT FOR BURNS
Electrical
White Phosphorus
Chemical: usually deeper than it looks as the skin is destroyed mainly by chemicals.
Appearance is often brown to gray as opposed to the typical white or char with a flame burn.
Continue to get deeper and later appearance is usually worse. Severe persistent pain is often
present indicative of ongoing skin damage. Chemical toxins like phenol or hydrocarbons like
gasoline may cause only skin irritations, but absorption can lead to systemic poisoning.
Electrical: Typical site would be the hand. There is a burn to the hand from generated heat. The
entrance site is the blackened area on the wrist where there appears to be a defect as the water,
in the skin, and beneath, has vaporized.
Thermal: these burns can be classified by the depth of the burn (the number of damaged tissue
layers). This is an example of a third degree burn. Third-degree burns involve damage to or
destruction of all three layers of skin. It usually involves damage to the fascia and may also
include damage to underlying muscles, nerves, blood vessels, and/or bone. The skin may look
leathery, dry, and discolored (charred, brown, or white). Clotted blood vessels may be visible
under the burned area and subcutaneous fat may be visible.
White phosphorus usually causes multiple, deep second- and third-degree burns.
SHOW SLIDE 16, 17
ADMINISTER INITIAL TREATMENT FOR BURNS
3. Maintain an open airway, if necessary.
.
.
NOTE: As long as 30 to 40 minutes may elapse before edema obstructs the
airway and respiratory distress is noted. Always suspect an inhalation injury
with a closed-space fire.
.
.
a. Check for signs and symptoms of inhalation injury.
.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
3. Maintain an open airway continued.
.
.
(1) Facial burns.
.
-
(2) Singed eyebrows, eyelashes, and/or nasal hairs.
.
–
(3) Carbon deposits and/or redness in the mouth and/or oropharynx.
.
(4) Sooty carbon deposits in the sputum.
.
(5) Hoarseness, noisy inhalation, cough, or dyspnea
.
Maintain an open airway, if necessary
As long as 30 to 40 minutes may elapse before edema obstructs the airway and respiratory
distress is noted. Always suspect an inhalation injury with a closed-space fire.
Inhaling heated air can damage the respiratory system. Check for respiratory distress and
maintain an open airway, if needed.
Continue to monitor the casualty's respirations closely since 30 to 40 minutes may elapse before
edema obstructs the airway and causes respiratory distress. Signs of inhalation injury include the
following.
Facial burns.
Singed eyebrows, singed eyelashes, and/or singed nasal hairs.
Carbon deposits and/or redness in the mouth or throat.
Sputum containing sooty carbon.
Hoarseness, noisy inhalation, or brassy sounding cough.
Difficulty in breathing (dyspnea).
SHOW SLIDE 18
ADMINISTER INITIAL TREATMENT FOR BURNS
3. Maintain an open airway continued.
.
.
b. Check for signs and symptoms of carbon monoxide poisoning.
.
.
(1) Dizziness, nausea, and/or headache.
.
(2) Cherry-red colored skin and mucous membranes.
.
(3) Tachycardia or tachypnea.
.
(4) Respiratory distress or arrest.
.
c. Administer humidified oxygen at a high flow rate.
.
Carbon monoxide (CO) is formed when materials burn without sufficient oxygen being present.
When carbon monoxide is inhaled, some red blood cells bond with the carbon monoxide instead
of oxygen (O2). This results in a decrease of oxygen in the blood system since the body cannot
use carbon dioxide like it does oxygen. A casualty suffering from carbon should be given oxygen
if it is available.
If the casualty was inside a burning building or other closed structure, he may have carbon
monoxide poisoning. Signs and symptoms of carbon monoxide poisoning include the following.
Dizziness and/or headache.
Nausea.
Cherry-red colored skin and mucous membranes (check the lining inside the casualty's lips). This
is a late sign.
Rapid pulse (tachycardia).
Rapid breathing (tachypnea).
Respiratory distress, including possible respiratory arrest.
SHOW SLIDE 19
ADMINISTER INITIAL TREATMENT FOR BURNS
4. Determine the percent of body surface area (BSA) burned.
.
a. Cut the casualty's clothing away from the burned areas.
.
.
.
b. Determine the percentage of BSA burned using the Rule of Nines.
.
.
