You place the full thickness, third-degree burns, in Silvadene or into a bacitracin dressing, loose fitting. We wash all the wounds with soap and water, Hibiclens, Betadine, etc. If it wipes off or looks like a big blister, it needs to come off. Local wound care, basically you want to debride and remove all loose tissue from the burn. This is the period of time that patients are going through resuscitation and going to the operating room would actually be or could be detrimental to them. Skin grafting may be required, however, and we do recommend surgical intervention in the first 72 hours. We begin by cleaning the wounds very thoroughly with a surgical scrub and then assessing the wound depth and whether or not an escharotomy is going to be required. Remember, just because what you see on the outside can be distracting, they may have injuries on the inside.īurn wound management in the local cares is important. You want to monitor for ongoing traumatic injury such as intracranial hemorrhages, bowel injuries, etc. You want to monitor bladder pressures and compartment pressures of the affected extremities. You want to monitor and trend central venous pressures. Circulation, you may need to place arterial lines for accurate monitoring as this tissue on the extremities may be extremely burned and become very swollen and have the inability to use blood pressure cuff measurements. This is the only time you'll treat a patient with bolus therapy. However, if the patient is hypotensive and has low blood pressure, treat that first with bolus fluid therapy. You resuscitate with crystalloid at a predetermined rate that we'll talk about later. The burn will remain stable throughout the hemorrhage, and so think of it after you've moved through the first few bullet points. If there's active hemorrhage, control to direct pressure, and if this fails, you may require a tourniquet or surgical control. Again, look for areas that are bleeding or areas that are not being profuse due to trauma. However, if you have singed nasal hairs with a hoarse voice, a large percentage total body surface area that was in a closed space resulting in respiratory fatigue or a patient utilizing his accessory muscles, then these are reasons to control a patient's airway and intubate.Ĭirculation, we want you to assess for pulses in extremities and their hemodynamic stability. If you have a patient with singed nasal hairs and that alone, that's not an indication to intubate a patient. When assessing the airway and breathing on a burn patient and or trauma patient, don't take any one of these changes or physical diagnoses as an indication to intubated patient, but rather take the story as a whole. Lose sight of your natural algorithm of caring for patients. You also want to look at the initial resuscitation flow like any other trauma patient where you want to assess the airway, the breathing, circulation, disability, exposures of other extremities and areas of the body and then begin your fluid resuscitation.Īgain, don't be overwhelmed with the burn. The initial care is to stop the burning process. We'll talk about analgesine sedation, and we'll discuss some of the follow-up care and transfer criteria. We'll talk about fluid resuscitation and what it means to urinary output. We'll estimate the total body surface area of a burn. We're going to describe the basics of initial burn assessment and management. Gayken: The third module, we're going to talk about burn treatment and stabilization. Next: Module 4 Advanced: Special Treatment Considerationsĭr. The basics of initial burn assessment and management, estimate TBSA percentage of burn, fluid resuscitation and urine output, analgesia and sedation, and discuss follow-up care and/or transfer criteria. Module 3 Advanced: Burn Treatment and Stabilization
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