Burns

Burn Assessment

■ Depth of burn (1st; epidermis, 2nd; epidermis and partial dermis, or 3rd; penetrating the dermis and underlying tissues).

■ Percentage of TBSA involved.

■ Age of the Pt (age + TBSA = % probability of mortality).

■ Pulmonary injury (smoke inhalation, toxic fumes).

■ Associated injuries (airway burns and other trauma).

■ Special considerations (chemical/electrical burns, CO poisoning).

■ Preexisting diseases (potential for exacerbation).

Emergency Management (may need MD order)

■ Establish and manage ABCs and intubate if indicated.

Use c-spine precautions if traumatic injury is suspected.

■ Administer 100% oxygen via NRB mask or use BVM if indicated.

■ Obtain IV access and titrate to hemodynamic status.

■ Attach ECG monitor and manage dysrhythmias per ACLS.

■ Order and review labs (glucose, BUN, creatinine, CBC, electrolytes, PT, and PTT).

Fluid Replacement—First 24 hr (Start From Time of Injury)

■ 4 mL x percentage of BSA x weight (kg).

■ Infuse half over 1st 8 hrs, a fourth over 2nd 8 hrs, and a fourth over last 8 hrs.