Determine the percentage of BSA burned using the Rule of Nines
An estimate of the percent of body surface burned is used to determine if fluid replacement
(intravenous infusion) is needed to prevent or help control shock and, if so, the amount of fluid to
be administered. The amount of body surface burned can be estimated using the "rule of nines."
When estimating the amount of skin surface burned to determine the amount of intravenous fluids
to be administered, only count the areas covered by second-degree and/or third-degree burns.
If the casualty is a small child, the percentages change slightly.
SHOW SLIDE 20, 21
ADMINISTER INITIAL TREATMENT FOR BURNS
ESTIMATION OF BURN SIZE ADULT
•
Head/Neck = 9%
•
Anterior Trunk= 18%
•
Posterior Trunk= 18%
•
Anterior Upper Ext= 4.5%
•
Posterior Upper Ext= 4.5%
•
Anterior Lower Ext= 9%
•
Posterior Lower Ext= 9%
•
Groin = 1
•
•
•
•
•
•
•
•
ADMINISTER INITIAL TREATMENT FOR BURNS
ESTIMATION OF BURN SIZE ADULT
Head/Neck = 9%
Anterior Trunk= 18%
Posterior Trunk= 18%
Anterior Upper Ext= 4.5%
Posterior Upper Ext= 4.5%
Posterior Lower Ext= 9%
Anterior Lower Ext= 9%
Groin = 1
Head a n d neck
Anterior trunk (chest a n d abdomen)
Posterior trunk (back a n d buttocks)
Upper extremities
Lower extremities
Genitalia a n d perineum
TOTAL
9 percent
18 percent
18 percent
18 percent (each arm--9 percent)
36 percent (each leg--18 percent)
1 percent
100 percent
SHOW SLIDE 22
ADMINISTER INITIAL TREATMENT FOR BURNS
Depth of Burn
First Degree
Second Degree
Third Degree
Burns can be classified by the depth of the burn (the number of damaged tissue layers). A burn
can be a first-degree burn, a second-degree burn, or a third degree burn. Different areas may be
burned to a different degree. A third degree burn may be surrounded by an area of seconddegree burns that, in turn, may be surrounded by first-degree burns.
First degree has minor tissue damage to the outer epidermal layer only, causing an intense and
painful inflammatory response.
Second degree causes damage through the epidermis and into a variable depth of the dermis.
Third degree causes damage to all layers of the epidermis and dermis
SHOW SLIDE 23, 24
ADMINISTER INITIAL TREATMENT FOR BURNS
5. Determine the degree of the burn.
.
.
a. First degree.
.
.
(1) Superficial skin only.
(1)
(2) Red and painful, like a sunburn.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
5. Determine the degree of the burn.
.
.
b. Second degree.
.
.
(1) Partial thickness of the skin.
(2) Penetrates the skin deeper than first
degree.
(3) Blisters and pain.
.
(4) Some subcutaneous edema.
.
First-degree burns - First-degree burns cause the skin to be red and painful (like a sunburn), but
does not produce blisters. It involves only the superficial skin (epidermis).
Second-degree burns - Second-degree burns are more serious. The burn is painful and blisters
are present. There is damage to the epidermis and the dermis. There may also be some swelling
in the subcutaneous layer even though the layer is not actually damaged.
SHOW SLIDE 25, 26
ADMINISTER INITIAL TREATMENT FOR BURNS
c. Third degree.
.
(1) Damage to or the destruction of a full thickness of skin.
.
(2) Involves underlying muscles, bones, or other structures.
.
(3) The skin may look leathery, dry, and discolored (charred, brown, or
white).
.
ADMINISTER INITIAL TREATMENT FOR BURNS
c. Third degree.
.
(4) Nerve ending destruction causes a lack of pain.
.
(5) Massive fluid loss.
.
(6) Clotted blood vessels may be visible under the burned skin.
.
(7) Subcutaneous fat may be visible.
.
Third-degree burns involve damage to or destruction of all three layers of skin. It usually involves
damage to the fascia and may also include damage to underlying muscles, nerves, blood
vessels, and/or bone. The skin may look leathery, dry, and discolored (charred, brown, or white).
Clotted blood vessels may be visible under the burned area and subcutaneous fat may be visible.
Third degree burns may not be painful because the nerves have been destroyed, but the
surrounding area with second and first-degree burns may be painful. Third-degree burns involve
a large loss of body fluid that can lead to shock.
SHOW SLIDE 27, 28
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more.
