FEATURE PARAMEDIC TRAINING
Primary Assessment: ABC, intubation, ventilation, vascular access, resuscitation. Secondary survey: Head to toe exam, Stop injury, Estimate burn size/depth and treat. The %TBSA burn is used to help
predict patient response to interventions, morbidity and mortality, and to help guide fluid resuscitation. There are several tools used to estimate %TBSA burned. The Rule of Nines, which is quick and relatively easy to remember, was used for this patient initially. The Lund-Browder method is a more accurate but more complicated assessment method based on age and burn depth. Using the palm of patient’s hand as a reference equal to 1% TBSA is simple for small burns, but is not as useful for large area burns. During initial emergency department resuscitation of burn patients, %TBSA burn should be estimated quickly and interventions initiated.
CLINICAL MANIFESTATION OF BURNS Burns can be described as a continuum from ‘superficial’ to ‘fourth degree burns’. Treatments will vary depending on extent of injury sustained. The following body systems will be affected in severe burn injuries: Respiratory: - Direct airway injury - Carbon monoxide poisoning - Thermal injury - Smoke poisoning - Pulmonary fluid overload - External factors
Cardiovascular - Hypovolemic shock and ↓ cardiac output - Impaired circulation/tissue perfusion - otential for ECG changes
Renal/urinary - Changes R/T ↓ renal perfusion and debris
- Fluid shift– ↓ GFR and urine output - Fluid remobilization-- ↑ GFR and diuresis
- Tubular blockage from myoglobin and uric acid
- Fluid resuscitation should maintain output at 30-50 mL/hour
Integumentary - Size of injury is important to diagnosis and prognosis • “Rule of Nines” • Lund-Browder method
- Specific treatments dependent upon depth of injury (Sanders, 2007)
Emergent Phase Begins at the time of
injury, the time duration between 36-48 hrs
Phases of management of the burn injury
Acute Phase
Begins when patients hemodynamically stable, capillary permeability is
restored, and diuresis has begun 48-72 hrs after the time of injury
Rehabilitative Phase Recovery represents the final care burn injury Overlaps acute phase and extends beyond hospitalization
Management
Management The primary goal at this stage is to prevent hypovolemia causing edema and shock
The goals at this stage are
to prevent infection, provide metabolic support, wound care, wound cleansing, and restorative therapy continues until wound closes
BURNS MANAGEMENT AND PHARMACOLOGY Burn patients commonly experience pain, anxiety and fear. Pain management is usually the most significant concern initially, and is treated most effectively with intravenous opioids, such as morphine. Repeated doses and close monitoring by the paramedic are necessary, due to pain severity and the hyper metabolic state associated with burn injury. Benzodiazepines are an effective adjunct to treat anxiety. For severe burns, artificial ventilation with intravenous analgesia and sedation to facilitate safe, adequate pain relief may be required.
BURN PREVENTION Do not smoke. If you do smoke, never smoke in bed. Avoid smoking while consuming alcoholic beverages. Never throw a lighted cigarette or a match anywhere. Dispose of those hazards in proper ashtrays. Be very cautious around any type of open flames. Supervise children carefully. Follow electrical safety rules. Never put electrical appliances or cords in or near water. Do not touch downed power lines.
KEY POINTS Airway status can deteriorate rapidly and may need complex interventions available pre-hospital
Stopping the burning process is essential
The time from burning is an essential
Management
The goals are designed for maximal functional and emotional recovery such as wound healing, increasing physical strength and function, provide emotial support
piece of information
Consider transport to regional burn centers’ as per local policy or protocols indicated
Pain relief is important Active Fluid Resuscitation
CONCLUSION Burns can range from relatively simple to lethal, but their severity may not be immediately apparent in the pre- hospital setting. Pre-hospital providers should thoroughly assess burn victims and anticipate both their immediate and long-term needs. Be aggressive in burn victim’s pain management. By having a thorough understanding of the pathophysiology of burns, providers can support their patients’ chances of recovery and good outcomes while reducing morbidity and mortality. ■
AH
REFERENCES References available on request (
magazine@iirme.com)
LEARN MORE The Emergency Medical Exhibition and Congress, part of the Abu Dhabi Medical Congress taking place on 23-25 October, is the region’s only event dedicated to emergency and trauma professionals. The event facilitates a broad spectrum of business opportunities for healthcare companies specialized in emergency medical products and services. For more information, visit
www.abudhabimed.com
Arab Health Issue 3 2011 15
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