First Aid Book2011for Web

7/30/2019 First Aid Book2011for Web

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Royal Adelaide Hospital Burns Unit

First aid and

emergencymanagementof adult burns

Medical Director John Greenwood A.M.Clinical Service Co-Ordinator Sheila Kavanagh O.A.M.

2011 Practice guidelines

Burns Unit Direct Line

Tel: 8222 4462>

or 8222 5512

Fax: 8222 5676>


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Resources available through RAH Burns Service 3

burns assessment team 3>

education 3>

clinical guidelines 3>

clinical services 3>

RAH criteria or Burn Unit reerral 4

First aid: General 5

First aid: 6

scalds 6>

electrical injury 6>

chemical injury 6>

bitumen burns 6>

Emergency management 7-8

Appendix A Community irst aid protocol or thermal injury 9

Appendix B Protocol or the management o chemical skin injuries 10

Appendix C Electrical burn injury 11

Appendix D Escharotomy 12

Appendix E Management o small thermal burns < 15% 13

Appendix F Dressing guidelines or minor burn injuries in adults 14-15

Appendix G Modiied Lund and Browder chart (Adult) 17

Appendix H Blank body chart 18

Appendix I Modiied Parkland luid resuscitation ormula 19

Appendix J Protocol or burn depth assessment 20

Appendix K Protocol or Hydrogel cooling products use 21

Appendix L Primary burn wound care guidelines 22

Appendix M Lower airway injury 23

Appendix N Upper airway injury 24

Appendix O Facial burn 25

Appendix P Management o oot burns 26

Appendix Q Management o hydroluoric acid burns 2% 28

Contents

First aid and emergency management o adult burns, June 2011 page 2


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Resources available through RAH Burns service

Burns assessment team

A ull medical/nursing team is available as an adjunct to MedSTAR in multiple burn>casualty situations

A nurse specialist is available or situations where immediate up-skilling o sta in burn>dressing management is required

Sta education

The Burns Team can provide education sessions tailored to your needs. Current optionsinclude:

all-day education session aimed primarily at nursing and emergency services, with>

breakout sessions or therapy groups, operating room sta etc

evening sessions or GPs normally run in conjunction with the all day session>

evening session o one to our hours duration>

Clinical guidelines

Laminated A3 copies o any ow chart contained with this document are available.>

Laminated A3 posters o the> Guidelines or minor burn managementare available

the> Guidelines or minor burn managementdocument can be downloaded rom theRAH Burns Unit website atwww.rah.sa.gov.au/burns

Clinical services

Advice or acute burn management>

Review o scarring/contractures>

Scar management advice>

Wound management advice>

Psychosocial advice>

Occupational therapy advice>

First aid and emergency management o adult burns, June 2011page 3


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RAH criteria or Burn Unit reerral(Including telephone consultations and patient transfers for persons aged 16 years and over)

1. Burns greater than 10% o total body surace area (TBSA)

2. Burns o special areas ace, hands, major joints, eet and genitalia

3. Full thickness burns

4. Electrical burns to allow or ull assessment

5. Chemical burns to allow or ull assessment

6. Circumerential burns o limbs or chest

7. Burns at the extremes o age (children and elderly)

8. Burn injury in patients with a pre-existing medical disorder (or other disability)

which could complicate management, prolong recovery or increase risk o mortality9. Burns with associated inhalation injury

10. Any burn patient with concomitant trauma

11. Any patient with pre-existing psychiatric disorder that may compromisemanagement

12. Any other burn that the reerring department is not happy about orcondent to send home!

These criteria are based on the Australian and New Zealand BurnAssociation guidelines or Burn Unit reerral.



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Minor BurnContinue cold water irrigation or 20 minutes>

Keep non-burn area warm>

Cover with non-adherent dressing>

Seek medical advice>

Major BurnCold water treatment to burn or up to 20 minutes>

Wrap loosley in clean linen or cling wrap (do not cling wrap the ace or chemical burns)>

Keep warm with outer blanket>

Commence intravenous uids and transport to hospital>

I transer is going to be delayed, reer to Primary burn wound care guidelines >Adults (Appendix L)

Do not hesitate to contact Burns Unit or clarifcation i required>

Ice should never be used it causes vasoconstriction leading to urther tissue damageand hypothermia.

