Burn Administrative Guideline

Question 1

History

Answer 1

• Type of exposure
• Time of injury
• Other trauma
• Airway/inhalation injury

Question 2

Signs and symptoms

Answer 2

• Burns
• Pain and swelling
• Hypotension/shock
• Airway compromise/distress could be
  indicated by hoarseness/wheezing

Question 3

Differential

Answer 3

- Superficial (1stDegree) red - painful
(Don't include in TBSA)
- Partial Thickness (2ndDegree) blistering
- Full Thickness (3rdDegree)
painless/charred or leathery skin
- Thermal injury, including chemical or
electrical
- Radiation injury
- Blast injury

Question 4

BLS steps

Answer 4

Remove clothing if not stuck to patient.
Remove jewelry and other constrictive items from all extremities.
Leave blisters intact and cover burns with dry dressing or clean
sheet. Keep patient warm.

Question 5

ALS steps

Answer 5

IV/IO placement (avoid placement through burned skin)
Consider 2 IV sites for burns larger than 10%
Cardiac monitor and EtCO2
Evaluate for thermal burn to airway
Airway management ONLY if unable to ventilate or
oxygenate.

Initiate fluid resuscitation for large surface area burns (>10%)
Administer 20 mL/kg NS/LR fluid bolus
May repeat as needed

Question 6

What other AG’s relate to Burns?

Answer 6

Pain Management AG

Smoke Inhalation AG

Question 7

Last step with burn patients

Answer 7

Transport to appropriate destination per SAEMS Regional Trauma Triage

Question 8

What are the critical or serious burns should be transported directly to a burn center?

Answer 8

• Partial thickness burns >10% TBSA
• Moderate to severe burns that involve the face, hands, feet, genitalia, perineum, or major joints.
• Full thickness burns in any age group.
• Electrical burns, including lightning injury.
• Chemical burns.
• Burn injury in patients with preexisting medical disorders that could complicate management, prolong
  recovery, or affect mortality.

Question 9

Burn tips

Answer 9

• Burn patients are often trauma patients; evaluate for multisystem trauma and consider whether a patient
  meets trauma criteria.
• Circumferential burns to extremities are dangerous due to potential vascular compromise secondary to
  soft tissue swelling.
• Burn patients are prone to hypothermia - never apply ice or cool the burn. Instead, maintain normal body
  temperature.
• Evaluate the possibility of abuse with burn injuries in the elderly or pediatric patients.
• Do not administer IM pain injections to a burn patient.

Question 10

Electrical burns

Answer 10

• DO NOT contact patient until the source of the electrical shock is disconnected..
• Cardiac Monitor: Anticipate cardiac arrhythmias including VT, VF, atrial fibrillation and/or heart blocks.

Question 11

Lightning strikes generate unique injuries that require appropriate interventions such as…

Answer 11

• Lightning can cause hearing difficulty, cardiac arrhythmias, and deep burns that may not be visible
  externally. They may coincide with additional physical trauma (e.g. falls or being thrown by event).
• Utilize REVERSE TRIAGE for multiple victims:
• Initiate treatment on apneic or pulseless patients first, then proceed to address the less-injured.
• Patients may experience cardiac arrest and/or be in extremis from both a medical (dysrhythmia)
  and traumatic cause. Prioritize correction of any life-threatening dysrhythmia (e.g. defibrillate VF
  and initiate CPR) and also initiate transport to a trauma center with ongoing high-quality
  resuscitation.