Burn Nursing Care from

EMS to ICU: an overview

Amanda Richard, RN, CNS, CCRN

Adrienne Costello, RN, CCRN

UNM Burn Center

Adult & Pediatric Injury

from tragedy… hope!

Course Objectives

• Identify the 3 main concerns for burn patients.

• Discuss interventions to prevent each of these.
• Address adequate pain management strategies.
• Resuscitation evaluation.
• Basic review of wound care for each stage of
admission.
3 CONCERNS FOR A
BURN PATIENT

• Hypothermia
• Pain
• Infection
HYPOTHERMIA

• Easier to prevent
than treat
• Increases metabolic
and oxygen
demands
• Proportional to
degree of injury
• Tissue ischemia
AT THE SCENE
• Warm the rig

• Keep patient covered

• Pain medication per protocols

• Avoid IV access in burn unless

necessary
ER OF TRANSFERRING
FACILITY
• Warm room
– Adult – minimum of 80 degrees
– Children – minimum of 85 degrees

• Warm IV fluids and blood products

• Remove clothing

• Place in dry dressing/sheet

ER OF TRANSFERRING
FACILITY
• Pain is inversely proportional to
burn degree

• Pain is often severe

• IV route only

• Morphine/Fentanyl

• Anxiolytics

• Dosage
ER OF TRANSFERRING
FACILITY

• Debridement not necessary

• Dry dressing/sheet
• Limit flow into room
• Asceptic technique with all procedures
• Avoid IV access through burns unless necessary

UNM Burn Center

PRIOR TO TRANSFER…

Make sure the family sees

the patient prior to
transporting to the burn
center!!
ARRIVAL TO THE BURN
CENTER

• Room warmed
• Continue warm fluids
• Minimize exposure
• Hot line
• Cool guard
• Lighting
• Bair Hugger
ARRIVAL TO THE BURN
CENTER

• Room warmed
• Continue warm fluids
• Minimize exposure
• Hot line
• Cool guard
• Lighting
ARRIVAL TO THE BURN
CENTER

• Room warmed
• Continue warm fluids
• Minimize exposure
• Hot line
• Cool guard
• Lighting
ARRIVAL TO BURN
CENTER
• Morphine/Fentanyl drip
• Ativan/Propofol drip
• Riker scale
• Plan on increasing dosage over time
• Dosage
ARRIVAL TO BURN CENTER

• Clean lines
• Limit flow in room
• Precautions
• Daily tubbing
• Daily dressings
• Family education
• Nutrition
RESUSCITATION

Or…. How to give

more fluid than you
ever thought
possible.
RESUSCITATION
RESUSCITATION

• Fluid resuscitation goals

– maintain vital organ function

– avoid excessive or insufficient fluids

RESUSCITATION

• Formulas are guidelines

• Monitor urine output
• Labs
• Monitor vital signs
• Monitor distal pulses
• Warm Warm Warm
• Special Circumstances
DRESSINGS AND
WOUND CARE

Burn Nursing
FIRST DEGREE
Superficial…. “sunburn”

• Clean
– PAINFUL!!

• Topical
• Bacitracin
• Vaseline gauze
• Xeroform

• KEEP MOIST
SECOND DEGREE
Partial Thickness - Superficial

• Debride

• Dressing
– Silvadene
– Sulfamylon/Mafenide
– Acticoat

• Monitor
SECOND DEGREE
Partial Thickness - Superficial

• Debride

• Dressing
– Silvadene
– Sulfamylon/Mafenide
– Acticoat

• Monitor
SECOND DEGREE
Partial Thickness - Superficial

• Debride

• Dressing
– Silvadene
– Sulfamylon/Mafenide
– Acticoat

• Monitor
SECOND DEGREE
Partial Thickness - Superficial

• Debride

• Dressing
• Silvadene
– Sulfamylon/Mafenide
– Acticoat

• Monitor
THIRD DEGREE
Full Thickness
• Excise early
– 24-48 hours
• Graft
• Mepitel/Xeroform
• Wound vacs
• Assessment
– Day 3
– Day 5
 Resources For Tubbing

• RT
• 2 RN’s
• PT/OT
• Tech
• Supplies

Adult & Pediatric Injury

SUMMARY

• WARM
• RESUSCITATION
• PAIN MEDICATION
• CLEAN
• DRY
WWW.AMERIBURN.ORG

UNM Burn Center: from tragedy… hope!

Questions…

one child burned, is one child too many!

Amanda Richard, RN, CNS, CCRN

Adrienne Costello, RN, CCRN

UNM Burn Center

Adults & Pediatrics

from tragedy… hope!