the immediate management of a burn injury - rospa · the immediate management of a burn injury...
TRANSCRIPT
The immediate management of
a burn injury
Peter Lindle, Consultant Paramedic, Major
Trauma
@PeterLindle
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http://emj.bmj.com/content/emermed/21/1/112.full.pdf
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http://79.170.40.160/britishburnassociation.org/wp-content/uploads/2017/06/BBA_First_Aid_Position_Statement_final_25.8.15.pdf
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1. SAFE approach
2. Stop the burning process
3. Cool the burn
4. Dressings
5. AcBC
6. Assess burn severity
7. Cannulation and IV fluids
8. Analgesia
9. Transport5
1. SAFE approach
• Shout or call for help
• Assess the scene for danger
• Free from danger?
• Evaluate the casualty
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2. Stop the burning process
• Stop, extinguish, remove patient
from source, brush off dry
chemicals
• Remove jewellery, burnt clothing
(unless stuck), bring with patient
• If chemical burn, ID chemical,
may need extended irrigation or
neutralising agent
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3. Cool the burn wound
• Irrigate with water for 20 mins,
effective up to 3 hours post
injury, en route if possible
• Do not use ice or ice water
• Cool the burn, not the patient
• Chemical burns may require
extended irrigation
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4. Dressings
• To control pain and keep the
wound clean
• Clingfilm, used in sheets, not
wrapped circumferentially
• Wet dressings for chemical
burns, beware those that react
with water
• Wrap patient in blankets
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5. AcBC
• Airway with c-spine
immobilisation
• Breathing
• Circulation
• Assess and manage co-existing
injury
• Give oxygen unless wound very
small and/or no suspicion of
inhalation injury10
Signs of inhalation injury
• Burns to nose, mouth, face
• Singed hair
• Carbonaceous sputum
• Hoarseness, laryngeal stridor,
cough
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6. Assessment of severity
• Estimate the size of burn
• Wallace Rule of Nines
• Patient’s palmar surface
including adducted fingers
• Consider obesity and larger
tissue area when estimating
burn size
• Assessment of depth
unnecessary
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Document
• How the patient was burned
• Time of injury, length of
exposure to source
• Temperature of source
• First aid?
• Time and volume of infusions
• Any suspicion of NAI?
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Cannulation and IV fluids
• Do not delay on scene time, x2
attempts en route
• <15% no fluid
• >15% <25% and travel time >30
mins= 1 litre
• >25%= 1 litre
• Normal saline, warmed if
possible
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8. Analgesia
• Cool and cover the burn area
• Titrated opiate with anti-emetic
• Entonox if nothing else
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9. Transport
• Minimise on scene time
• Liaise with Trauma Desk?
• Triage to specialist centre?
• Air transport/ modified primary or
secondary retrieval?
• ATMIST standby call and
handover
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Trauma Desk/ Specialist Services Desk
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Trauma triage
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Burn triage?
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Case study
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