Flame burns (see Appendix A)For ame burns instruct the person to stop, cover, drop and roll extinguish ames>with a blanket

Remove the heat source>

Apply cool running water to the burn or 10-20 minutes>

Resuscitate i necessary.>

Remove non-adherent clothing and potentially constricting jewellery.>

Special cautions exist with the use o hydrogels see Appendix K

General frst aid(See appendix A)

Danger ensure your own saety and wear appropriate personalprotective equipment

Stop the burning process

Cool the burn wound

A Airway (protecting cervical spine)

B Breathing (add oxygen)

C Circulation (add haemorrhage control)



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First aid burn type specifc

Scalds (see Appendix A)

Remove all soaked clothing instantly every second counts as clothing soaked in hot>water retains heat.

A scald is deepest:>

where the clothing is thicker>

where the liquid is held in a natural old o the skin or>

where the clothing is compressed in the natural creases o the body.>

Immediately cool the burn with running cold water or 20 minutes.>

Chemical (see Appendix B):

Protective clothing or frst aid givers>

Remove all contaminated clothing>

Powdered agents should be brushed rom the skin>

Areas o contact should be irrigated with copious amounts o cool running water.>Avoid washing chemical over unaected skin. Take care that ootwear is removedto avoid pooling o the chemical in the shoes

Chemical eye injuries require continuous irrigation until ophthalmological review is>available always ensure that the unaected eye is uppermost when irrigatingto avoid contamination.

Bitumen (see Appendix B)

Immediately drench with cold water until the bitumen has lost all o its heat>

Leave bitumen intact unless it is compromising the airway or circulation.>

Electrical (see Appendix C)

Turn o mains / switch o at source (power point)>

Remove patient rom electricity source, remembering your own saety>

Spine protection> this is o particular importance as ractures o the spine may occurollowing the violent muscular jactitations that occur during the conduction oelectrical current through the body

Cervical spine protection> is mandatory

ECG>



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Emergency management

1. First aid (see Appendix A)

2. Airway management (see Appendix M and N)

Administer oxygen to all patients with a major burn>

Cervical spine protection>

Assess or signs o inhalation injury. Endotracheal intubation is advisable early i signs>o inhalation injury are present

3. Circulatory management

Burns >15% should be given ormal intravenous uid resuscitation as per the>Modifed Parkland Formula (see Appendix I)

Insert two large bore (16G) peripheral cannula (through damaged tissue i necessary)>

4. Insert naso-enteric tube

Burns >20 %>

5. Pain relie

Small doses o IV morphine titrated to pain and sedation scores>

Intramuscular, subcutaneous and oral analgesics are absorbed unreliably in burn injury>due to uid shits and GI stasis

6. Urinary catheter

All patients receiving intravenous uid resuscitation should have a urinary catheter>inserted

7. Assess capillary return and neurovascular perusion regularly

Circumerential extremity burns may obstruct venous return and capillary ow to a>level resulting in muscle ischaemia and necrosis

Elevate limbs>

Contact Burns Unit urgently or advice re management>

Escharotomy may be necessary (see Appendix D)>



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8. Assess eectiveness o ventilation

Circumerential chest burns may restrict ventilatory excursion and a chest escharotomy>may be necessary. Contact the Director o the Burns Unit through RAH switchboardor advice.

9. Emotional support

Severe burns oten occur under stressul circumstances and cause distress to patients,>riends and relatives. Reassurance and good communication are the most importanttools at this time. Local support services should be accessed or ongoing support. TheBurns Unit social worker or clinical psychologist may be contacted through the BurnsUnit or advice and assistance.

Emergency service personnel and hospital sta may also require support and local>critical incident response protocols should be initiated i appropriate. The Burns Unitsocial worker or clinical psychologist may be contacted through the Burns Unit oradvice and assistance.

10. Initial laboratory investigations

Baseline Hb>

Haematocrit>

Electrolytes including blood glucose>

Urinalysis>

Trauma series x-rays>

11. Tetanus immunisation

Follow the NHMRC guidelines>

Australian Immunisation Handbook 8th Edition> or tetanus prophylaxis

Burns are deemed to be a tetanus prone wound>



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Appendix A

First aid and emergency management o adult burns, June 2011

Community irst aid protocol or thermal Injury

Scald Thermal burn Radiant heat/contact

Flame

Clothing on fre

Flash burn toskin only

Running cold water available Still cold water available No water available

20 minutes under coldrunning tap water (~15oC).

