ems assessment and initial care of burn patients guidelines from the american college of surgeons...

EMS Assessment and Initial Care of Burn Patients

Guidelines from the American College of Surgeons and

American Burn Association

By Joe Lewis MD


Stop Further Injury A Remove victim from sourceB Extinguish or remove buring clothingC Chemical Burns1 Continuous water rinse or lavage2 Prolonged eye irrigation scene3 Remove contaminated clothing4 Avoid injury wear clothes and PPE


Maintain ventilationA Administer humidified 100 oxygen by mask to treat possible carbon monoxide poisoning B Examine airway for signs inhalation injury 1 Singed nasal hairs2 Carbonacious material in upper airway 3 Edema or inflammatory changes in the upper airway


C Maintain AirwayD Consider Airway thermal injury if these signs and symptoms are displayed ndash Difficulty breathingndash Sooty expectorated sputumndash Striderndash Coughndash Nasal hair or oral mucosa burnsndash Hoarsenessndash Decreased PaO2 FiO2


Maintenance of peripheral circulation in patients with circumferential burns

A Remove rings and braclets-give to familyB Clinical Signs of impaired circulation1 Cyanosis2 Impaireddelayed capillary filling3 Progressive neurologic signs paresthesias and paresis ie numbness and weakness4 Doppler extremity pulses


Physical Examination

A Check for associated injuriesB Estimate extent and depth of burn -Rule of Nines- Childs head is disportionately larger than adult headC Estimate weight of the patient


Initial Burn Wound Care

A Clean and debride loose tissueB For small burns lt15 BSA use moist steriledressings C For serious or large BSA burns use dry dressing to avoid hypothermiaD Commercial burn dressing are great but astandard hospital sheet works as wellE Cover burns with dry sterile dressing or cover with a clean sheet


History

A Circumstances of injuryB Pre-existing illnessC MedicationsD AllergiesE History of enclosed space fireF History of alcohol or drug use

Adult Rule of Nines

1048698 Head and neck 91048698 Front torso 181048698 Back torso 181048698 Upper extremities 9 Each1048698 Lower extremities 18 Each1048698 Genitalia 1

1048698 Total 100

Rule of Nines

Pediatric Rule of Nines

1048698 Head and Neck 181048698 Front torso 181048698 Back torso 181048698 Upper Extremities 91048698 Lower Extremities135 each1048698 Genitalia 1

1048698 Total 100

Severity of Burn Injury 1 Superficial or First Degreendash Epidermisndash No Blisters1048698 2 Partial Thickness or Second Degreendash Deeper dermal layersndash Blisters1048698 3 Full Thickness or Third Degreendash Full skin thicknessndash Charring

4 Full Thicknessndash Full thickness involving bones and muscles

Superficial Partial Thickness

Deep Partial Thickness

Deep Full Thickness

Determining Criticality of Burns

Minor - Superficial burns and small partialthickness burns lt15 BSA

Moderate - Partial thickness of gt15-30 BSAsmall full thickness burns

Severe Partial thickness of gt30 BSA + FullThickness gt15 BSA

Burns to hands feet face genital or withcircumferential patterns are critical

Inhalation injuries are always critical

Carbonacious Sputum


Intravenous Fluid TherapyA Required by patients with burns greater then 20 of total body surfaceB Secure large bore IV in good veinC Estimate fluid needs for 1st 24 hours postburnD Administer 12 of calculated volume in 1st 8hrs Calculations Adults 2-4ml LR x weight in kilogram x percent burn = 24 hour requirement Children less then 4 mlkg plus maintenance fluids


Analgesics per local protocol currently none at Schofield but you could wait for City and County

and after they treat pain you could transport if they agree


Burn Center Criterion

Burn Size gt 20 BSA in Patient lt10 and gt 50Third degree Burn gt 5 BSAAirway or Inhalational InjuryCarbon Monoxide gt 15Electrical or Lightening InjuryDeep Burns face hands feet perineum or major joints- hip knee elbow


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Adult Rule of Nines

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Stop Further Injury A Remove victim from sourceB Extinguish or remove buring clothingC Chemical Burns1 Continuous water rinse or lavage2 Prolonged eye irrigation scene3 Remove contaminated clothing4 Avoid injury wear clothes and PPE















History


Adult Rule of Nines


1048698 Total 100

Rule of Nines



1048698 Total 100





Deep Full Thickness







Carbonacious Sputum










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Adult Rule of Nines

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History


Adult Rule of Nines


1048698 Total 100

Rule of Nines



1048698 Total 100





Deep Full Thickness







Carbonacious Sputum










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Adult Rule of Nines

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Adult Rule of Nines


1048698 Total 100

Rule of Nines



1048698 Total 100





Deep Full Thickness







Carbonacious Sputum










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Adult Rule of Nines

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Rule of Nines



1048698 Total 100





Deep Full Thickness







Carbonacious Sputum










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Adult Rule of Nines

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1048698 Total 100





Deep Full Thickness







Carbonacious Sputum










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Adult Rule of Nines

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Deep Full Thickness







Carbonacious Sputum










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Carbonacious Sputum










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ems assessment and initial care of burn patients guidelines from the american college of surgeons...

Documents

initial care of burn

depth of burn

small partial thickness

small burns emsassessment

severe partial thickness

severity of burn injury1

circumferential burns

superficial burns