Page 113 - Journal of Special Operations Medicine - Winter 2016

Appendix F Summary Table
Airway
Best • Rapid-sequence intubation
• Continuous sedation + airway maintenance and suctioning
• O and portable ventilator
2
Better • Cricothyroidotomy
• Continuous sedation + airway suctioning
• O concentrator and portable ventilator
2
Minimum • Cricothyroidotomy
• Ketamine
• Bag-valve mask with PEEP valve
Assess Burn Size
Best • For initial estimate: Rule of 9s
• After wounds are cleaned/debrided: recalculate burn size using Lund-Browder chart
Better • Same as minimum
Minimum • For large burns: Rule of 9s
• For small burns: Patient’s hand = 1% TBSA
Fluid Resuscitation
Best • Use isotonic crystalloid (lactated Ringer’s or Plasma-Lyte)
• Starting fluid rate calculated by Rule of 10s (TBSA × 10; +100mL/h for each 10kg over 80kg)
Better • Oral resuscitation with electrolyte solution (avoid plain water)
• Possible for up to 30% TBSA burns
• “Coached” drinking on a schedule to meet target fluid rate
Minimum • Rectal infusion of electrolyte solution
• Can infuse up to 500mL/h
• May use to supplement oral hydration
Teleconsultation
• Establish contact early • Burn >20% TBSA
• Ventilator management • Electrical burn
• Measuring burn size • Escharotomy needed
• Hemorrhagic shock + burns • Infection
Monitoring
Vital Signs
Best • Portable monitor
• Capnography
• Document vital signs (VS) and intake/output (I/O) on flow sheet
Better • Blood pressure (BP) cuff, stethoscope
• Pulse oximetry, capnometry
• Document VS and I/O on flow sheet
Minimum • BP cuff, stethoscope
• Pulse oximetry
• Document VS on flow sheet
Urine Output
Best • Foley catheter, titrate fluids to keep urine output (UO) 30–50mL/h
• Increase or decrease fluid rate by 25% each hour if UO not at goal
Better • Collect urine in graduated container
• >180mL every 6 hours is adequate
Minimum • If unable to measure UO, adjust fluids to maintain HR <140, good capillary refill, intact
mental status
• Treat hypotension if needed, but this is a late sign of hypovolemia
(continues)

PFC Guideline: Burn Management 97