The immediate management of a

Peter Lindle, Consultant Paramedic, [email protected]

@PeterLindle

1 http://emj.bmj.com/content/emermed/21/1/112.full.pdf

2 http://79.170.40.160/britishburnassociation.org/wp- content/uploads/2017/06/BBA_First_Aid_Position_Statement_ final_25.8.15.pdf

3 4 1. SAFE approach 2. Stop the burning process 3. Cool the burn 4. Dressings 5. AcBC 6. Assess burn severity 7. Cannulation and IV fluids 8. Analgesia 9. Transport

5 1. SAFE approach

• Shout or call for help • Assess the scene for danger • Free from danger? • Evaluate the casualty

6 2. Stop the burning process

• Stop, extinguish, remove patient from source, brush off dry chemicals • Remove jewellery, burnt clothing (unless stuck), bring with patient • If , ID chemical, may need extended irrigation or neutralising agent

7 3. Cool the burn

• Irrigate with water for 20 mins, effective up to 3 hours post injury, en route if possible • Do not use ice or ice water • Cool the burn, not the patient • Chemical may require extended irrigation

8 4. Dressings

• To control pain and keep the wound clean • Clingfilm, used in sheets, not wrapped circumferentially • Wet dressings for chemical burns, beware those that react with water • Wrap patient in blankets

9 5. AcBC

• Airway with c-spine immobilisation • Breathing • Circulation • Assess and manage co-existing injury • Give oxygen unless wound very small and/or no suspicion of inhalation injury 10 Signs of inhalation injury

• Burns to nose, mouth, face • Singed hair • Carbonaceous sputum • Hoarseness, laryngeal stridor, cough

11 6. Assessment of severity

• Estimate the size of burn • Wallace Rule of Nines • Patient’s palmar surface including adducted fingers • Consider obesity and larger tissue area when estimating burn size • Assessment of depth unnecessary

12 Document

• How the patient was burned • Time of injury, length of exposure to source • Temperature of source • First aid? • Time and volume of infusions • Any suspicion of NAI?

13 Cannulation and IV fluids

• Do not delay on scene time, x2 attempts en route • <15% no fluid • >15% <25% and travel time >30 mins= 1 litre • >25%= 1 litre • Normal saline, warmed if possible

14 8. Analgesia

• Cool and cover the burn area • Titrated opiate with anti-emetic • Entonox if nothing else

15 9. Transport

• Minimise on scene time • Liaise with Trauma Desk? • to specialist centre? • Air transport/ modified primary or secondary retrieval? • ATMIST standby call and handover

16 Trauma Desk/ Specialist Services Desk

17 Trauma triage

18 Burn triage?

19 Case study

20 21