Treatment Guidelines For The Burn Patient
You’ve taken an educated guess on burn depth, calculated the burn area and classified the burns severity. With those priorities out of the way we can start treating the victim. (Yes, I’m taking some creative literary licence here, since assessment and treatment tend to occur in tandem.)
There are things we tend to do well and things we tend to do poorly in prehospital burn management. Here are some “do and don’t” type guidelines to direct your burn treatment.
Always consider the possibility of non - accidental trauma in pediatric burns.
Do:
Assess the heck out of the Airway.
- Inhalation burns are easy to miss if you’re not paying attention. Burn victims have a tendency to gasp when they are burned. You need to look really close at that airway. Shine a light on the patients facial hairs (yes women have them also) and look for singed or missing patches. Look up their nose and in their mouth for evidence of burns.
- Listen to the lungs and auscultate over the trachea. Reassess frequently. Only time will tell for certain if there is damage to the lower airway or lungs. Until then, you need to reassess frequently and don’t get caught behind the eight ball trying to manage an airway that goes down hill due to unrecognized burns.
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Burn Assessment and Treatment: Making The Call
In our first installment, we looked at how to determine the thickness of a burn and what that might mean for the patient. Now let’s talk about the things that will help us decide how to determine if our patient’s burn is minor, moderate of severe.
Our three considerations when deciding on burn criteria are:
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burn depth,
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burn surface area
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burn location.
We covered burn depth last time, this time we’ll cover estimating burn area and the particular locations that change our burn assessment.
Estimating Burn Surface Area
Let’s look at two widely accepted guidelines for estimating the surface area of a burn. For smaller burns, the palm method can be useful. Look at the palm of your patient’s hand. The surface area of the palm (we’re not including the fingers here) is about 1% of the patients total body surface area. This can be useful if the burn involves 15% or less of the total body surface area.
Another rapid estimation tool is the rule of nines. This rule requires a bit of memorization on your part, but the effort is well worth it. In the rule of nines we divide major body regions into percentages. The head is 9%. The chest and back are both 18% respectively. Each leg is also 18%. Each arm is given 9% and the genitalia add the remaining 1% to total body area. From that foundation, large area burns can be estimated rapidly. One half of one arm is a 4.5% total body surface area burn (TBSA). One entire leg and the front of the other leg is a 27% TBSA burn.
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For complex burn patterns, the two rules can be used together as well.
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An EMT Guide to Burn Assessment and Treatment
Your patient has been burned. You are going to have to make two important decisions and you may need to make them fast. First you’re going to need to decide the thickness or “degree” of the burn. Then you’re going to need to determine if the patient meets critical burn criteria.
You may not have a lot of time to put all this together. Your assessment of what does and does not constitute a critical burn will effect your decision to transport emergent or not. It can determine if you transport to a burn center and if the burn team is activated. In many rural areas, the decision to call advanced caregivers or fly a helicopter may all hinge on what you feel is a critical burn … and the determination may not always be that obvious.
Today we’ll begin a three part series on burn assessment. Here, we’ll take a look at identifying burn degree or thickness by appearance and in our next installment we’ll look at the factors that separate our critical burn patients from our moderate and lesser burns. In part three, we’ll talk about management of burn patients.
So what does burn thickness mean?
And what difference does it make anyway?
Burn thickness is important because the layers of the skin all have multiple functions. Your skin protects you, pads you and insulates you. It has the ability to growing new skin, regulate body temperature, growing hair, guard against infection and communicate with you brain about what your environment feels like. The supple flexibility of your skin allows you to move and breath.
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