8.3. BURNS

Related titles

Absent.

Purpose of assistance

Minimizing tissue damage and morbidity due to burns.

Description of the patient

The patient may have symptoms:

a) respiratory tract – stridor, hoarse voice;
b) mouth and nostrils – redness, existing blisters, soot, burnt hair;
c) breathing – fast, shallow, with wheezing;
d) skin – total area of burn damage and depth (partial or complete);
g) related injuries – explosion, fall, attack.

Inclusion criteria

Patient with thermal burns.

Exclusion criteria

Electrical, chemical and radiation burns (see Toxins and the Environment section).

Peculiarities of transportation

1. Transport to the most appropriate receiving unit in case of damage to the respiratory system or suspected serious or blast injury.
2. Remember the possibility of air evacuation if the receiving department is remote or if airway control requires interventions that are not available at the prehospital EMD level.
3. Transport immediately to a burn center for shallow or deep burns over 10% of the body that extend to the extremities, genitals, face, and/or circular burns.

Control of the scene

Make sure the crew is safe:

a) the current source is turned off;
b) the power lines are intact;
c) the gas source is blocked;
d) the absence of secondary devices;< br />e) detection of the possible presence of harmful substances;
e) the use of special protective equipment, including breathing apparatus, may be required.

Management of the patient

Status assessment

1. Reasons for the occurrence of the event – consider:

a) related trauma in addition to burns;
b) inhalation of chemicals such as CO and cyanide;
c) violence against children or individuals old age.

2. Follow the ABC algorithm during resuscitation (according to the guideline “General trauma”).

3. If airway burns are present, perform aggressive airway control.

4. Keep the spine at rest if there are signs of injury (according to the guideline “Care for Spine Injury”).

5. Estimate the total area of burns and their depth:

a) apply the rule of “nines” (see Table of burns in Appendix 2);
b) first degree burns (only skin erythema) are not included in the calculation total area affected by burns.

6. Use the scale of pain sensations.

Treatment and intervention

1. Stop the burning process:

a) remove wet clothing (if it does not stick to the patient);
b) remove jewelry;
c) do not touch the blisters.

2. Minimize infection of the burned area:

a) cover the burns with dry bandages or clean sheets;
b) do not use gels or ointments.

3. Monitor SPO2, ETSO2, and heart rates – if available, use a carboxyhemoglobin monitor.

4. Administer high-flow oxygen therapy to all patients who have been in a confined space.

5. Get intravenous access, avoid manipulations in the burn area.

6. Assess the presence of distal circulation in case of opercular burns of the limbs.

7. Administer early analgesia and use antiemetics.

8. Start fluid resuscitation – enter a combined drug with the composition of sodium chloride + potassium chloride + sodium lactate + calcium chloride or isotonic saline:

a) in the presence of shock:

• • • • consider other causes such as trauma or cyanide poisoning;
      • carry out infusion therapy according to the instruction “Shock”;

b) in the absence of shock:

• • • • initiate infusion therapy based on total burn area (see Appendix 2);
      • children weighing less than 40 kg need to use auxiliary devices for measuring weight (determining weight by height);

c) if the weight of the person is more than 40 kg, the primary bolus can be calculated thanks to the “10” rule:

• • • • determine the total area of burns (round to the nearest ten);
      • multiply the area by 10 = primary bolus (ml/h) (for a person weighing 40-80 kg);
      • add 100 mg/kg for every 10 kg if the patient weighs more than 80 kg.

9. Avoid systematic heat loss and keep the patient warm.

Special precautions when providing assistance

1. In the case of an explosion injury, provide assistance according to the guideline “Injuries from explosions”.
2. Airway burns can quickly lead to upper airway obstruction and respiratory failure.
3. Maintain a high level of suspicion for cyanide poisoning in patients with low CGD scores, respiratory distress, and cardiovascular collapse after exposure to a confined space. In such situations, enter the antidote (hydroxocobalamin).
4. Especially for fires in closed environments, suspect the possibility of carbon monoxide poisoning, and therefore pulse oximetry readings may not be accurate (see the instruction “Smoke/carbon monoxide poisoning”).
5. In the presence of exposure to a specific substance (cyanide, hydrofluoric acid, other acids and alkalis) (see the instruction “Local chemical burns”).
6. Consider the question of decontamination and notification of the reception department about the reception of a potentially infected patient (for example – a case in an amphetamine laboratory).

Useful information for training

Key points

1. Stridor and voice changes are warning signs of potential airway burns, which can quickly lead to obstruction or respiratory failure.
2. If the patient is in shock within the first hour after receiving the burn, the cause of the shock is not the burn. Examine the patient for injuries or cyanide poisoning.
3. In the absence of shock, the above volumes of fluids will be quite adequate to maintain the level of fluids in the patient’s body.
4. Patient pain control is very important in severe burns.
5. ETCO2 monitoring may be useful for tracking respiratory status in patients receiving large doses of narcotic analgesics.
6. Monitoring heart rhythms is especially important for electrical burns and chemical inhalation injuries.
7. The area of burns is determined based on second and third degree burns only – first degree burns are not taken into account.

Key elements of documentation

1. Primary status of respiratory tract.
2. Total volume of received infusion therapy.
3. Body surface covered with second and third degree burns.
4. Evaluation of the pulse and capillary filling in the presence of girdling burns of the extremities.
5. Documentation of pain according to the scale of pain and analgesia.

Criteria for the effectiveness of aid provision

1. Transportation of the patient to the most appropriate reception department, preferably a burn center.
2. Documentation of pain using a pain scale and appropriate treatment.
3. Correct documentation of the results of examination and control of the respiratory tract.