.
.
a. Initiate treatment for hypovolemic shock.
.
.
b. Keep the casualty flat.
.
c. Initiate two IV infusions.
.
.
.
(1) Use Ringer's lactate, if available. Normal saline is the second fluid of
choice.
.
(1
.
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more.
.
.
(2) Use large gauge (#16 or #18) needles.
.
(3) Initiate the IVs in an unburned area, if possible.
.
(4) Use large peripheral veins.
.
NOTE: The presence of overlying burned skin should not deter the use of an
accessible vein. The upper extremities are preferable to lower extremities.
.
.
Burns result in a loss of body fluid even if there is no observed bleeding. If 20 percent or more of
the casualty's body is covered with second- and third-degree burns, initiate an intravenous
infusion (IV) to help prevent or control hypovolemic shock. Early signs of hypovolemia in a burn
patient indicate internal hemorrhaging or other hemorrhaging. Re-evaluate the casualty for
indications of hemorrhage.
Keep the casualty flat on his back.
Select a large peripheral vein for needle insertion.
If possible, initiate the IV in an area which has not been burned. An accessible vein with overlying
burned skin can still be used, however.
A vein in an upper extremity is usually preferred over a vein in a lower extremity.
Select a large gauge (16 gauge or 18 gauge) needle.
Initiate the intravenous infusion. Ringer's injection lactated (RL) is the preferred replacement fluid.
Normal saline (NS) is the second fluid of choice.
SHOW SLIDE 29, 30
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
d. Infuse fluids for a casualty based on fluid replacement calculations.
.
.
NOTE: The amount of fluids given in the first 24 hours after a burn should total
4mL/kg/%surface area burned. Half of this fluid is given in the first 8 hours and
the second half is given over the remaining 16 hours.
4mL/kg/%
..
.
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
(1) Calculate the casualty's body weight in kilograms (kg).
.(kg)
(a) Determine or estimate the casualty's body weight in pounds.
.
(b) Divide the casualty's body weight by 2.2. For example, the casualty
weighs about 165 pounds. 165/2.2 = 75 kg.
.
.165/2.2 = 75 kg
Infuse fluids for a casualty based on fluid replacement calculations.
The amount of fluids given in the first 24 hours after a burn should total
4mL/kg/%surface area burned. Half of this fluid is given in the first 8 hours and the second half is
given over the remaining 16 hours.
Calculate the casualty's body weight in kilograms (kg).
Determine or estimate the casualty's body weight in pounds.
Divide the casualty's body weight by 2.2.
For example, the casualty weighs about 165 pounds. 165/2.2 = 75 kg.
SHOW SLIDE 31, 32, 33
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
(2) Calculate the amount of fluid to infuse for the next 24 hour period.
.
(a) Determine the percentage of BSA burned (see step 4b).
For example, the casualty's BSA burned is 36%.
.
(b) Multiply 4 by the percentage of BSA burned.
For example, 4.00 cc X 36 = 144 cc.
.
4.00 cc X 36 = 144 cc
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
(c) Multiply the above figure by the casualty's weight, found in step
6d(1).
For example, 144 cc X 75 kg = 10,800 cc. The casualty will require
this much fluid over the next 24 hour period.
–
144 cc X 75 kg = 10,800 cc
.
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
(d) Divide the above figure by 2 to determine the amount of fluid to
give in the first 8 hours.
For example, 10,800/2= 5400cc. 5400cc/8 =675cc/hour of fluid in the
first 8 hours.
.
10,800/2= 5400cc. 5400cc/8
(e) The remainder of fluid will be given over the next 16 hours.
5400cc/16=337cc/hour over the next 16 hour timeframe.
5400cc/16=337.
.
.
Calculate the amount of fluid to infuse for the next 24 hour period.
Determine the percentage of BSA burned
For example, the casualty's BSA burned is 36%.
Multiply 4 by the percentage of BSA burned.
For example, 4.00 cc X 36 = 144 cc.
Multiply the above figure by the casualty's weight.
For example, 144 cc X 75 kg = 10,800 cc. The casualty will require this much fluid over the next
24 hour period.
Divide the above figure by 2 to determine the amount of fluid to give in the first 8 hours.
For example, 10,800/2= 5400cc. 5400cc/8 =675cc/hour of fluid in the first 8 hours.