Remove jewellery oncecooling commenced.

Submerge burned area inwater or use towels/cloths

soaked in water andapplied to burns. Rereshthe water in the towels

every two to three minutesor total o 20 minutes.Remove jewellery oncecooling commenced.

Smear hydrogel* egBurnAid or hydrogelimpregnated towels

over the surace o theburn. Remove

jewellery once coolingcommenced.

*Consult hydrogel protocol priorto use

Gently pat dry with cleantowel

Cover with cling flm(not ace) or non adherent

dressing

Wrap clean towelaround hydrogel

Seek medical attention/advice. Advice can be obtained on a24 hour basis by phoning the Burns Unit at the Royal

Adelaide Hospital on 8222 5512 or 8222 4462

Take care!Remove scalding agent

(water, hot at etc)

Take care!Extinguish ames

(stop, cover, drop and roll)

Cool the burn wound do not use ice, ice-water or icepacks!!!

Remove hot or soakedclothing

page 9


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Appendix B


Emergency Department protocol or themanagement o chemical skin injuries

Chemical Injury

Personal protective equipment Personal protective equipment

Liquid Bitumen Solid

Alkali AcidCool with

running water orwater soaks

Powder Alkali metal

Do not apply water!

Brush opowder.Remove

adherent largeparticles with

orceps

Pick metalparticles o

skin withorceps

Irrigate withwater using

patientssubjective

cessation o

burningsensation asend-point

Irrigate or upto two hours.

Use thepatients

subjective

cessation oburning

sensation asend-point

Soten and dresswith yellow sot

parafn only

Do notattempt to

removebut allow to

detachspontaneously

over time

Irrigate to thefoor* or upto one hour.

Use thepatients

subjectivecessation o

burning


Irrigate to thefoor* or upto two hours.

Use thepatients

subjectivecessation o

burning


Ophthalmic opinionimmediately i ace involved

Liaise with Burns Unit or advice regardingappropriate dressings

Admit to Burns Unit/ICU as appropriate

*From contaminated area to oor directly to avoid run-o injury to other areas i possible

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Appendix CEmergency Department Protocol or Electrical Burns(low voltage = A/C

jewellery

Standard primary survey ull>trauma clearance

Examine or contact wounds(especially. scalp, hands, eet)

Full (documented) neurological exam- peripheral and spinal nerves

Estimate burn depth and area>

Record on Lund and Browder>chart

Resuscitate i >15% TBSA>

12 lead ECG

Exclude concomitant bone racture/

joint dislocation, particularly shoulderdislocation and thoracolumbar bony injury(even in presence o longstanding historyo joint pain)

Monitor limbs hourly - assess capillary>refll, skin colour and sensation

Compartment syndrome suspected?>(increased tension in compartment,

pain on passive stretching, decreasedperipheral sensation, prolongedcapillary refll)

I abnormalities or history o>unconsciousness, admit and cardiacmonitor or 24 hours in monitored bed

Repeat cardiac enzymes 6 hourly>

Contact Burns Unit and plasticsregistrar re admissionWrap loosely in cling flm (not acial burns)

Immediate contact Burns Fellow/Director or asciotomy and admission

Catheterise - i haemochromogenuria/>pigment in urine then increase uidsto give urine output >2ml/kg/hr

Consider mannitol 12g/l administered>uid and urine alkalinisation

page 11


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Appendix DEscharotomy


In the presence o any circumerential burn, advice should be sought romthe Burns Unit consultant (contact through RAH switchboard 8222 4000).

An escharotomy should be considered when there is

a circumerential deep dermal or ull thickness burninjury (dry wound) and where:

a delay in transer to the tertiary Burns Unit is>expected

or

there is evidence o circulatory compromise indicated>by an extended capillary refll time compared tounburned or non circumerential burned limb.

Escharotomy is designed to divide inelastic burned skinand the incision does not usually need to be extendedar into the underlying at.

