IMMEDIATE CARE OF THE BURN PATIENT

Shah Fahad
B.S Emergency Care (KMU)
Certificate in Respiratory Therapy (RMI)
Demonstrator institute of paramedical Sciences-KMU
Immediate Care
• Immediate care of the burn patient include:
• 1. pre- hospital care
• 2. hospital care
Pre- hospital care:
• 1. ensure the rescuer safety:
• this is particularly imp in house fires & in case of electrical &
chemical injuries.
• 2. stop the burning process:
• Stop, drop and roll is a good method of extinguishing fire burning
on a person.
• 3. Check for other injuries:
• A standard ABC check followed by a rapid secondary survey will
ensure that no other significant injuries are missed.

• Patients burned in explosions or even escaping from fires may

have head or spine injuries and other life-threatening problems.
• 4. Cool the burn wound:
• This provides analgesia & slows the delayed microvascular damage
that can occur after a burn injury.
• Cooling should occur for a minimum of 10 minutes and is effective
up to 1 hour after the burn injury.
• It is a particularly important first aid step in especially scalds.
• In temperate climates, cooling should be at about 15°C, and
hypothermia must be avoided.
• 5. Give oxygen:
• Anyone involved in a fire in an enclosed space should receive
oxygen, especially if there is an altered consciousness level.

• 6. Elevate:
• Sitting a patient up with a burned airway may prove life-saving
in the event of a delay in transfer to hospital care.
• Elevation of burned limbs will reduce swelling and discomfort.
Hospital care
• The principles of managing an acute burn injury are the same as
in any acute trauma case:
• Airway control
• Breathing and ventilation
• Circulation
• Disability – neurological status
• Exposure with environmental control
• Fluid resuscitation.
Major determinants of the outcome of a
burn
• Percentage of body surface area involved
• Depth of burn
• Presence of an inhalational burn
Burn- airway management
• 1.Burned airway creates problems for the patient by swelling
• 2.if not managed proactively, can completely occlude the upper
airway
• 3. Intubate the patient until swelling subside, which is usually after
about 48 hours, this is elective intubation.
• 4.The symptoms of laryngeal edema (change in voice, stridor,
anxiety and respiratory difficulty) are very late symptoms
• 5.Intubation at this point is often difficult or impossible owing to
swelling
• 6. be ready to perform emergency cricothyroidotomy if
intubation is delayed.
• 7. Because of this, early intubation of suspected airway burn is
the treatment of choice in such patients
• 8. The time-frame from burn to airway occlusion is usually
between 4 and 24 hours
• 9. this is time to make a sensible decision to intubate the patient
Recognition of potentially burned airway
• A history of being trapped in the presence of smoke or hot gases
• Burns on the palate or nasal mucosa, or loss of all the hairs in the
nose
• Deep burns around the mouth and neck
Burn –breathing assessment
• Signs of Inhalational injury:
• anyone trapped in a fire for more than a couple of minutes
must be observed for signs of smoke inhalation
• presence of soot in the nose and the oropharynx
• chest radiograph showing patchy consolidation
Clinical features of inhalational injury
• progressive increase in respiratory effort and rate
• rising pulse
• anxiety and confusion
• decreasing oxygen saturation
• These symptoms may not be apparent immediately and can
take 24 hours to 5 days to develop
Breathing- management
• Treatment starts as soon as this injury is suspected and the airway is
secure
• Physiotherapy, nebulisers &humidified oxygen are all useful.
• patient’s progress should be monitored using respiratory rate,
together with ABG’s measurements
• If the situation deteriorates, continuous or intermittent positive
pressure may be used with a mask or T-piece.
• In the severest cases, intubation and management in an ICU will be
needed.
Thermal Burn injury to the lower airway
• These rare injuries can occur with steam injuries.
• Their management is supportive and the same as that for an
inhalational injury.
Metabolic poisoning – Assessment &
management
• history of a fire within an enclosed space and any history of
altered consciousness are important clues to metabolic
poisoning.
• Blood gases must be measured immediately if poisoning is a
possibility.
• Carboxyhemoglobin levels raised above 10 percent must be
treated with high inspired oxygen for 24 hours to speed its
displacement from hemoglobin.
Mechanical block to breathing-
assessment & management
• mechanical block to breathing is caused by the eschar of a
significant full-thickness burn on the chest wall.
• There will also be CO2 retention & high inspiratory pressures if
the patient is ventilated
• The treatment is to make some scoring cuts through the burned
skin to allow the chest to expand (escharotomy).
• The nerves have been destroyed in the skin, and this procedure
is not painful for the patient
References

• Baily & Love short practice of surgery 26th edition

• Chapter No: 30
• Thank you