Blisters, Bandages and Beyond: Care of the Burn Patient From

Injury to Rehab

Andrea Wipperfurth Melissa Beltran, MSN, RN, CCRN

Lee Faucher, MD

• Airway • Burns • Circulation • Disaster • Equally Important

Commonly Asked Questions

• When should you intubate? – When there is an immediate concern for loss

of airway due to edema of the pharynx • Things to remember

– Big burns lead to a lot of edema all over – Prolonged time in an enclosed burning space

leads to a lot of edema – Flash burns to the face leads to no edema – When in doubt: Intubate!

Airway

• The only definitive airway through the mouth is the endotracheal tube – A supraglottic airway can

become dislodged as burn edema progresses

– Every attempt must be made to replace it if it is used

Airway

Chemical • Never neutralize • Water, water, water,

water, water, water…… – Continue until the

patient tells you it has stopped burning

Burns

Electrical • Do NOT become a victim!

Burns

Flame • Stop the burning

by removing all charred clothing

• Keep warm • Cover with plastic

wrap

Burns

Scald • Can lose a lot of fluid

quickly • Keep warm • Cover with plastic wrap

Burns

• Cover with plastic wrap - No need for the sterile burn sheet

Burns

• Start IV fluid replacement with LR – NS OK if LR not available

• Rate for large burns – < 6 years = 125mL/hr – 6-13 years = 250mL/hr – >13 years = 500mL/hr

• DO NOT BOLUS!

Circulation

Normal

Burn Causes Capillary Leak

Fluid Replacement for Capillary Leak

Foley Placed to Monitor Fluid Replacement

Bolus over fills tank

• A burn disaster in Wisconsin may be as few as 10 patients with major burns

Disaster

Patient Flow in a Burn Center

(c) American Burn Association 2015. All rights reserved. Burn Disaster

Management

Disaster

• Pain control – Plastic wrap – IV meds (avoid other routes of administration) – Opioids – Ketamine

Equally Important

Case Example Flame

Case Example Flame

Case Example Scald

Case Example Chemical

Case Example Chemical

Case Example Chemical

Case Example Electrical

• Cover the burns and keep the patient warm.

• Give fluids but do not bolus! • Burns hurt! Don’t forget about pain control.

Key Points

Questions