Note: This protocol applies to thermal burns, chemical burns and electrical burns



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State of Wisconsin

Emergency Medical Services

Sample Medical Guidelines


Burns


Note:

  • This protocol applies to thermal burns, chemical burns and electrical burns

  • Scene safety is of utmost concern.

  • Loosen and remove any clothing and jewelry that can become constricting when tissue swells.

  • Burns over 10% should not be cooled with water due to possibility of causing hypothermia.

  • In the presence of major trauma (in addition to the burn), stabilizing life-threatening injuries takes precedence over the care of the burn.

  • Pain Management should be aggressive. Burn patients may require much higher doses for pain control.

  • Remember that carbon monoxide poisoning is a common complication of burns suffered in a structure fire. Oxygen should always be administered in a thermal burn setting.

  • Consider early communication with medical control to determine appropriate destination, i.e.: children, trauma or burn centers.




Priorities

Assessment Findings

Chief Complaint

Burns, pain, burning sensation; electrical/lightning injury; chemical (caustic) exposure

OPQRST

Identify cause of burn, exposure time and time of burn

Associated Symptoms/ Pertinent Negatives

Respiratory distress, ulcerous skin in chemical burns, entrance and/or exit wounds with possible cardiac changes in electrical burns

SAMPLE

Note previous medical conditions

Initial Exam

Scene safety, ABCs support as necessary

Detailed Focused Exam

General Appearance: Varies depending on burn; may show signs of extreme pain

Skin: Depending on the degree on the burn, erythema, blisters, pale leathery appearance, charring, sloughing; Estimate BSA with “rule of nines” or “rule of palms”

HEENT: Check nose & mouth for signs of burns (e.g. soot, edema, redness)

Lungs: Signs of respiratory distress, stridor, diminished or absent lung sounds?

Heart: Rate and rhythm? Especially in electrical burns

Neuro: Loss of movement and/or sensation in extremities, focal deficits?

Goals of Therapy

Stop the burn; airway management; fluid resuscitation; pain control; management of associated injuries; (Decontamination in hazmat incidents)

Monitoring

BP, HR, RR, EKG, SpO2. Watch for cardiac dysrhythmias, increasing respiratory distress and signs of shock



EMERGENCY MEDICAL RESPONDER (EMR)

  • Routine Medical Care/Routine Trauma Care.

  • Get the patient away from the heat source. Remove burned, hot, warm, and/or contaminated clothing. Stop the burning process.

  • Oxygen

  • If the patient is unconscious without a gag reflex, consider:

    • Oropharyngeal airway in adults or children

    • Nasopharyngeal airway in adults.

    • Advanced airway, if approved.

  • Remove rings, bracelets, and other constricting items as soon as possible

  • Keep the patient warm with dry blankets




EMERGENCY MEDICAL TECHNICIAN (EMT)

  • If less than 10% body surface area (BSA), dress burns with wet saline dressings.
    Be careful not to induce hypothermia.

  • If burns are more than 10% BSA, use dry dressings or clean sheets.




ADVANCED EMT (AEMT)

  • IV/IO NS, if approved. 1 Liter wide open for adults and 20 ml/kg for children in the first hour.

    • Unburned sites are preferred for IV initiation, but burned sites are acceptable.

  • Monitor ABCs and vitals closely




Contact Medical Control for the following:

  • Additional orders




INTERMEDIATE/PARAMEDIC

  • 2nd IV in Adult

  • For Pediatric patients initiate IV/IO as appropriate

  • Consider endotracheal intubation if evidence of burns to the airway or lungs is present or if respiratory distress is apparent.

  • Pain Management, refer to Pain Management Guideline




Contact Medical Control for the following:

  • Additional orders




Origination 09/2008 Page of

Directory: ems -> provider
ems -> Dental Health and Tooth Fillings
provider -> State of Wisconsin Emergency Medical Services
provider -> State of Wisconsin Emergency Medical Services
provider -> Note: This protocol may be used as a general guide for trauma in both Adults and Pediatrics. Priorities
provider -> State of Wisconsin Emergency Medical Services
provider -> State of Wisconsin Emergency Medical Services
provider -> Note: Consider reversible causes of aloc: hypoglycemia, hypoxia, narcotic overdose, hypovolemia, shock, sepsis, head injury, drug or alcohol intoxication, toxic exposures, syncope, seizures, arrhythmias Priorities
provider -> Note: This protocol is to be used for patients with a known sensitivity or allergy to latex products. Priorities
provider -> State of Wisconsin Emergency Medical Services


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