Page 51 - PJ MED OPS Handbook 8th Ed

Burn Management

NOTE: This information complements the MTPs in Chapter 4 and expounds upon the 9, 10,
20, 30 principles for burn care.
2nd degree or greater burns covering 20% of the total body surface area (TBSA), or those with
smoke inhalation injury (and airway or breathing problems), are life threatening. Burns that affect
vision, decrease hand function, or cause severe pain can take the warfighter out of action.

Hypothermia risk is high in burn patients. Anticipate that all burn casualties will become hypother-
mic and take immediate measures to prevent it by covering patient. Aggressively rewarm if tem-
perature falls below 36°C (96.8°F).

Telemedicine: Management of burns is complex. Also, burns are highly visual and a lot can be com-
municated via pictures or video. Establish telemedicine consult as soon as possible.
If the unit flight surgeon can’t be reached, contact the USAISR Burn Center for consultation:
US Army Institute of Surgical Research (USAISR) Burn Center
DSN 312-429-2876 (429-BURN)
Commercial (210) 916-2876 or (210) 222-2876
E-mail to burntrauma.consult.army@mail.mil

Airway Management

• Patients with smoke inhalation injury may present with a range of symptoms in terms of
severity.
• Patients with severely symptomatic smoke inhalation injury (e.g., respiratory distress, stridor)
require immediate definitive airway (cuffed tube in trachea) because they are at risk of imme-
diate airway loss. Oxygenate and ventilate.
• Patients with signs of inhalation injury and burns >40% TBSA are at high risk for airway edema
and need to be monitored closely for signs of respiratory distress. Be prepared for urgent
intervention.
• While it is appropriate in a hospital setting with advanced medical providers to intervene early,
our policy is to avoid definitive airway placement unless it is necessary for casualty survival.
○ The indication for a definitive airway is respiratory distress and/or stridor.
○ Rapid-sequence intubation, followed by continuous sedation and airway maintenance,
supplemental oxygen, portable ventilator.
○ In the case of laryngeal edema and the inability to intubate, perform a cricothyroidot-
omy followed by continuous sedation and airway maintenance, supplemental oxygen via
an oxygen concentrator, portable ventilator if the patient is not breathing adequately on
their own. If there is airway obstruction from edema without significant lung injury, the
patient may not need to be on a ventilator. Rely on pulse oximetry, capnography and clin-
ical findings to guide decision making.

Chapter 6. Surgical and Medical Procedures n 49