This procedure is not to be undertaken lightly, as it hasthe potential or considerable damage to underlyingstructures. These include:

common peroneal nerve at the outside o the knee>(over neck o Fibula)

radial nerve at the wrist (superfcial branch)>

ulnar nerve at the elbow>

cephalic vein at the wrist>

great saphenous vein and nerve at ankle.>

Equipment

Local anaesthetic infltration with Adrenaline (i patient awake)>

Povidone lodine>

Cutting monopolar diathermy with either needle or blads (set to equal cutting/>coagulation). A normal scalpel may be used in the absence o this but more bleedingshould be expected

Bipolar diathermy or haemostasis>

Kaltostat> TM or dressing escharotomy wound. Cover with antibacterial dressing andbandage then elevate limb.

page 12


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Appendix E


Management o small thermal burns (


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Appendix F Dressing guidelines or minor burn injuries in adultsPlease refer to RAH Criteria for Burn Unit referral (Including telephone consultations and patient transfers)

Aims o burn wound dressings

Promote healing>

Prevent desiccation o the wound>

Prevent or treat inection>

Patient comort pain, exudate, odour management>

Ease o management or patient and sta>

Allow normal movement>

Initial burn wound care

Remove restrictive jewellery (ie rings) as soon as possible>

Pain relie superfcial and partial thickness burns are very painul>

Wash area with antiseptic sponge eg Medisponge>

Shave any body hair rom burn wound and at least 2.5cm margin surrounding burn>site (do not shave eyebrows)

Debride blisters and remove all loose burned tissue>

Assess wound depth by pressing on wound bed and looking or presence o capillary>refll according to the burn wound assessment chart (Appendix J)

Use the appropriate dressing based on the wound depth, site and likelihood o> inection

Elevation o limbs to reduce oedema ormation>

Superfcial burns unblistered (erythema, sunburn or healed burns)

Wash with non-perumed soap and dry well>

Apply moisturising cream. May need to do this several times a day>

Advise patient regarding the use o sun-block agents>

physical hats and long sleeved shirts

chemical SPF actor 30+

Important note

Partial thickness burns due to petrol, riction, lames, chemicals cooking water, hot oilor other contaminated/car radiator water dirty materials oten become inected resultingin burn wound progression ie tissue death requiring surgical intervention. It is prudent totreat these with a topical anti-bacterial (silver containing) dressing. Systemic antibiotics

are usually only used when there has been organisms identiied in conjunction with aclinical picture o a wound inection.



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Superfcial burns/clean partial thickness burns

I exudate present (usually frst 72 hours) Hydrocolloid dressing eg Duoderm> TM

Will need changing within 48 hours otherwise it will leak and become malodorous>

When exudate ceases, dressing can change to a retention dressing such as Hypafx> TMwhich can be changed every three days

Patient can then wash over the Hypafx> TM twice a day with gentle soap and water andpat dry with a clean towel

Use an adhesive remover such as Zo> TM to remove HypafxTM. In the absence o acommercial adhesive remover, liquid parafn or vegetable oil can be used. This shouldbe applied to the Hypafx 60 minutes beore attempting to remove it. This will avoid

traumatic removal o new epithelium

Contaminated/inected partial thickness burns

Small ull thickness burns (eg under size o a 20 cent piece)

Three day ActicoatTM

Apply Acticoat> TM directly to wound, secure with HypafxTM

Patient instructed to keep dressing activated by dampening under tap at home once a>day or when dressing starts to eel too dry

For some patients, it can cause a stinging or burning sensation on application. This>can be minimised by resting the product ater activation with water or a couple o

minutes beore application.

Silver Sulphadiazine CreamTM (SSD)

Apply a one centimetre thick layer o SSD cream to the wound with secondary>dressing otherwise drying out will occur making dressing removal difcult and/orpainul

SSD needs to be washed o the wound (Medisponge) and redressed daily>

SSD can change partial thickness wound appearance, making it look as though the>wound has become deeper

Not recommended or anyone with a sulphur allergy>

Do not use on the ace can cause corneal ulceration>

For some patients it can cause a stinging or burning sensation on application, i this>does not settle within 30 minutes remove SSD and choose alternative dressing



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Facial Burns (Appendix O)

Ophthalmic review (within 12 hours)>

Male patients shave one or twice daily depending on rate o beard growth>

Daily hair wash>

Four hourly cleaning o acial burns with normal saline using aseptic technique.>Debride the blisters and remove crusts. Pay particular attention to eye and ear care

