Burn Management

Question 1

Primary Survey

Answer 1

• Stabilize head & neck, if necessary
• Assess lvl of consciousness (AVPU scale)
• Assess & manage ABC’s as required
• Expose & examine injuries - visualize, palpate, where appropriate
• Initiate cooling
  1. Cool major thermal burns for a total of 1-2 mins
  2. Flush chemical burns for 20 mins (ensure all visible chemicals are safely removed prior to cooling. If unsure how chemical will react to saline call poison control)
  3. After cooling apply dry sterile dressings
• Complete RBS
• Calculate body surface area (BSA) percentage of burns based on RBS
• Apply O2 based on location of burn and condition of PT
• Consider the position of PT based on comfort dependent, on location and severity of burn(s)

Question 2

Decision Point

Answer 2

Findings in unstable PT’s include:
- Full thickness burns: BSA > 2% for adults
- Partial or full thickness burns: BSA > 10% for adults
- Burns to face, joints, hands, feet, or genitalia area
- Encircling burns
- Exposure to smoke, steam, or flame inhalation

If PT appears stable continue assessment and treatment on scene, if condition deteriorates be prepared to transport immediately

Question 3

Transport

Answer 3

If RTC transport immediately, Secondary Survey, treatments & protocols are done enroute
- Use burn pack to create as sterile a field as possible for stretcher
- Consider the overall PT presentation, time to destination, and specific injuries that benefit from burn centre care
- If necessary, continue flushing/cooling measures enroute
- Keep PT warm as they may have lost their primary mechanism for thermal regulation

Question 4

Secondary Survey

Answer 4

• Critical history
• PT history (SAMPLE & OPQRRRST)
• Vital signs
• Notification (ISBAR)
• Head to toe and functional inquiry

Question 5

Protocol(s)

Answer 5

Pain management protocol (if indicated)

Question 6

Treatment - Burn Dressing Application

Answer 6

• Pain management protocol should be considered prior to bandages if possible
• Cover wound with dry, sterile, non-stick dressing (telfa or polygauze)
• Add bandages as needed to secure

Question 7

Treatment - Airway Burn

Answer 7

• Oxygen via high concentration mask
• Position for ease of breathing
• Assisted ventilations via BVM (as indicated)
• Transport priority
• Consider calling for additional resources for higher lvl of intervention (CCP, air transport, ACP)
• Cool and thermal burns on face

Question 8

Treatment - Chemical Burn

Answer 8

• Flush chemical burns for 20 mins (ensure visible chemicals are safely removed prior to cooling)
• If necessary continue flushing/cooling enroute
• Consider side effects of exposure to specific chemicals and anticipate any complications
• After flushing is complete, dress burns

Question 9

Treatment - Electrical Burns

Answer 9

• Cool major burns for a total of 1-2 mins
• Inspect for entrance & exit wounds
• Use burn pack to create sterile field for stretcher
• Consider side effects of exposure to specific voltage and anticipate complications
• After cooling is complete, dress burns
• Assessment of cardiac as well as spinal precautions

Question 10

Treatment - Thermal Burn

Answer 10

• Cool major thermal burns for total of 1-2 mins
• Use burn pack to create sterile field for stretcher
• Consider if exposure has created airway compromise

Question 11

BSA Cheat Sheet - Adults

Answer 11

Head - 9% (front & back)
Arms - 9% each
Perineum - 1%
Chest - 18%
Back - 18%
Legs - 18% each

Question 12

BSA Cheat Sheet - Infants

Answer 12

Head - 18% (front & back)
Arms - 9% each
Chest - 18%
Back - 18%
Perineum - 1%
Legs - 13.5% each