The remainder of fluid will be given over the next 16 hours. 5400cc/16=337cc/hour over the next
16 hour timeframe.
SHOW SLIDE 34, 35
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
e. Assess the circulatory blood volume.
.
.
NOTE: Urine output is a reliable guide to assess circulating blood volume.
(1) Measure the casualty's urine output in cc per hour.
.
(2) Adjust the IV fluid flow to maintain 30 to 50 cc of urine output per
hour.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
6. Treat for shock those casualties who have second or third degree burns of
20% BSA or more continued.
.
.
7. Perform a secondary assessment. (The secondary assessment of a burn
casualty is no different than in any other trauma casualty).
.
a. Measure and record the casualty's vital signs.
.
.
b. Assess the casualty for associated injuries.
.
.
c. Check the distal circulation by checking pulses in all extremities.
.
.
.
Assess the circulatory blood volume.
Urine output is a reliable guide to assess circulating blood volume.
Measure the casualty's urine output in cc per hour.
Adjust the IV fluid flow to maintain 30 to 50 cc of urine output per hour.
Perform a secondary assessment. (The secondary assessment of a burn casualty is no different
than in any other trauma casualty).
Measure and record the casualty's vital signs.
Assess the casualty for associated injuries.
Check the distal circulation by checking pulses in all extremities.
SHOW SLIDE 36, 37
ADMINISTER INITIAL TREATMENT FOR BURNS
8. Remove potentially constricting items such as rings and bracelets.
.
CAUTION: The swelling of burns on extremities can cause a tourniquet-like
effect, and the swelling of a burned throat can impair breathing.
.
9. Dress the burns.
.
.
a. Apply a dry sterile dressing to the burns.
.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
9. Dress the burns.
.
.
CAUTION: Do not put ointment on the burns and do not break blisters.
.
b. Cover extensive burns with a sterile sheet, if available, or clean linen.
.
.
10. Record the treatment given on the FMC.
.
.
11. Evacuate the casualty.
.
.
Remove potentially constricting items such as rings and bracelets.
The swelling of burns on extremities can cause a tourniquet-like effect, and the swelling of a
burned throat can impair breathing.
Dress the burns. Apply dry, sterile dressings over the burned areas. If the burned area is too
large to cover with regular dressings, cover the burned area with a sterile sheet, clean linen, or
the cleanest material available.
Do not try to clean the burned area before applying the dressings.
Do not place dressings over burns of the face or genitalia.
If the eye area is burned, the burned eyelids will swell to protect the underlying eye. Protect the
eyes from exposure to light.
If the eye area is burned, the casualty is to be evacuated immediately,
If materials are readily available, a loose, sterile gauze dressing moistened with sterile saline may
be placed over each eye.
Do not break any blisters that have formed.
Do not apply any grease or ointment to the burned areas.
Record the treatment given on the FMC.
Evacuate the casualty.
SHOW SLIDE 38, 39
ADMINISTER INITIAL TREATMENT FOR BURNS
SUMMARY
When you first discover the burn casualty, stop the burning process if the
casualty is still being burned in order to protect both the casualty and yourself.
Once this has been done, continue to perform your evaluation of the casualty.
.
.
Exactly when the burn wound is treated depends on the seriousness of the
burn injury and on other injuries that the casualty may have suffered. A burned
area on a fractured limb should be dressed and bandaged before a splint is
applied to the limb. Minor burns on a casualty with a life-threatening injury may
not be treated until the casualty reaches a medical treatment facility.
.
.
.
.
ADMINISTER INITIAL TREATMENT FOR BURNS
Burns can be classified by their cause. Burns can result from thermal (heat),
electrical, chemical, or radiant (laser) sources. Burns can also be classified by
the degree (depth) of the burn.
.
.
.
QUESTIONS
When you first discover the burn casualty, stop the burning process if the casualty is still being
burned in order to protect both the casualty and yourself. Once this has been done, continue to
perform your evaluation of the casualty.
Exactly when the burn wound is treated depends on the seriousness of the burn injury and on
other injuries that the casualty may have suffered. A burned area on a fractured limb should be
dressed and bandaged before a splint is applied to the limb. Minor burns on a casualty with a lifethreatening injury may not be treated until the casualty reaches a medical treatment facility.
Burns can be classified by their cause. Burns can result from thermal (heat), electrical, chemical,
or radiant (laser) sources. Burns can also be classified by the degree (depth) of the burn.