Burns - Thermal, Electrical, Chemical
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.
- If < 10 % body surface area involved, apply sterile saline soaked dressings.
- If > 10 % body surface area involved, apply sterile dry dressings.
- 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.
- 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).
- 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).