EMERGENT PHASE ON-THE-SCENE CARE
compartment
PREHOSPITAL CARE
• Assess the need for IV fluids
• Transport to the Emergency department
• Emergent Phase
• eschar(devitalized tissue resulting from the burn)
Minor burns
• Administer pain medications as prescribed
• Administer tetanus prophylaxis
• Wound care – cleansing, debriding loosse
tissue, topical antimicrobial cream, sterile
dressing
• Instruct client in follow up care. Wound care
treatments
• Emergent Phase
EMERGENCY DEPARTMENT CARE
Major burns
• Evaluate the degree and extent of the burn
• Treat life-threatening situations
• Ensure a patent airway, administer 100%
oxygen
• Monitor for respiratory distress. Assess the
need for intubation
• Assess oropharynx for blisters and erythema
• Emergent Phase
• Monitor ABG and carboxyhemoglobin levels
• For an inhalation injury, administer 100%
oxygen via a tight-fitting non-rebreather face
mask
• Initiate peripheral IV access to nonburn skin
proximal to any extremity burn, or prepare a
central venous line
• Assess – hypovolemia. IVF to maintain fluid
balance
• Monitor VS
• Emergent Phase
• Insert a foley catheter, maintain UO – 30 -50
ml/hr
• Maintain an NPO status
• Insert NGT – remove gastric secretions, prevent
aspiration
• Administer tetanus prophylaxis as prescribed
• Administer pain medications IV as prescribed
• Prepare the client for an escharatomy or
fasciotomy as prescribed
COMPARTMENT SYNDROME
- Compartments are enclosed spaces located in the
muscles of extremities and are made up of muscle,
bone, nerves and blood vessels wrapped by fibrous
membrane or fascia.
- Internal pressure - bleeding or edema into a
ASSIST IN SURGICAL FASCIOTOMY
 Escharotomy – surgical incision into the
to relieve the constricting effect of the eschar
tissue
• Fluid and Electrotype Shifts—Emergent Phase
• Generalized dehydration
• Reduced blood volume and hemoconcentration
• Decreased urine output
 Trauma causes release of potassium into
extracellular fluid: hyperkalemia
 Sodium traps in edema fluid and shifts into cells as
potassium is released: hyponatremia
EMERGENT PHASE
- Begin initiation of fluid
- Amount of fluid administered based on client’s
weight and extent of injury
GOAL: Prevent shock by maintaining adequate
circulating blood volume and maintaining vital
organ perfusion
 American Burn Association Fluid Resuscitation
Formula:
Adults: within 24 hours Post Thermal or Chemical
Burn
Formula: 2 ml Lactated Ringers (LR ) x weight in kg
x % TBSA
GIVEN: 70 kg patient with a 50% TBSA burn
2ml x 70 kg x 50 TBSA = 7000 ml/24 hours
Plan to administer:
First 8 hours = 3500 ml (half is given first 8 hours)
or 437 ml/h
Next 16 hours = 3500 ml, or 219ml/h
 American Burn Association Fluid Resuscitation
Formula:
Adults: within 24 hours Post Electrical Burn
Formula: 4 ml Lactated Ringers (LR ) x weight in kg
x % TBSA
GIVEN: 70 kg patient with a 50% TBSA burn
4ml x 70 kg x 50 TBSA = 14,000 ml/24 hours
 Plan to administer:
First 8 hours = 7000 ml (half is given first 8 hours)
or 875 ml/h
Next 16 hours = 7000 ml, or 437 ml/h
EMERGENT PHASE
 Successful fluid resuscitation – stable VS,
adequate UO palpable peripheral pulses and
clear sensorium.
 Foley catheter is inserted to monitor hourly
urine output and provide data to determine
whether fluid resuscitation is adequate.
 30ml/hr – minimum acceptable urine flow for
adults
• Burgundy-colored urine suggests the presence
of hemochromogen and myoglobin resulting
from muscle damage. This is associated with
deep burns caused by electrical injury or
prolonged contact with flames.
• Glycosuria, a common finding in the early
postburn hours, results from the release of
stored glucose from the liver in response to
stress
 Monitor for tracheal/laryngeal edema
 Monitor ABG
 Elevate head of the bed to 30 degrees – burns
of the face and head
 Shave or cut body hair around wound margins
 Monitor gastric output, auscultate bowel
sounds
 Monitor stools for occult blood
 Address pain
Pain meds – opioid analgesics
Only IV medication should be administered
(morphine)
Medicate clients before painful procedures.
 Nutrition - proper nutrition to promote
wound healing maintain an NPO status until the
bowel sounds are heard
• Encourage patient to cough – to remove
secretions by suctioning .
• Bronchodilators and mucolytic agents
administered
• Edema of the airways – endotracheal tube,
Mechanical ventilation
• Contact lenses removed
• Clean sheets to protect the burn from
contamination
• Patient is stabilized and condition is continually
monitored
• Patients with electrical burns should have ECG
• Psychosocial consideration and emotional
support should be given to patient and family
• Transferred to a burn unit
ACUTE/INTERMEDIATE PHASE
- Begins when the client is hemodynamicaly stable,
capillary permeability is restored and diuresis has
begun to near completion of wound closure
- Usually begins 48-72 hours after time of injury
- Focus is on infection control, wound care, wound
closure, nutritional support, pain management,
physical therapy
- GOAL: Placed on restorative therapy and the phase
continues until wound closure is achieved
ACUTE PHASE
 Prevention or treatment of infection or complication
 burn wound is an excellent medium for bacterial
growth
 infection impedes wound healing by promoting
excessive inflammation and damaging tissues
 use of cap, gown, mask and gloves
TYPES OF DEBRIDEMENT
1. Surgical debridement (Sharp)– excision of eschar
or necrotic tissue via surgical procedure in the
operating room.
2. Mechanical debridement – is by irrigation,
hydrotherapy, wet-to-dry dressings, and an
abraded technique. This technique is cost-effective,
can damage healthy tissue, and is usually painful.
 3. Enzymatic debridement is performed by the
application of a prescribed topical agent that
chemically liquefies necrotic tissues with enzymes.
These enzymes dissolve and engulf devitalized
tissue within the wound matrix
4. Autolytic debridement uses the body's enzymes
and natural fluids to soften bad tissue. This is done
with a moisture-retaining dressing that is typically
changed once a day. When moisture accumulates,
old tissue swells up and separates from the wound.
- Only necrotic tissue is liquefied.
- It is also virtually painless for the patient.
- Hydrocolloids, hydrogels and transparent films.

BURN WOUND CARE

Wound cleaning
– Hydrotherapy –cleansed by immersion, showering,
or spraying
– Burn Wound Care

• Use of topical agents

1. Silver Sulfadiazine (Silvadene) water soluble
cream – wide antimicrobial coverage minimal
penetration of eschar- S.E. LEUKOPENIA
2. Mafenide acetate (Sulfamylon) – gram positive
and negative bacteria
3. Silver nitrate – bactericidal , does not
penetrate eschar
4. Acticoat – gram positive and negative bacteria

• Skin grafting
- is a technique in which a section of skin is
detached from its own blood supply and
transferred as free tissue to a distant(recipient)
site.
- Commonly used to Cover areas denuded of
skin(burns)
- Commonly used to cover areas denuded of
skin(burns)