Page 20 - 2023 SMOG Digital

Trauma

BURNS

Signs and Symptoms: Differential Diagnosis:
• Burns, Pain, Swelling • Superficial Burns (1 st degree)
• Dizziness • Partial Thickness (2 nd degree)
• Loss of Consciousness • Full Thickness (3 rd degree)
• Airway Involvement (e.g., singed nasal • Chemical Burns
hair, carbonaceous sputum) • Thermal Burns
• Hoarseness / Wheezing • Electrical Burns
• Loss of Consciousness • Radiation
• Secondary Trauma
All TC3 interventions can be done Universal Patient Care Guideline Burn Depth:
through burnt or charred skin e.g. Superficial / Partial Thickness Burns:
IV, TQ, surgical cricothyroidotomy, • 1 st Degree: (limited to epidermis)
needle decompression. Remove rings, bracelets, or other Red, Hypersensitive, and Painful: Not medically
Consider escharotomy if constricting items significant and not calculated in Fluid Therapy
• 2 nd Degree: (epidermis and part of dermis)
circumferential burn to chest Very Painful, Red and Blistered, Wet, Weepy or
compromising ventilation. Rapid exam for additional Injuries Whiter and Edematous
Full Thickness Burns
>40% TBSA burn, comatose, Position patient supine • 3 rd Degree: (destruction throughout dermis)
symptomatic inhalation injury, or deep Immobilize area Non Painful, Whitish / Charred skin often with
facial require large ETT (Sz 8 adult) coagulate vessels (does not blanch to touch)
• 4 th Degree: (destruction through fat, fascia,
YES AIRWAY INVOLVEMENT? muscle, and bone)
AIRWAY Guideline
Consider: NO
Early establishment
of Advanced Airway THERMAL / ELECTRIC (See Pearl) CHEMICAL (See Pearl)
Brush off any dry chemical
Pediatric AIRWAY contamination
Guideline Remove burning / charred clothing
Consider: Cool with sterile saline / gel pad
Early establishment Cut off contaminated clothing
of Advanced Airway Flush area with saline 10-15min
Return to Cover with Dry sheet / dry sterile If Eye is involved:
dressings Flush with saline x 30min
Determine / Start Fluid Replacement
Pearl: Hydrofluoric Acid- Arterial infusion over (BURN Fluid Resuscitation)
4 hr (40mL of D5W with 10mL of 10% calcium
gluconate).
Tear Gas- rinse skin and eyes with NS. HYPOTHERMIA PREVENTION Tactical
Alkali Burns to eye- 1-2L of NS each eye for 30 Evacuation
minutes. Guideline
All symptomatic electric burn patients require an PAIN CONTROL
ECG regardless of the potential voltage.

Place Foley Catheter (as able)
Urinary Output is the MOST Reliable Guide Monitor Urinary Output
Predicting Adequate Resuscitation
• Adult: 0.5ml per kg per hour (100mL/hr Electrical Burn)
• Children <40kg: 1ml/kg/hr
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