Page 56 - PJ MED OPS Handbook 8th Ed

Extremity Burns

Goal: Prevent and manage (edema) of burned extremities to prevent long-term damage from im-
paired tissue perfusion.
• Remove any constrictive items/clothing to include watches, bracelets, or rings.
• Elevate burned extremities above the level of the heart, ensure limb is protected from exces-
sive movement and secondary injury.
• Monitor extremities for decreased capillary refill, progressive pain, increased tension of the
muscles to palpation and decreased pulses.
• Perform escharotomies (refer to detailed description below) if pulses are diminished or ab-
sent in circumferential burns.
• Bleeding is typically limited but may require application of hemostatic dressings.
• Obtain teleconsultation if able.

Pain Management
Burns can be extremely painful and require a deliberate approach to analgesia with consideration
for long term control.
• Pain management may be initiated with an IV/IM dose of Ketamine or Hydromorphone per
pain management protocol.
• For prolonged care of burn patients, a ketamine infusion may provide more consistent anal-
gesia and help conserve supplies of analgesic medications.
• Ketamine infusion (500mg/250mL NS = 2mg/mL) administered at 5–15mL/hr (0.1–0.3mg/
kg/hr) for analgesia.
• Burn wound care is extremely painful. Procedural sedation should be considered prior to
performing wound cleaning, debridement, escharotomy or dressing changes.

Infection
Burn wounds are easily infected.
Goal: Prevent burn wound infection through wound care. If evacuation to higher level of care is an-
ticipated within 24 hours, simply cover burns with clean, dry gauze and leave intact blisters in place.
Always avoid wet dressings, because of the risk of hypothermia. If evacuation is not anticipated for
more than 24 hours, and time, medication, and human resources permit, provide wound care as
soon as possible after the injury (within the first 24 hours). If resources are not available initially,
provide wound care as soon as possible.
• Clean wounds and debride loose dead skin by washing with any antibacterial soap in clean
water, dress wounds with any available dressings; optimize wound and patient hygiene to the
extent possible given environment.
• Cover with clean sheet or dry gauze. Leave blisters intact. Avoid wet dressings.
• Begin antibiotics for fevers above 100.4°F, and for patients that may have been exposed to
the elements for greater than several hours. Prophylactic IV antibiotics are not indicated for
burn injury in the absence of infection.
• For missions where the patient is expected to reach definitive care in 24 hours post injury,
apply dry sterile dressings after initial debridement. Change dressings at 12 hour intervals.

54 n Pararescue Medical Operations Handbook / 8th Edition