ED treatment for severe burn victim

[jcast2213]

Hi all,

I'm doing a presentation on the different degrees of burns as well as the treatment given in the ED when a burn victim comes in.

I was involved with the trauma team as a phlebotomist for a case like this nearly a year ago and just don't remember all the things we did.

I remember giving the patient a tetorifice shot, starting an IV and pumping fluids and electrolytes, keeping the patient warm, etc. They also knocked the patient out with some kind of white/milky medicine they injected into an IV in the knee. After that, the patient was intubated even though he was talking just fine.

I guess what I'm asking is clarification on why we did the things we did and what other things you do in your hospital. Thank you so much!

[Wuzzie]

What is this presentation for?

[jcast2213]

It's a presentation for my Pathophysiology class.

[chare]

Why don't you start by showing us what your research on burn treatment has revealed?

[jcast2213]

I've covered first-degree, second-degree, and third-degree signs and treatment. My last powerpoint slide I want to put how third-degree burns are treated as a trauma situation in the ED. I want to list it how it would actually be done in a trauma situation like what I'd do first, second, third, etc.

[chare]

I've covered first-degree, second-degree, and third-degree signs and treatment. My last powerpoint slide I want to put how third-degree burns are treated as a trauma situation in the ED. I want to list it how it would actually be done in a trauma situation like what I'd do first, second, third, etc.

Again, why dont you start by showing us what your research has revealed regarding ED treatment of burn patients.

[jcast2213]

As I stated above......

IV, keep them warm, tetorifice shot, intubation. That's all I know.

[chare]

Deleted.

[marienm, RN, CCRN]

Let me point you in the direction of "burn resuscitation," which is the general term for the first 24-48 hours of care for a serious burn. It focuses mostly on fluids...we do not actually just pump then full of fluids without monitoring their response...and what to monitor for.

Like any emergency, focus on the ABCs: your patient's Airway was managed...why do you think this could have been necessary? What sequelae from the burn could have made this necessary? Do you think giving someone a lot of IV fluid and pain medicine could affect their airway?

How would you monitor their Breathing? (Honestly, this one is probably beyond the scope of your pathophys class and requires a basic understanding of ventilators to fully grasp, but look up "indications for chest escharotomy" for one line of thought.)

How would you monitor their circulation? Burn patients lose a lot of fluid that can't be measured...how do you know that some of their blood is still perfusing their vital organs *especially* now that the patient has been sedated with diprivan (Propofol...the milky white stuff) and you can't do a full neuro assessment?

If you can answer all that, your next step is trimming it all down to fit on one slide :) I am glad you're trying to get a good understanding of this, but it's broader than your experience in the ED led you to believe. (Once you become an RN, take an ABLS class and come work in the burn unit!)

[phoenixrn]

1) We don't refer to them as victims unless they're dead. Burn SURVIVOR.

2) The primary focus of the ER should be to stabilize the patient and get them to a Burn Center as quickly as possible. Parkland Formula should be the standard guiding fluid resuscitation, then we often titrate per urine output in the ICB.

3) To explain why your patient was intubated, we'd need to know several factors.... was there any smoke inhalation? Were they burned in the face, neck or chest regions? Are they a very large, very deep burn? All of those are indicators that intubation is necessary to protect the airway.

4) The true damage and illness associated with large burns often doesn't present until hours after the injury. Patients can walk and talk in the ER.... but the next day be intubated, sedated, in pulmonary edema and kidney failure, and unrecognizable because of third-spacing.... sometimes taking months of hospitalization before they can go to rehab.

5) The milky stuff was probably propofol.

[marienm, RN, CCRN]

2) The primary focus of the ER should be to stabilize the patient and get them to a Burn Center as quickly as possible. Parkland Formula should be the standard guiding fluid resuscitation, then we often titrate per urine output in the ICB.

The American Burn Association currently recommends the modified Brooke formula instead of the Parkland formula. (2mL x kg x TBSA). Urine output goals are 30-50 mL/hour or 0.5mL/kg/hr except in rhabdo and titrate fluids up or down by 1/3 hourly to achieve goal. (Of course, many burn centers have much more complicated formulas they follow, but if an ED was caring for a burn patient for several hours this would be a good start.)