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									                                                                                                    For Assistance or to Arrange Transfer:
                                                                                                       877-863-9595 or 706-830-7511
                                                                                                             888-259-0971 pager
                                                                                                                                         Fred Mullins, MD
                                                                                           Zaheed Hassan, MD         Hermann Orlet, MD      Juan Col
                                                                                            Claus Brandigi, MD                                Alton F. Garrison, MD
                                                                                                    William C. Lineaweaver, MD    Erin F. Switzer, DO
                Joseph M. Still Jr., MD

                                           EMERGENCY TREATMENT
                                             OF BURN PATIENTS
     IMMEDIATE EMERGENCY                                                     4.
•    Treat according to CPR protocol (ABC’s)                                 •    Calculate Fluids: Parkland Formula
•    Use airway and C-Spine                                                          Adults:                                                  •   How the        was burned
•    Stop the burning process. Remove clothing and jewelry                           Ringer lactate: 4ml x weight in kg x %TBSA burn          •   Concomitant injuries
                                                                                             Give first half of fluids over first 8 hours        •   Allergies
                                                                                             Give remaining fluid over next 16 hours           •   Medical/Surgical history

     EMERGENCY BURN                                                                  Children over 10 years old:                              •   Current
                                                                                             Use same formula as above                        •   Drug and/or alcohol history
     MANAGEMENT                                                                      Children under 10 years old:                             •   Most recent tetanus
                                                                                             Use the same f
•    Airway Management                                                                       maintenance fluid of D5W to maintain
        A                                                                                    glucose levels- Consult Burn Center Surgeon
        pr                                                                   •    High Dose Vitamin C
                                                                                                                                              8. PAIN RELIEF MEASURES
        necessary                                                                    For burn injuries > 30% TBSA,
        B. If an inhala                                                              Con
        immediately; assess for the following:
                                                                                                                                              •   Give all              via IV route:
                1. Burned in an enclosed space
                                                                                                                                                     Morphine Sulfate (if not contraindicated)
                2. Darkened or reddened oral and/or nasal
                                                                                                                                                     in the following
                3. Burns to the face, lips, nares/singed eye
                brows, singed nasal hairs                                    5. INJURIES                                                                                         es
                                                                                                                                                             3-5 mg Q 10 minut or prn
                4. Carbon or soot on teeth, tongue or throat
                                                                                                                                                             Titrate IV Morphine Sulfate by body
                5. Raspy, hoarse voice or cough
                                                                                                                                                             weight (0.1mg/Kg/dose) or consult Burn
                6. Stridor or inability t
                indicate impending airway occlusion
                                                                             •    Treat burn         as trauma          check for:
                7. Cir
                                                                                      1. Head Injury (Note: burns do not alter                       -Do NOT use ice or iced saline to comfort-
        C. Elevate HOB 30-90 degrees to decrease facial or
        airway edema once C spine cleared
•    Insert two large bore IV catheters                                              ano
         (in non-burned area if possible)                                            injury)                                                  9. WOUND CARE MEASURES
•    Insert foley catheters if >20% TBSA                                             2. Fractures
                                                                                     3. Spinal Injuries
                                                                                     5. Foreign bodies (especially in explosions)
3. TOTAL BODY SURFACE AREA                                                                                                                    •   Remove burned clothing or foreign debris
                                                                             •    Proceed with emergency treatment of any concurrent          •   Wound debridement is not usually necessary at
                                                                                  injuries and prevent further injuries                           the referring facility: discuss with local Surgeon/
                    Body Surface Area In Percent                                                                                                  Burn Center Surgeon need for escharotomies in
                                                                                                                                                  cir              burns
                    4.5       Age 15 & Over            4.5                                                                                    •   Wrap burned areas with clean/sterile gauze or
                                                                                ESTIMATE DEPTH OF                                             •   Elevate HOB and burned                  to decrease
                                                                                BURN INJURY                                                       swelling



                     9                                 9
                                                                                                                                                     -Do NOT apply ice, ointments or creams-
                     9                                  9                    •    Determine the probable depth of the burn injury using
                                                                                  these guidelines:
                                                                                     1st degree                                               10. OTHER INTERVENTIONS
                          9         9              9         9                              warm to touch; no blisters or skin sloughing,
                                                                                            e.g. sunburn
                                                                                     2nd degree
                                                                                            painful to touch, blanches to touch; when         •   Labs; Rainbow, ABG, Carboxyhemoglobin
                                                                                            blister debrided, weeps fluid from wound           •   X-ray: CXR, and areas of suspected trauma
                                                                                     3rd degree (full thickness) Black, brown, white, or      •   Insert NG tube and decompress stomach if nausea
                                                                                            leathery wound, firm in appearance; does not           and           are present; if TBSA is greater than
                              areas by using the
                                                                                            blanch and is not pain to touch                       20% or if          is intubated
                                   palm as 1%                                        4th degree (full thickness) Charred appearance;          •   Keep          NPO
                                                                                            burns that extend below the dermis and            •   Monitor             blood pressure, breath sounds,
                                   0-14 Years                                               subcutaneous fat into the muscle, bone or             apical and peripheral pulses every 15 minutes
                         9                         9
                                                                                            tendon                                            •   For urine that is black/brown/red or <30cc/hr
                                                                                                                                                  consult Burn Center


                         18                        18
                                                                             American Burn                              criteria for Injuries Requiring Referral To A Burn Center

                              7            77                    7                                                and treatment at an emergency department:

                          For each year over age 1:
                          •   subtract 1% from the head                                                                                              trauma (such as fractures) in which the
                          •   add 1/2% to each leg                                     2. Burns that involve the face, hands, feet,                  burn injury poses the greatest risk of
                                                                                              genitalia, perineum or major joints                    morbidity or mortality

                                                                                       3. Third degree burns in any age group                 9. Burned children in hospitals without
                                                                                                                                                     qualified personnel or equipment for the
                                                                                       4. Electrical burns, including lightning injury               care of children

          A liated                                                                     5. Chemical burns


                                                                                              medical disorders that could complicate
                                                                                              management, prolong recovery or a ect

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