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
Cover affected areas with a clean dry cloth,
towel or blanket to protect the burn and minimize
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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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.
irrigate profusely with running water
for 20 minutes. Brush away dry powders first. Monitor for hypothermia
while irrigating. Transport victim’s clothing for analysis.
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
For a compromised airway:
Assess circulation, blood pressure, pulse rate and skin color. Fluid
shifting in burn patients’ causes edema and volume loss. Elevate
Burn patients should be initially alert and oriented. If not,
consider trauma or other associated injuries. Determine
level of consciousness by AVPU method;
Obtain a complete history of the events, time, open or enclosed space,
last meal, medications, allergies, past medical history and any other
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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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
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
Administer analgesia; I.V. Morphine Sulphate (1mg/10Kg).
Infection prophylaxis: tetanus immunization. Defer antibiotics
if for burns only.
Take a complete history and physical. Evaluate and treat any
Insert nasogastric tube to empty stomach, keeping patient NPO.
Keep patient warm. Cover with dry blankets.
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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(click to enlarge)
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- Partial thickness (2°) burns > 10% TBSA
- Full thickness (3°) burns, in any age group
- Burns to the face, hands, feet, genitalia or
- Electrical, Chemical or Inhalation burns
- Patients with pre-existing medical disorders
- 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
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,
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