Apply sterile sot parafn to raw areas.>

Apply moisturising cream to healed areas>

Advise patient to stay out o sun and dusty conditions>

Oedema

Swelling to the burned area can be reduced by elevation>

Patients with burns to the ace and neck are best nursed sitting up (~45> 0 at the hip)

Considerations for hospital admission

Pain not adequately controlled with oral analgesia>

Inection cellulitis o burn wound requiring intravenous antibiotics>

Need or bed rest with lower limb(s) elevated>

Living alone and inadequate support at home>

Inability to cope with own dressing care>

Transport difculties eg getting to appointments or dressing changes>



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Appendix G Modifed Lund and Browder chart (adult)

4 3

61/2

4 4

13132 2 2 2

11/2

11/2

11/2

11/4

11/2

21/2

21/21

13/4

1

1

11/4

11/4

21/2

21/2

31/2

31/2

61/2

11/4

13/4

13/4

13/4

Anterior52

Posterior48



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Appendix H

Anterior Posterior



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Appendix IRoyal Adelaide Hospital modifed Parkland resuscitation protocol or adultswith >15% total burn surace area

Assess total burns surace area (TBSA) using the Lund and Browder chart.>

Assess patient body weight as accurately as possible (in kilogrammes).>

First 24 hours Total Fluid requirement derived via ormula:> Total (mls) = 4ml x weight kg x % TBSA

In the frst period o eight hours rom the time o the burn,> give one hal o thetotal calculated fuid required as Hartmanns solution. Normal saline may be used iHartmanns solution is not available. Timing begins at the time o the burn,not at thetime o arrival at hospital

Maintenance uid is not required in adultsDuring the second period o 16 hours, give the remaining> hal o the calculatedtotal fuid requirement as Hartmans solution. Normal saline may be used iHartmanns solution is not available.

Second 24 hours uid requirement is Albumex 4 via the ormula:> Total (mls) = 0.5ml x weight kg x % TBSA

The patient may need no urther intravenous uid>

The urine output should be measured each hour and the Medical Ofcer notifed every>

two-hour period

The urine output is to be maintained between 0.5ml and 1ml per kilogram body>weight per hour

Venous blood should be sent or Hb, PCV and Serum Electrolytes on admission and>6-hourly until transer

Monitoring>

Indwelling catheter mandatory>

Nasogastric tube i indicated>



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Appendix JBurn wound assessment chart


*A positive Nikolsky signoccurs when the epidermis oskin detaches rom the dermis/burn bed with slight riction.

Protocol or burn depth assessment

Epidermal

Thin walledor popped

Supericial

dermalOther signs:

blanches withpressure, very

painul, very oozy

Yes Is there epidermalintegrity? (NikolskySign* see below)

No

Run a gloved inger over the burn

Type o blister Yes NoIs it

slippery?

Thick walled

Mid dermal

Other signs: somemottling, blanching

sluggish, darker/red base, some

anaesthesia, lessoozy

Red Burn Colour

White

Full thicknessOther signs:

anaesthesia, noreilling ater

blanching, maybe amber and

translucent withvisible black vessels,may be waxy, hairsall out easily, dry

Deep dermal

Other signs:decreasedsensation, absent

or reducedreilling ater

blanching, ixedmottling, little or

no ooze

Look at the burn

page 20


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Appendix KUse o hydrogel cooling products or burn Injury frst aid and primarywound dressing care

Low risk

> Use as permanuacturersguidelines.

> Monitorpatientstemperatureregularly

> Warm nonburned areas

High risk

Hydrogel productsshould only beused or initialcooling (a periodo no more than20 minutes).Ater that timethey should beremoved

B. Patient risk

Extreme

> Neonates

High

> The very young

> The elderly

> Burn surace area > 15%

Low

> Burns Fit healthy persons 10 60 yo

A. Burn assessment

> Cause o burn

> First aid (type and length)

> Depth

> % total burn surace area (TBSA)

> Site o burn

> Immediate risk to circulation/ventilation

> Need or transer to RAH Burns

Unit

Burn assessment(see A)

