ER nurse wondering whats the best way to treat burns

I'd be listening to the burn unit nurse. The heat loss is just a fact of life with burns and we tend to keep the room toasty to minimize it as much as possible. There's also huge fluid losses that the wet-to-dry tend to mitigate somewhat. The key is to cover the open areas to protect from infection until they can be transferred to the burn unit and be seen by plastics.

I would ask the ER attending to order Silvadene. It's pretty much the standard treatment initially for burns, at least for the first dressing. Silvadene, covered with a non-adherent dressing (adaptec non-adherent gauze) and then wrapped with kerlix (not tightly).

I hated it when I would see patients in wet dressings upon transfer, especially on children. Xeroform is the next best thing if you can't get an order for silvadene. It'll keep the wound covered without adhering to the wound itself. And wrap that with kerlix.

The nurses at the burn center are going to change the dressing upon arrival anyway to assess the burns, so it doesn't have to look pretty, it just needs to be functional.

ABLS (Advanced Burn Life Support, sponsored by the American Burn Association, required training for all in my unit) states that any burns over 20% TBSA are to go into DRY DRESSINGS. Heat loss is not "just a fact of life" with burn patients, hypothermia can kill a burn patient just as surely as sepsis. If you just want to temporarily cover the burns for transport to the unit, sterile towels moistened (NOT WET) with NS are OK. Xeroform would be OK, silvadene would probably be better, except for the fact that, like Sondheim said, the dressings are coming off when the pt gets to the burn unit anyway.

I guess my main question would be, is your burn unit in-house or do the patients have to be air/ground transported to the burn center? If it's in house, the moistened sterile towels (covered in warm blankets) will work. If it's an external transfer, silvadene covered with kerlex, then burn net.

Next time, I would also recommend starting LR instead of NS, per the Parkland Burn Resuscitation Formula (2-4 cc fluid x weight in kg x % TBSA, give 1st half in 8 hours, give 2nd half over 16 hours).

I sincerely appreciate your asking the question here as a way to improve your practice. I have seen more than a few mishandled major burns in my almost 2 years in a major burn center.

Mike in Michigan

Nice reply Mike! I think the few things to remember is the percentage of body surface the burn covers, the area (airway involvement always keep in mind inhalation injuries.INTUBATE INTUBATE,INTUBATE--when in doubt-INTUBATE!!!!!!) You can always extubate. It is also the best way to manage pain too-when properly sedated and paralyzed while on the vent. Airways go bad VERY FAST!!!
ALWAYS CALL the BURN CENTER and take orders from them--they are the Gurus!!
-Keep in mind the distance of transport- a reputable transport team will (should) also know what to do.
-Lastly remember allergies- Silvadene contains Sulfa.