Emergency Burn Care

Objectives
 Discuss the key components in emergency
management of burn injuries
 Review priorities and phases of care
 Recognize the importance of, and risks
associated with, fluid resuscitation of the
burn patient
 Phases of Burn Care
 Emergency assessment and care (ABCs)
 Resuscitation (hours 0-48)
 Definitive care (day 3 until wounds are
closed)
 Rehabilitation (begins during resuscitation
and lasts entire lifespan)
 Rescue
 A-B-C-D-E-F
 Stop the burning
 Decontaminate casualty at the scene

Avoid injury to the rescuer
 Careful with high voltage electrical wires
 Assess for other injuries
 ABCs of Emergency Burn Care
(Advanced Burn Life Support)
 A = Airway (with cervical spine assessment)
 B = Breathing
 C = Circulation
 D = Disability
 E = Exposure and Environmental Control
 F = Fluid Resuscitation based on Burn Size and
Weight Measurement
 Secondary Survey
 A: Airway
 Assess the patient’s airway
 Upper airway edema due to inhalation injury
 Rapid or delayed progression
 Decision to intubate: individualized
 Mild symptoms: observe in ICU
 Pre-transport: prophylactic intubation
 When in doubt, intubate
 B: Breathing
 Look, listen, feel for breath sounds and
chest movement
 Give 100% oxygen to all victims of major
burn beginning in the field
 Pulse oximetry
 Arterial blood gases
 Required for definitive diagnosis of CO
 Baseline chest x-ray
 C: Circulation
 Who needs fluid resuscitation?
 All >20% total body surface area burned (TBSA)
 Young and old with >10% TBSA
 2 large bore peripheral IVs
 Unburned skin
 Burned skin
 Central access
 Cutdown
 Interosseous
 D: Disability
 Assess level of consciousness: AVPU
 Alert
 Responds to verbal stimuli
 Responds to painful stimuli
 Unresponsive
 Alteration in mental status is not normal
 Pupils
 Moves extremities
 E: Exposure and Environment
 Remove clothing, jewelry
 Keep warm
 blankets
 warm I.V. fluids
 heating lamps
 heat the room
 Keep Patient Dry
 F: Fluid Resuscitation
(based on burn size and weight)
 Determine fluid needs based on burn size and
weight
 Burn size: include second and third degree only

Rule of Nines
 One hand = one percent

Lund-Browder chart

Overestimation by referring hospitals is common
 Weight: pre-burn weight
 Extent of Burn
Initial Estimate of PT and FT: “Rule of Nines”
Adult anatomical areas = 9% BSA (or multiple)
• Not accurate for
infants / children due
to larger BSA of head
& smaller BSA of
legs.

Burn diagrams
illustrate adult and
child differences.
Fluid Resuscitation
 JTTS Burn
Resuscitation Flow
Sheet
 Valuable tool for
management fluid
resuscitation
 Transmits important
information
 References
 Emergency War Surgery manual: Chap 28
 Advanced Burn Life Support course
 Total Burn Care by Herndon et al
 Journal of Burn Care and Rehabilitation
 Burns: Journal of International Burn Society
 CENTCOM Clinical Practice Guidelines on
Joint Patient Tracking Application