3-17. THERMAL BURNS: MANAGEMENT
a. History. Observe the scene of the injury. Find out how long the burn
occurred before help arrived. Try to obtain the answers to these questions.
What has the patient or bystanders done for the injury?
(2) Was the patient in a closed space with smoke, steam, or other products
of combustion? If so, for how long? Did the patient lose consciousness?
What was the patient burned with? Open flame? Hot liquids?
(4) Does the patient have any history of significant heart disease which
might complicate fluid therapy? Pulmonary problems which might cause a reaction to
smoke inhalation? Other underlying illnesses?
b. General Treatment.
(1) Remove the casualty from the source of the burn. Smother any flames
and turn off the electrical source. Extinguish and cut off burning clothes, etc. That is,
generally, eliminate the cause of the burn.
(2) Maintain the airway, continually assessing for patency (making sure the
airway is open).
Administer humidified oxygen.
Assess vital signs.
(5) Remove the patient's clothing and constrictive articles such as rings and
bracelets. Clothing may continue to smolder so cut it away. DO NOT pull away clothing
if it is stuck to the skin.
(6) Evaluate the casualty for other injuries such as hemorrhage or central
nervous system injury.
(7) Treat for shock. Start an IV to replace body fluids. Use a large-bore
catheter. For burns that are greater than 20 percent of the TBSA and for significant
electrical burns, perform gastric intubation. (Later in this lesson, you will be instructed
how to determine the amount of fluid to give, depending on the casualty's body weight
and the total body surface area burned.)
(8) Perform urinary catheterization if the burns are greater than 20 percent
of the body surface and the patient has significant electrical burns.