2. Introduction
• Burn injuries present a major challenge to a
healthcare team
• Burn care has improved with the establishment of
dedicated regional Burns unit
• The initial treatment at the scene of the burn
accident is extremely important in minimizing the
extent of the burn injury
3. • 1st
step: Before any specific treatment, the pt must
be removed from burning process
• Imp: Rescuer should be careful not to sustain burn
himself in this process
• Burning clothing should be removed as soon as
possible
• All rings, watches, jewellery, ornaments should be
removed as soon as possible
• Can cause tourniquet like effect – Vascular Ischemia
• Also known to retain Heat
4. Primary Injury Treatment
• The amount and depth of damage is proportional to-
• Duration of flame exposure
• Size of the flame
• Intensity of the heat
• Individuals whose clothing has been ignited, should
be prevented from running and be placed in supine
position
• Motion - ↑ the flames
• Upright position - ↑ facial injury and scalp burns
5. • Water should be poured over the burned area
• Early cooling reduces the depth of the burn and pain
• Ice / Ice packs should never be used –
• can produce hypothermia
• can cause arrhythmias
• For the control of pain – effective are –
• Use of towels in ice water
• Putting the hand under running cold water
• Flames should be doused by rugs, coats, towels,
blankets or water
6. • Cover the wound with a sterile towel or a clean
dressing as soon as possible
• Home remedies should NOT be applied to the
burned areas
• They contaminate the wound
• Difficult and painful to remove, when cleaning the
wound
• Withhold any oral intake initially -
• Ilues noted after burns, can cause vomiting
7. Chemical Burns
• Initial management –
• Removing saturated clothing
• Irrigation with copious amount of water
• Taking care to not spread the chemical on burns to
adjacent unburned area
• Do not try to search for the neutralizing agent
• Wastes times
• Reaction can generate heat - ↑ burning process
• Injury of proportional to –
• Concentration of the acid
• Duration of exposure
8. Electrical Burns
• Electrical current should be removed as soon as
possible by –
• Switching off the current
• Using a non conductor to separate the victim from the source
• It is influenced by –
• Type and voltage of the current
• resistance through the body
• Pathway of the transient body
• Duration of the contact
• Rescuer should avoid contact with the burns
• Examine the patient – ABCDE. B & C is imp in Elect.
Burns
9. On-site assesstment of Burn
patient
• A burn pt is treated as – A trauma patient with
Burns
• It involves –
• Primary Assessment
• Secondary Assessment
• Primary Assessment
• Immediate life threatening conditions are quickly
identified and treated
• Follows the protocol of – ABCDE
10. • Inhalation of gases – Damage to Airways
• 100% humidified oxygen should be started
• Establish the airway
• Respiration should be assessed
• Endotracheal Intubation should be done early –
• Nasal route is preferred
• Blood pressure is not the most accurate method of
monitoring the circulatory status
• Pulse rate is more helpful
• Cervical spine stabilization is important
11. • Secondary Assessment: More commonly performed
at the Initial Care facility
• Starts after completion of the primary survey and
once initial resuscitative measures have commenced
• Identify all injuries and perform a more thorough
head-to-toe evaluation is important
• Secondary assessment examines-
• a patient’s past medical history
• Medications
• Allergies
• the mechanisms of injury
12. • IV Access -
• Not required if the Pt is <1hr distance from the hospital
• If established, Fluid is started empirically as –
• Pre-hospital care of the wound –
• Aim: protect from the environment
• Covering the wound – first step
• Cover with – a sterile towel / dressing material
13. Pre-Hospital Triage
• Dictum in transporting Burn
patients is – transport to a
hospital designated to treat
them
• To effectively triage burn
patients, following must be
ascertained –
• Extent of the burn
• Depth of the burn
• Presence of complications
14. Estimation of the Extent of the
Burns
• It is expressed as the
amount of surface area
injured in relation to
total body surface area
• Most convenient way is
– Rule of Nines
• Lund Browder chart etc
– not useful for initial
survey
• Smaller areas – assessed
by ‘Plamar surface’ = 1%
15. Estimation of the Depth of the
Burns
• Most imp. Parameter for prognosis of long term
morbidity and mortality
• Depth can be assessed by degree of burns
• 1⁰
burns are not included when estimating the total
extent of burns
• Better to over estimate than under estimate the
total %
17. Modes
• Mode of transport include -
1.Ground Transport
• Most commonly used
• Ideally for distances
<120kms
1.Air transport
• Used for long distances
• Transport team should be
able to provide ICU level
care
18. • Aim: Transport the pt in a stable condition
• If travel time is >1hr :
• IV access should be established
• Fluids to be started
• Oxygen should be administered
• If pt unconscious – pt should be ideally be intubated
at the scene of the accident itself
• Initial stabilization should be obtained at the
primary hospital and then shifted to a Burns unit
19. • Burn patient tolerate movement early after injury,
hence no delay is appropriate
• Iv access, catheterization and Ryles tube should be
inserted
• Maintenance of body temperature important during
transfer
• In inhalational injury patient, airwary consideration
is very important
• Endotracheal intubation or tracheostomy should be
performed
20. • Cardiac status should be checked and arrhythmias
should be ruled out before transfer
• Electronic cardiac monitors are available with BP
recording facility
• A physician should accompany the pt and should be
equipped with all the kits
• Intimation and Communication with the receiving
hospital is Important
