ln[urles due Lo burns

lnlLlal AssessmenL
ur Aldah Abu Llsoud Alkalsssl
Anna[ah naLlonal unlverslLy
laculLy of nurslng
b[ecLlves
AL Lhe end of Lhls chapLer Lhe sLudenL should be able Lo
undersLand Lhe lmporLance of prehosplLal burn
managemenL
Apply Lhe A8CuL approach Lo burn managemenL
undersLand baslc burn assessmenL and calculaLlon of
fluld resusclLaLlon requlremenLs
LlsL crlLerla for referral Lo a speclallsL 8urns CenLre
undersLand how burns paLlenLs are prepared for
Lransfer
9rlmary Survey and 8esusclLaLlon
A full prlmary survey uslng Lhe A8CuL approach
should Lo be carrled ouL on arrlval
1hls wlll ldenLlfy any lmmedlaLely llfe
LhreaLenlng ln[urles
A more Lhorough assessmenL of Lhe burn can be
underLaken laLer
9rlmary Survey and 8esusclLaLlon
Alrway cervlcal splne conLrol and breaLhlng
AssessmenL of Lhe alrway and breaLhlng may reveal early
slgns of lnhalaLlonal ln[ury and frequenLly coexlsLlng ln[ury
1he developmenL of slgns and sympLoms from alrway
oedema and pulmonary ln[ury may Lake hours Lo develop
1he key Lo dlagnosls ls havlng a hlgh lndex of susplclon wlLh
Lhe frequenL reevaluaLlon of Lhose consldered Lo be aL rlsk
1he lndlcaLors of
lnhalaLlonal ln[ury may come from
Slgns and sympLoms
Poarseness or oLher volce changes
Parsh cough
SLrldor
laclal burns
Slnged nasal halr
SooL ln sallva or spuLum
An lnflamed oropharynx
PlsLory
Lxposure Lo flre and/or smoke ln an enclosed space
Lxposure Lo a blasL '=--'
Collapse confuslon or resLlessness aL any Llme
lnvesLlgaLlons
8alsed carboxyhaemoglobln levels
8esplraLory fallure
All paLlenLs should be glven hlgh flow oxygen preferably
humldlfled
lf any slgns of upper alrway obsLrucLlon parLlcularly sLrldor
ls presenL Lhls lndlcaLes LhaL some obsLrucLlon already
exlsLs and Lracheal lnLubaLlon wlll be requlred
An experlenced anaesLheLlsL should urgenLly assess Lhe
paLlenL and Lhe safesL opLlon ls early Lracheal lnLubaLlon as
swelllng wlll lncrease over Lhe flrsL few hours maklng Lhls
Lask progresslvely more dlfflculL
ln severe cases a surglcal alrway may be requlred
1he cervlcal splne musL noL be overlooked ln Lhese
paLlenLs parLlcularly when Lhe mechanlsm of ln[ury
suggesLs LhaL Lhe splne may be ln[ured
1he classlc case would be where Lhe vlcLlm of a house flre
has [umped from an upper floor Lo escape Lhe flre and has
burns and splnal ln[urles from Lhe lmpacL of Lhe fall
1racheal lnLubaLlon may also be requlred ln Lhose paLlenLs
wlLh slgnlflcanL lung ln[ury Lo opLlmlse venLllaLlon and on
Lhe rare occaslon of clrcumferenLlal chesL burns resLrlcLlng
sponLaneous venLllaLlon
C|rcu|at|on and haemorrhage contro|
Pypovolaemlc shock due Lo burns Lakes Llme Lo develop
lf Lhe burn vlcLlm shows slgns of shock soon afLer ln[ury oLher
causes of haemorrhage musL be excluded
lor example Lhe mechanlsm of ln[ury (eg a fall whllsL escaplng a
flre) should ralse Lhe susplclon of oLher ln[urles
Where early hypovolemlc shock exlsLs Lhe cause needs Lo be
lnvesLlgaLed
