Page 123 - JSOM Winter 2023

Prolonged Field Care of Major Burns – blood loss during escharotomy (avoid cutting blood vessels, pack
The Manchester Approach wound with alginate, use epinephrine soaks, hemostatic bandages
Dr. Winston de Mello or pressure dressings, elevation of affected limb, and tranexamic
acid 1-2 G intravenously). 8) For wound management, use baby
Introduction: Burns are a distracting injury and the fourth most wipes for initial clean followed by Octenilin and cover with dry
™
common cause of death worldwide. Management of burns in pre- gauze dressings or clean linen, and at next dressing use either 3 or
hospital care is similar for both civilian and military practice and 7 days Acticoat . 9) Perform physical therapy to chest and major
™
involves a SAFE approach, stopping the burning process and cool- joints with splintage in neutral position. 10) Consider enteral nu-
ing the burn followed by evaluation of MARCH (massive hemor- tritional support via a nasogastric tube.
rhage, airway, respiration, circulation, hypothermia/head injury)
and getting an AMPLE (allergies, medications, past history, last Conclusion: Depending on the military situation, rarer causes of
meal, events) history. In prolonged field care, the medic may have burns such as white phosphorus may have to be considered. In a
to attend the burn victim beyond the initial assessment, triage, and mass casualty situation involving burns, further information can
fluid resuscitation and take on wound coverage and supportive be obtained from the literature [2, 3].
and critical care. Special Forces medics who had clinical attach-
ments to the Adult Burn Centre, Manchester, U.K., have over the References
past two decades discussed their burn management issues with the 1. de Mello WF, Greenwood NP. The burns fluid grid. A pre-hos-
Burn MDT members. The pragmatic solutions offered in response pital guide to fluid resuscitation in burns. J R Army Med Corps.
to their queries are summarized in 10 clinical pearls. 2009;155(1):27-29.
2. Hughes A, Almeland SK, LeClerc T et al. Recommendations for
Ten Clinical Pearls: 1) Shock within 12 hours of injury look for burn care in mass casualty incidents: WHO emergency medical
another source of fluid/blood loss. 2) Place patient in a Fowler teams technical working group on burns. (WHO TWGB). Burns.
position (if not contraindicated) to minimize head and neck swell- 2021;47(2):349-370.
ing and consider use of nebulized epinephrine to reduce tracheal 3. Sandhu A, Herron JBT, Martin NA. Burns management in the mil-
mucosa swelling and improve oxygenation. 3) A circumferential itary and humanitarian setting. BMJ Mil Health. 2022; 168:467-
chest burn may need an escharotomy to improve ventilation. 4) 472. DOI:10.1136/bmjmilitary-2022-001672.
TBSAB% (total body surface area burned) are overestimated in
a prehospital setting, so use the Burn Fluid Grid [1] instead of
formulae-based ones. 5) Clingfilm strips applied longitudinally
offer protection from the neuropathic component of burn pain, Keywords: trauma; combat medicine; prolonged field care;
which can be detected by using the painDETECT questionnaire tactical casualty care; special operations
and use the co-analgesic of choice. Methoxyflurane inhaler is use-
ful for procedural analgesia. 6) Major burn patients become poiki- PMID: 38133634; DOI: 10.55460/TYR7-1DLL
lothermic, so use hypothermia mitigation techniques. 7) Minimize

Evolving

SOF Medicine:

Enhancement
Ahead of Conflict

–
May 13 17, 2024
Raleigh Convention Center | Raleigh, NC

Training, Education, & Scientific Assembly

2023 CMC Abstracts | 121