Burn Demographics (08:51)
Objectives include assessing and providing physical and psychological interventions for those afflicted. Every year an estimated 4,000 people die due to fires and burns; most deaths are a result of carbon monoxide inhalation. Most burn victims are males between the ages of 20-50.
Initial Assessment (19:59)
Prioritize intubating the patient if necessary; remember to assess the "ABCDE": airway, breathing, circulation, disability, and exposure. Wear gloves, eyewear, gowns, and respiratory masks if needed. Obtain a medical history after stabilizing the patient and determine the total body surface area using the Lund and Browder chart instead of the rule of nines.
Initial Care of Burn (05:02)
The individual needs to be transported to a burn center if the TBSA is over 10% or if burns are on the face, feet, hands, or genitalia. Obtain a baseline weight to determine fluid resuscitation amounts, caloric needs, and medication dosage. Remove all clothing prior to flushing out chemical burns.
Airway Management (08:04)
Cyanide and carbon monoxide molecules will not allow oxygen to bond with hemoglobin. Subglottic or tracheobronchial injury causes parenchymal pulmonary edema, atelectasis, and pneumonia. Obtain an arterial blood gas if the patient presents with carbon monoxide poisoning.
Shock and Fluid Resuscitation (10:26)
Patients with burns greater than 20-25% TBSA present with increased capillary permeability and cardiac output. Edema can form after 24 hours post burn. Insert a large bore intravenous catheter to begin fluid administration and use warm solutions to prevent hypothermia; half the fluid needs to be given within eight hours.
Electrical Burns (02:39)
Main causes are lightening and working on an electrical outlet; direct current injuries tend to be worse than alternating current. Look for an exit wound. Consider scene safety, administer oxygen, and assess for arrhythmia.
Blast Injuries and Burns (06:39)
Shrapnel can cause blast injuries; organs can rupture from the sound waves. Chemical burn injuries account for 3% of all burn center injuries. Alkaline and acid burns cause different reactions.
Pediatric Burn Care (05:32)
Children require more fluid than adults and temperature drops are greater. Airways are much smaller; remember the ABCs. Assess for child abuse if there is a long delay between burn injury and seeking treatment, the child appears passive, if there are additional injuries, or if the caregiver seems more concerned about themselves.
Burn Dressings (02:15)
Silver sulfadiazine (Silvadene) and escharotomy procedures are potential treatments. Complications include infection, itching, and hyperpigmentation.
Pain, Agitation, and Delirium Management (07:00)
Pain level needs to be routinely monitored; do not use vital signs pain scales alone for adult ICU patients. IV opioids, carbamazepine, and gabapentin are potential treatments. Keep the patient as calm as possible.
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