First Aid & Transportation of Burns patient

- Dr Abhay Agrawal

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

• 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

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

• 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

• 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

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

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

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

• 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

• 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

• 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

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

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%

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 %

Transportation

• Transportation involves – 1. Shifting from the Injury site to Initial Care Facility

2. Transfer from the Initial care facility to Burns Unit

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

• 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

• 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

• 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

• Thank you