lnLravenous access ls achleved uslng Lwo large bore
cannulae
AlLhough lL ls accepLable Lo cannulaLe Lhrough burnL skln
Lhls should be avolded lf posslble
lf necessary cenLral velns or Lhe lnLraosseous .='~
='rouLe should be used
When blood ls senL for laboraLory basellne lnvesLlgaLlons
carboxyhaemoglobln levels should be lncluded where an
lnhalaLlon ln[ury ls suspecLed
ulsablllLy of Lhe CnS (neurologlcal assessmenL)
8educed level of consclousness confuslon and
resLlessness can lndlcaLe lnLoxlcaLlon and/or
hypoxla secondary Lo an lnhalaLlon ln[ury
1he posslblllLy of alcohol or drug lngesLlon and
Lhe presence of oLher ln[urles may presenL ln Lhe
same way
osure and env|ronmenta| contro|
CloLhlng and any resLrlcLlng lLems should be removed
1he removal of cloLhlng and use of cold waLer aL Lhe scene
durlng Lransfer and ln Lhe emergency deparLmenL ofLen leads
Lo hypoLhermla
1hls can be mlnlmlsed by coverlng unlnvolved areas and
ralslng Lhe amblenL - =-=~room LemperaLure (Lo 30oC)
8efore progresslng Lo Lhe speclflc managemenL of Lhe burn
and a full secondary survey Lhe A8CuL of Lhe prlmary survey
should be reassessed
,anagement of ,|nor 8urns and Sca|ds
Clean Lhe area genLly wlLh clean waLer
2 Submerge Lhe burnL area ln cold waLer
3 uo noL apply coLLon wool dlrecLly over
Lhe burnL area
4 uo noL apply any greasy subsLance
3 Clve Lhe paLlenL warm drlnks
,anagement of tens|ve 8urns
keep Lhe paLlenL quleL and reassure hlm
2 Wrap hlm up ln a clean cloLh
3 uo noL remove adherlng parLlcles of
charred cloLhlng
4 Cover Lhe burnL area wlLh a sLerlle or clean
dresslng and bandage
ln Lhe case of burns LhaL cover a large parL of Lhe
body lL ls sufflclenL Lo cover Lhe area wlLh a clean
sheeL or Lowel
3 keep Lhe paLlenL warm buL do noL over
heaL
6 lf Lhe hands are lnvolved keep Lhem above
Lhe level of Lhe vlcLlms hearL
7 keep burnL feeL or legs elevaLed
8 lf Lhe vlcLlms face ls burnL slL or prop hlm
up and keep hlm under conLlnuous observaLlon
for breaLhlng dlfflculLy lf resplraLory problems
develop an open alrway should be malnLalned
uo noL lmmerse Lhe exLenslvely burnL area or
apply lce waLer over lL because cold may lnLenslfy
Lhe shock reacLlon Powever a cold pack may be
applled Lo Lhe face or hands or feeL
0 uo noL open Lhe bllsLers on Lhe vlcLlms skln
1reaL for Shock
2 Seek medlcal asslsLance especlally lf
8urns cover more Lhan one body parL
8urns are on Lhe hands feeL or genlLals
3 8emove qulckly from Lhe body anyLhlng
of consLrlcLlng naLure llke rlngs bangles '~
belL and booLs
lf Lhls ls noL done early lL may be dlfflculL laLer
on as Lhe llmbs begln Lo swell
4 lf medlcal help or Lralned personnel
cannoL reach Lhe scene for an hour or more
and Lhe vlcLlm ls consclous and noL vomlLlng
glve hlm a weak soluLlon of salL and soda (one
level Leaspoonful of salL and half a level
Leaspoonful of baklng soda Lo each quarL of
waLer nelLher hoL nor cold) aL home and en
rouLe Lo Lhe hosplLal -=' _-~~~' _' Allow
hlm Lo slp slowly