BURN INJURIES THAT SHOULD BE REFERRED TO A BURN CENTER INCLUDEURNERITETERINATIONPartial thickness burns greater than 10 total body surface area TBSABurns that involve the face hands feet genitalia per ID: 886978
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1 | PROTOCOLBURN STABILIZATION PROTOCOL B
| PROTOCOLBURN STABILIZATION PROTOCOL BURN INJURIES THAT SHOULD BE REFERRED TO A BURN CENTER INCLUDE:URNERITETERINATIONPartial thickness burns greater than 10% total body surface area (TBSA)Burns that involve the face, hands, feet, genitalia, perineum, or major jointsThird-degree burns in any age group Burn Physicians are available to consult 24 hours a day via the TransferCenterPhone1.888.731.4791RULE OF NINESRev.09/13 18%front18%back18%18%front18%back14%14%18%18% 1.DER SAFETa. Removeanysourceanyclothingjewelryareamaycoveredchemicalsareconstricting.flushwoundstepidwater,avoidinghypothermia.Coverdrysheetblankettopreventhypothermia.ASSESS AIRWA/BREATHINGa. Carbonmonoxidemaypresentrestlessness,headache,coordination,memoryimpairment,disorientation,Administer100%BURN PEARL: Consider obtaining a blood gas with carboxyhemoglobin level.b. Intubationgenerallynecessaryforhypoxicsmokeflameflashinvolvingfaceneck.Indications include: pharyngeal burns, air hunger or carbonaceous sputum with hoarseness.Insertintubated.c. IfbreathingtocompromisedbycircumferentialPhysicians.ESTIATE PERCENT TOTAL BOD SURFACE AREA BURNED (% TBSA)a. UseRuletoestimateTBSAfordiagramback.BURN PEARL: Remove as much soot as possible for a more accurate assessment; 1st degree burns are not included in TBSA estimation.OBTAIN I ACCESSa. Burns15%TBSA:resuscitatedorallyinjury,associatedtraumab. Burns15TBSA:securelargeboreextremity;transporthour.c. BurnsTBSA:requirestwolargeboreextremities.BURN PEARL: IVs may be placed through burn if necessary (suture to secure). Avoid saphenous vein and cut-downs through unburned skin.INITIATE FLUID RESUSCITATIONformula:RingersLactateweightkgTBSA first24hours.Givetotalfirsthourspost BURN PEARL: Adults use 2 mL: Pediatrics use 3 mL: Electrical injuries use 4mL.Do not give dextrose solutions (except for maintenance fluids in children) —it may cause an osmotic diuresis and confuse adequacy of resuscitation assessment.Childrenkghavemaintenancefluidsdextrosetoformula.Adult Example: Patient weighing 70
2 kg with a 50 % TBSA burn: 2 mL x 70 x 5
kg with a 50 % TBSA burn: 2 mL x 70 x 50 = 7000 mLs needed in 24 hours. 3500 mLs are needed in the first 8 hours so IV fluids are initially started at 437 mL/hour.a. Insertfoleycatheter>15%TBSA.Adequateforchildrenkg/kg/hr.b. ObserveforburgundymassiveThere is a high incidence of renal failure associated with these injuries, requiring promptaggressiveintervention.BURN PEARL: Lasix, other diuretics and fluid boluses are never given to improve urine output; slowly adjust fluid rates up to increase urine output. BURN TREATENT PROTOCOL 7.EDICATIONSa. Assessforcurrentstatusgivetetanusb. Afterfluidresuscitationstarted,Morphine)maytitratedpressure,respiratoryratelevelaftereachincrementc. Antibioticsarenotindicated.BURN PEARL: Even small degrees of hypovolemia may grossly exaggerate effects of all medications. If blood pressure or respiratory rate falls or pulse rises by more than 20% of baseline, do not give additional narcotics without consulting a Burn Physician.8. CIRCUforcircumferentialextremitiestrunk.Elevateextremitiespillowsabovelevelheart.transferdelayed,checkdistalPhysiciansweaken,complainsWOUND CAREa. Debridementtopicalantimicrobialsunnecessarytransport12hours.Coverdrysheetblanket,keepingwarm.b. Iftransportdelayed,layerSilverSulfadiazinetoareascoveringwoundssteriledressings.notdelaytransporttowoundcare.10. SPECIAL CONSIDERATION WITH CHEICAL BURNSProtectyourself.Removeclothingjewelry.powderedchemicalsoffflushtepidwatercarefultokeepwarm.d. Irrigateeyesstreame. Determinechemicalconcentrationinjury.BURN PEARL: Never neutralize an acid with a base or vice versa.11.SPECIAL CONSIDERATIONS WITH ELECTRICAL INJURIESTreatlife-threateningdysrhythmias.forassociatedtrauma;centralperipheralneurologicTitratefluidstomaintainadequatetoflushthroughurinarytract.Elevateextremitiesabovelevelheartpillows.Monitordistal12. GENERAL ITEa. Ahistorydetailspre-existingdisease/allergiesb. Includerecords,fluidsgiven,vitalc. TheTransferCenterarrangetransportAirliftNorthwest,CALL888-731-4791UWMEDICINE.ORG/TRANSFERCENTER