Inclusion Criteria: Adult or pediatric patients with thermal, chemical, and/or electrical burns, and/or those who have sustained inhalation injuries. Hypotension in the presence of burns suggests other trauma. Refer to the TRAUMA guidelines, as needed. Aggressive pain management, monitoring of airway patency and temperature control to prevent hypothermia are critical.
- Assess and support ABCs. Look closely for evidence of inhalation injury (hoarseness, stridor, sooty sputum, facial burns, or singed nasal or facial hair) and be prepared to manage the airway aggressively.
- Is spinal injury is suspected, initiate spinal motion restrictions; refer to the SPINAL MOTION RESTRICTION Policy. If spinal injury is not suspected, place the patient in a position of comfort. If there is evidence of shock, place the patient supine with the feet elevated, if tolerated, and closely monitor the airway. Treat shock according to the SHOCK Guidelines.
- Administer oxygen, as needed, to maintain a SpO2 of at least 94%.
- Remove and secure any jewelry, belts, shoes and other items from burned areas. Remove burned or singed clothing that is not stuck to the skin. Remove contact lenses, if possible, especially for facial burns and/or chemical exposure.
- Control any obvious external hemorrhage. Prevent hypothermia and initiate care for burn wounds:
- Chemical injury – Brush off dry chemical and flush with water to remove any residual chemical.
- Thermal injury – Apply dry sterile dressings.
- Begin transport as soon as possible. Major and moderate burns require transport to a burn center*.
- IV fluid resuscitation, as needed to maintain adequate perfusion. Do not exceed 1 liter of IV fluids unless authorized by BioTel. Contact BioTel for fluid orders in patients with congestive heart failure, cardiac disease, or age greater than 65 years.
- Apply continuous ECG and ETCO2 monitors, if respiratory distress or shock is present, anticipated or develops. Monitor carbon monoxide (SpCO) levels, if possible, especially for closed-space and suspected inhalation injury. ECG monitoring is mandatory if electrical injury is present or suspected.
- Follow PAIN MANAGEMENT Guidelines.
- For additional patient care considerations not covered under standing orders, consult BioTel.
*Patients Requiring Transport to a Burn Center
- Burns greater than 10% of total body surface area (TBSA), regardless of the depth
- Burns of face, eyes, ears, hands, feet, genitalia, perineum, or involving major joints
- Full-thickness (3rd-degree) burns of any size in any age patient
- Electrical burns (including lightning)
- Chemical burns
- Inhalation injury (including smoke inhalation)
- Burns associated with traumatic injuries (e.g., fractures)
- Burns in patients with pre-existing medical conditions or comorbidities (e.g. elderly, immunosuppressed, diabetic, cardiac history, etc.)
- Burns in patients needing special social, emotional, or rehabilitative intervention