First Aid and Emergency Care

 

First Aid: COOL, COVER & CALL

Immediate care of a burn injury should always include:

  • Cooling all burns with tepid to cool water, regardless of degree.  Continue flushing the area for up to 10 minutes.  Do not apply ice, ointments, butter or other “home remedies”.  Remove all clothing or garments to reduce the contact time with hot items.

  • Cover affected areas with a clean dry cloth, towel or blanket to protect the burn and minimize pain.

  • Seek medical attention if burn is larger than the victim’s hand size, if the victim is a child or elderly person.  (refer to Transfer Criteria)

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Basic Care

Stop the Burning Process:

Remove clothing and jewelry.  Flush all burns with water, NOT ice for approximately 10 minutes.  Cover burns with a clean, dry sheet.  Keep blisters intact.  Do not apply dressings.

Chemical Burns: irrigate profusely with running water for 20 minutes. Brush away dry powders first.  Monitor for hypothermia while irrigating.  Transport victim’s clothing for analysis.

ABCDE’s of Care

Assess the airway, respiratory rate and rhythm.  Note chest wall expansion, especially if full thickness burns are circumferential to the trunk.  Administer 100% (humidified) oxygen by non-rebreather mask. 

For a compromised airway:

  •  consider Chin Lift

  • Jaw Thrust

  • Oral Pharyngeal Airway (for the unconscious patient)

Assess circulation, blood pressure, pulse rate and skin color.  Fluid shifting in burn patients’ causes edema and volume loss.  Elevate extremities.

Burn patients should be initially alert and oriented.  If not, consider trauma or other associated injuries. Determine level of consciousness by AVPU method;
Alert, Verbal/Painful stimuli, Unresponsive

Obtain a complete history of the events, time, open or enclosed space, last meal, medications, allergies, past medical history and any other pertinent data.

Conduct a thorough head-to-toe examination of the patient, noting any deformities, irregularities, as well as calculating out the total burn surface area (Refer to Rule of 9’s Chart)

If the patient requires advance burn care, contact paramedics or transport to the nearest medical facility.

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Advanced Care

Airway Management:

Administer 100% (humidified) oxygen by non-rebreather mask.  Symptoms of smoke inhalation may have a delayed onset.  If there is any suspicion or history of airway injury, check arterial blood gases and carboxyhemoglobin level.  Consider endotracheal intubation.  (Nasotracheal intubation is preferred.)  Be sure the ET tube is secure and in good position.

Intravenous Fluid Resuscitation:

Insert TWO large-bore I.V. lines.  Secure with sutures if necessary.  Infuse Lactated Ringer’s solution (without dextrose).  Administer 2-4 ml’s x Kg x %TBSA.  Set I.V. rate to give 1/2 of the calculated needs in the first eight hours, from time of injury.  Adjust I.V. rate in order to maintain urine output between1/2 to 1 ml/Kg/hr.  Insert Foley Catheter.

Administer analgesia; I.V. Morphine Sulphate (1mg/10Kg).

Infection prophylaxis: tetanus immunization.  Defer antibiotics if for burns only.

Assessment and Preparation:

Take a complete history and physical.  Evaluate and treat any associated injuries.

Insert nasogastric tube to empty stomach, keeping patient NPO.

Keep patient warm.  Cover with dry blankets.

Special Considerations:

Circumferential Burns: assess distal circulation, remove jewelry.  Evaluate for escharotomies as necessary.  Contact the regional burn center for further instructions.

High Voltage Electrical Injuries: suspect myoglobinuria or hemoglobinuria.  Keep urine output at 100ml/hr and urine alkaline.  Place on cardiac monitor.  Record EKG.  Suspect Compartmental Syndrome, consider fasciotomies.  Contact the regional burn center for further instructions.

Frostbite: do not use heat.  Warm gradually to room temperature.

Toxic Epidermal Necrolysis: TEN’s is an exfoliative dermatitis with clinical manifestations similar to partial thickness burns.  Early consultation and transfer to a burn facility increases patient survival.

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Rule of 9's Chart

Rule of 9's Chart

(click to enlarge)

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Transport Criteria

AMERICAN BURN ASSOCIATION GUIDELINES FOR TRANSFER

  • Partial thickness (2°) burns > 10% TBSA
  • Full thickness (3°) burns, in any age group
  • Burns to the face, hands, feet, genitalia or major joints
  • Electrical, Chemical or Inhalation burns
  • Patients with pre-existing medical disorders compromising outcome
  • Patients with burns and concomitant trauma.Follow local regional medical control and triage protocols
  • Patients requiring extensive social, emotional or long-term rehabilitation support
  • Pediatric burns without qualified personnel or equipment

The Burn Center at Saint Barnabas is New Jersey’s designated burn treatment facility.  For 24-hour transportation or consultation to The Burn Center at Saint Barnabas,
call (973-322-5920).

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Saint Barnabas Burn Foundation