Chemical andcold injuryburns

Do not use

Please contactRAH Burnsregistrarthrough RAHswitchboard(8222 4000) oradvice

Thermal,electrical

andionisingradiation

burns

Assess patientrisk (see B)

Extreme

Hydrogel productsshould only beused or NO morethan 10 minutes,then removed



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Appendix LPrimary burn wound care guidelines adults

Emergency burnmanagement

(see A)

Burn assessment(see B)

Transer to RAH

Burns Unit(see C)

Minor Burnsuitable or local

management(see D)

A. Emergency management

Reer RAH frst aid and emergencymanagement guidelines

B. Burn assessment > Cause o burn

> First aid (type and length)

> Depth

> % total body surace area (TBSA)

> Site o burn

> Immediate risk to circulation/ventilation

> Need or transer/consultation* to RAH

Burns Unit

C. Transer to RAH burns unit

Note: hydrogel products such as Burn AidTM

specically designed or burn rst aid useare those reerred to below.

Anticipated time to arrival at RAH.

Face - wet soaks or hydrogel(see hydrogel protocol.

> Other burn areas - cling flm or hydrogel(see hydrogel protocol).

1 - 4 hours

> Face wet soaks, sot parafn orhydrogel (see hydrogel protocol).

> Other burn areas cling flm orhydrogel (see hydrogel protocol).

4 - 24hours

> Face sot parafn.

> Other burn areas Atrauman AgTM/InadineTM

>24 Hours

> Face sot parafn.

> Other burn areas ActicoatTM

D. Minor burn or localmanagement

> Follow RAH dressing guidelines orminor burn management


For any chemical injury pleasecontact RAH Burns registrarthrough RAH switchboard(8222 4000) or advice.

*Consultation may consist o discussion, or the traner o photographic images o burn injury or appropriate advice

page 22


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Appendix MLower airway injury

Lower airway injury low risk

> Flash or short contact with

thermal agent> No confnement in smoke

flled environment

> Scald injury

> Contact burn injury

> Normal mentation/speech

> Normal appearance onbronchoscopy below

the cords

Lower airway injury high risk

> History o prolonged confnement in smoke flled

environment ie house or car fre, including under car hood

> Signifcant acial burns> History o unconsciousness or obtundation

> Raised carboxyhaemoglobin

> Hypoxia

> Respiratory difculty (dyspnoea, tachypnoea, increased

use o accessory muscles and increased work o breathing)

> Sooty or productive sputum

> Conusion, obtundation, unconsciousness

> Wheezing or added sounds on auscultation

> Abnormal fnding below the cords on bronchoscopy

I lower airway risk low

Rx

> O2

> Trauma Clearance ASAP

> Elevate 45 at hips when C-spine clear

> Chest X-ray

> Notiy duty ICU Dr

> Notiy burns registrar

Obs> Continuous SaO2> Continuous visual observation

> 15 minute airway observations

Placement: Burns Unit

I lower airway risk high

Rx

> O2> Trauma Clearance ASAP> Elevate 45 at hips when C-spine clear> Chest X-ray> Intubation long term (i required)> ABGs> ? nebulised Adrenaline/Heliox> Bronchoscopy/review survival status

Obs

> Continuous SaO2

> Continuous visual observation


Placement: HDU/ICU

No deterioration in condition

> O2

> Continuous SaO2

> 1/24 observations



Deterioration in condition code blue

> Contact duty anaesthetist

> Intubate

> ICU

0 hours

Time o injury

4 hours post injury90% oedemapresent

12 hours post injurymaximal oedema(superfcial burn)

18 hours post injurymaximal oedema(deep burn)


> Continuous SaO2

> 4/24 observations





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Appendix NUpper Airway Injury

Upper airway injury low risk

> History o ash or short contact with thermal

agent such gas/petrol explosion characterized bysuperfcial acial burn or erythema, with somesinging o acial hair/nostril hair.

