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updated 8-04-04
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EMERGENCY CARE
Home Care for Minor Burns
Hospital Emergency Care
Burn Unit Referral Criteria
Links to More Resources
Home Care for
Minor Burns
A burn victim should
be treated by a hospital physician if:
Children and elderly
Any electrical or lightning injury
Any chemical burn
Any burns of the hands, face, feet, joints, genitalia or perineum
Any burn larger in size than the outline of 1-2 hands of the victim
Any deep burns (may be white, brown, or dark red in color)
Any burn in a patient that has other pre-existing medical conditions
Any burn that becomes red around the edges after a couple days
Any burn patient that also inhaled smoke or chemicals at the time of
burn
Minor burns can
be treated with:
Cool water immediately after the burn.
Topical antimicrobial such as Polysporin, polymyxin, bacitracin,
neomycin.
Top
Hospital
Emergency Care
- Assessment
- Airway: Support or
provide airway and provide cervical spine protection.
- Breathing: Assess
breathing and ventilation. Provide assistance as necessary.
Monitor chest movement with deep burns of the trunk. Administer
oxygen at a high flow.
- Circulation: Assess
vital signs. Assess circulatory status of burned extremities by
monitoring distal pulses. Start IV access.
- Disability: Assess
orientation and neurological status, associated injuries, hypoxia.
- Exposure: Keep patient
warm.
- Medical History and Head
to Toe Physical Exam with x-rays and laboratory assessment
- Assess Burn
- Assess type of burn and
circumstances of injury.
- Percent of burn injury
(% Total Body Surface Area Burn)
- The
Burn Diagram
(Get
Adobe Reader) can be used to calculate burn size.
Children are different than adults.
- The outline of the
patient’s hand and fingers is equal to 1% of the body surface area
and can be used to calculate burn size. (An area the size of 2 of
the patient’s hands would be a 2% burn.)
- Body Surface Area
nomogram: A patient’s height and weight are used to measure
Total Body Surface Area in centimeters squared.
- Burn Depth
- 1st Degree
Burn
- 2nd Degree
Burn
- 3rd Degree
Burn
- 4th Degree
Burn
|
Degree |
Depth |
History |
Etiology |
Sensation |
Appearance |
Healing |
|
1st
Degree |
Superficial
Epidermis
only
|
Momentary
Exposure |
Sunburn |
Sharp, uniform
pain |
Blanches red,
pink. Edematous, soft, flaking, peeling |
±
7 days |
|
2nd
Degree |
Partial Thickness
Epidermal
and part of Dermal layer
|
Exposure of
Limited Duration to Lower Temperature (40-55°C) |
Scalds, flash
burn without contact, weak chemical |
Dull or
hyperactive pain, sensitive to air/temperature changes |
Mottled, red
blanches red/pink, blisters, edema, serous exudate, moist |
14-21 days |
|
3rd
Degree |
Full Thickness
Entire
epidermis, dermis and subcutaneous tissue
|
Long duration of
exposure to high temperature |
Immersion,
Flame, Electrical, Chemical |
Painless to
touch and pinprick, May hurt at deep pressure |
No blanching,
pale white, tan charred, hard, dry, leathery, Hair absent |
Granulates,
Requires Grafting |
|
4th
Degree |
Underlying
structures of muscle or bone |
Prolonged
duration of exposure to extreme heat |
Electrical,
Flame,
Chemical
|
Usually painless |
Charred,
Skeletonized |
Requires
Fasciectomy, Possible amputation |
- Fluid Resuscitation
- The most important
aspect of early clinical management of the burn victim is fluid
resuscitation beginning within the first couple hours of burn
injury.
- Adult resuscitation:
- Ringers Lactate 2-4 ml
/ kg / %TBSA burned.
- Give ½ of total volume
over the first 8 hours from time of burn injury.
- Give second ½ of total
volume over the following 16 hours.
-
Example
- Titrate to maintain
blood pressure and urine output of at least 30 cc/hr.
- Pediatric resuscitation:
- Ringers Lactate 5000
ml / TBSA burn (m2) + 2000 ml / TBSA (m2).
- Give ½ of total volume
over the first 8 hours from time of burn injury.
- Give second ½ of total
volume over the following 16 hours.
-
Example
- Titrate to maintain
blood pressure and urine output of at least 1 cc/kg/hr.
- Wound Care for Emergency
care and transport
- No ice or cold water
soaks, no wet dressings or sheets.
- Cover with clean dry
cloth.
- Keep patient warm.
- For delayed transfer -
- Wash wounds and
débride loose tissue.
- Topical Antimicrobial
(Silver Sulfadiazine) and gauze wrap.
- Monitor need for
escharotomies.
Top
Burn Unit Referral Criteria
Burn injuries
that should be referred to a burn unit include the following:
- Partial thickness burns
greater than 10% total body surface area (TBSA).
- Burns that involve the
face, hands, feet, genitalia, perineum, or major joints.
- Third-degree burns in any
age group.
- Electrical burns,
including lightning injury.
- Chemical burns.
- Inhalation injury.
- Burn injury in patients
with preexisting medical disorders that could complicate management,
prolong recovery, or affect mortality.
- Any patients with burns
and concomitant trauma (such as fractures) in which the burn injury
poses the greatest risk of morbidity or mortality. In such cases, if
the trauma poses the greater immediate risk, the patient may be
initially stabilized in a trauma center before being transferred to a
burn unit. Physician judgment will be necessary in such situations
and should be in concert with the regional medical control plan and
triage protocols.
- Burned children that are
in hospitals without qualified personnel or equipment for the care of
children.
- Burn injury in patients
who will require special social, emotional, or long-term
rehabilitative intervention.
Top
Links
Emergency Medical
Services for Children
EMSC Main Page
EMSC Fire and Burn Prevention Resources
This page contains a listing of many useful
Publications and Links to other relevant sites.
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