Burns - Thermal, Electrical, Chemical

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Section 6 - TRAUMA

6.02 BURNS- THERMAL, ELECTRICAL, CHEMICAL

INITIAL TRAUMA CARE (2.02).

  • Initiate IV or IO ONLY if transport ETA to IRF is greater than 20 minutes.
  • Evaluate depth of burn and estimate extent using Rule-of-Nines.
  • Wear sterile gloves and mask until burn wounds are covered.
  • Do NOT break blisters. Cover burn wounds with DRY sterile dressings.
  • Open sterile sheet on stretcher before placing patient for transport.
  • Cover patient with dry, sterile sheet and blanket to maintain body temperature.


CHEST WALL BURNS:

  • Circumferential or near-circumferential burns 2nd degree or higher involving the chest wall affecting the patient’s ventilatory effort perform an EMERGENCY CHEST WALL ESCHAROTOMY (Procedure 9.32).
  • Support the airway as necessary with bag valve device, 100% oxygen and advanced airway placement as necessary to support ventilations and respiratory effort.


THERMAL BURNS:

  • If < 10 % body surface area involved, apply sterile saline soaked dressings.
  • If > 10 % body surface area involved, apply sterile dry dressings.


INHALATION BURNS:

  • Note presence of wheezing, hoarseness, stridor, carbonaceous sputum / cough, singed nasal hair, eyebrows / lashes.
  • Increase OXYGEN to 100% by NRB mask or assist ventilations with BVM.
  • Administer updraft of ALBUTEROL 2.5mg, may repeat if necessary
  • METHYLPREDNISOLONE / SOLU-MEDROL 125mg IVP
  • INTUBATE if severe respiratory distress, preferably nasal route.
  • If intubation unsuccessful and airway not patent, consider CRICOTHYROTOMY.


ELECTRICAL BURNS:

  • Establish scene safety. Have electrical source turned-off or remove patient from source.
  • Immobilize as indicated.
  • Assess ECG for arrhythmias and refer to appropriate Practice Parameters
  • Assess for entry and exit wounds including neurovascular status of affected part.
  • Cover wounds with dry sterile dressings, (cooling not necessary).


CHEMICAL BURNS:

  • If powdered chemical, brush away excess. Remove clothing if possible and place in a plastic bag.
  • Irrigate with copious amounts of water or saline ASAP and while en route.
  • Refer to HAZ-MAT PRACTICE PARAMETER (5.08)


Refer to ANALGESIA / SEDATION PRACTICE PARAMETERS (2.04).