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.

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).