> Normal voice at initial examination

Upper airway injury high risk

> Burns to mouth, nose and

pharynx> Steam inhalation

> Intra oral burns or blisters

> Hoarse voice

> Inspiratory stridor

I upper airway risk low

Rx

> O2> Trauma Clearance ASAP


> Chest X-ray

> Notiy duty ICU Dr

> Notiy burns registrar

Obs> Continuous SaO2> Continuous visual observation



I upper airway risk high

Rx

> O2> Trauma Clearance ASAP

> Elevate 45 at hips when C-spineclear

> Chest x-ray

> Intubation short term (i required)

> ABGs

> ? nebulised Adrenaline/Heliox

Obs> Continuous SaO2

> Continuous visual observation


Placement: HDU/ICU


> O2

> Continuous SaO2

> 1/24 observations



Deterioration in condition code blue

> Contact duty anaesthetist

> Intubate

> ICU

0 hours

Time o injury

4 hours post injury90% oedemapresent

12 hours post injurymaximal oedema(superfcial burn)

18 hours post injury

maximal oedema(deep burn)


> Continuous SaO2

> 4/24 observations





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Appendix OManagement o acial burns

Supercial

Mid dermal

Theatre ordebridement

Discuss with burnsconsultant re orderor Chloramphenicol

ointment

Possibility o Herpessimplex burninection (especiallycoldsore suerers)

Signs o Inection

> Pain

> Vascularity

Wound>deterioration

Abnormal ooze>

Odour>

Overgranulation>

Deep dermal

Full Thickness

Intubated? Yes

Four hourly sot paran Aquacel Ag

Four hourly sot

paran

Swab wound Bacteriology

Virology

Start Acyclovir

No

Facial burns mandatoryeye stanining



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Management o burns to the oot

Clean skin>

Moisturising cream>

Massage>

Analgesia>

Elevation (toilet privileges>only)

Analgesia>

Meticulous wound cleaning>

De-roo blisters>

Silver dressing>

Consider antibiotics>(depends on aetiology andlikely patient compliancewith treatment)

Consider hospital admission>i patient unlikely toelevate oot or 24 hours(ie mothers with youngchildren)

Assess wound every>three days

Elevation (toilet privileges>only)

Analgesia>

Meticulous wound cleaning>

De-roo blisters>

Silver dressing>

Routine antibiotics>

Consider hospital admission>i patient unlikely to elevateoot or 24 hours

Assess wound every>two days

Discuss withburn consultant

Assess burndepth

Mid dermalSupericial dermalEpidermal (sunburn/no blistering

Full thickness/Deep dermal

Yes No

Does the patient have diabetes mellitus/paraplegia or otherperipheral vascular disease?

Appendix P


Each oot is colonised by 1,000,000,000,000 bacteria. Inadequate management ooot burns requently results in serious inection. This can then lead to a need or skin

grating (where spontaneous healing was expected) and even digital/other amputation.

Avoid any constrictive/abrasive ootwear. Loose ootwear should be worn ie thongs orslippers. Initial elevation or at least 24 hours is o utmost importance in preventing burndepth progression. Time o work should be considered especially or those whose jobsentail standing or a hot dusty dirty environment.

page 26


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Intra-arterial (via radial artery) injection o 10% calciumgluconate (ater Allens test shows patient ulnar artery)

Spreading/continuing ache


Consider isolated limb perusion

Intravenous injective o calcium gluconate using modiiedBiers Block technique

Wash and reapply gel every15 minutes or one hour orcessation o pain, considerremoval o nails and application

o gel to bed i aected

No Deep tissue discomortdevelops

Irrigation or 30 minutes to one hour to

remove H+ ion eect (burn); ends with patientssubjective cessation o burning sensation

Apply calcium gluconate 10% gel to skin oentire burn area. Wash and reapply gel every15 minutes

I primary survey passed transport to RAH, i

not, consult at nearest Trauma Centre

No deep tissuediscomort

Burns Unitconsultant andtoxicology consults

Deep tissue discomort(aching/painsubcutaneously)

Burn Unit admission overnightthen D/C and standard FU


>1 digit aectedSingle digit: sites o aching/deep pain injected with10% calcium gluconatesolution 0.5cm2 into aected

subcutaneous tissue, pulpspaces and compartments odigit. I nail bed aected, nailremoval mandatory ollowedby injection into nail bed

Hydrouoric Acid Treatment Protocol (Burns


28/28

Hydrouoric Acid Treatment Protocol (Burns >2% TBSA orHF concentration >10%)

Patient is at risk o systemic luoride poisoning

Immediate Burn Unit and toxicology consultation

Local burn management as per protocol or

Documents

First Aid Book2011for Web