First response for severe burn??

EricJRN, MSN, RN · Jul 13, 2006

Moongirl,

I'm sorry to hear about your friend. From your post, it sounds like you're talking about burns that cover a large percentage of the body surface. In these cases, most prehospital care authorities recommend covering the burned areas with clean, dry sheets while waiting for help. Some authorities say that you can initially apply cool water to the burn (for a minute or two max), but the risk there is that it might make hypothermia and infection (two common and lethal complications of burns) more likely to occur down the road.

tridil2000, MSN, RN · Jul 13, 2006

Hi,
I have not learned this yet, so I was wondering if anyone could help with some information on burn victims. If someone has caught on fire with an accelerant (gasoline) once you have extiguished the flames.. what next till emergency help arrives? do you keep them covered? wrap them in cold wet towels?? REcently, this happened to a friend and I am panicked at the thought that I wouldnt have had a clue what to do had I been ther
Thanks for all responses

what you would have done is almost irrelevant bc some say wet dressings and some say dry.

however, you can do A LOT for your friend now. he or she is in pain and facing tons of reconstructive surgeries, as well as disfigurement concerns.

those first minutes have passed. be there NOW for your friend as she goes through weeks of grueling rehab.

TazziRN, RN · Jul 13, 2006

What Eric said. You NEVER use wet dressings in the field for a large percentage burn because of hypothermia. People with large 3rd degree burns have little or no skin left to hold in the heat, and the body temp drops fast. Clean dry coverings are recommended. If the burn covers a small area (less than an extremity) then cool dressings can be applied as long as you watch for shivering and cover the pt with a coat or blanket.

nerrollus · Jul 13, 2006

Hi,
I have not learned this yet, so I was wondering if anyone could help with some information on burn victims. If someone has caught on fire with an accelerant (gasoline) once you have extiguished the flames.. what next till emergency help arrives? do you keep them covered? wrap them in cold wet towels?? REcently, this happened to a friend and I am panicked at the thought that I wouldnt have had a clue what to do had I been ther
Thanks for all responses

UGh, had a long reply typed out and my inet connection dropped after I hit submit. I'll try to get it all back up here again.

Just went over this in EMT school, so I'll try to repeat this all back best I can. :)

1) AIRWAY/BREATHING!! Primary concern should be the airway. Burn victoms will often times breath in super heated air, smoke, toxic fumes, etc that will cause their airway to swell up and stop them from breathing.

Steps are A) Open airway: Use the held tilt chin lift, or jaw thrust manuver depending on if there's a chance of a c-spin injury or not. B) Look: Look in their mouth and make sure there's no obstructions. #1 cause of airway obstructions for unresponsive patients is their own tongue. Head tilt or jawthrust should help with this. Make sure there's no vomit, dirt, rocks, wild animals, etc in there. C) Listen: Put your ear down on their mouth and listen. Make sure air is going in and out. D) Feel: Put your hand on their chest and make sure their chest is moving and they're getting good tidal volume. Also feel against your cheak to see if you can feel air coming out of them.

You may need to do rescue breathing if they're not breathing well enough. (Think it's less than 8 breaths per minute or not getting good tidial volume) Basically you do mouth to mouth, BVM, mouth to mask, whatever 1 breath every 5 seconds for adult or 1 breath every 3 seconds for children. This ensures they're getting oxygen in their lungs.

Odds are you won't have the following things available to you, but some firefighters/EMT/Paramedics/etc cary jump kits with them in their personal vehicals. You can use oral/nasalpharangils(sp?) depending on the patients LOC to help maintain an airway. The might also have a BVM (Bag Valve Mask) if you need to do some breathing for them. And of course high flow oxygen at 15 LPM. Like I said, that stuff probably won't be there, but just in case...

2) Second part is going to depend on how bad their burns are. If they've got major burns all over, you're want to use clean/DRY blankets, sheets, whatever to keep them warm. Whenever the skin gets burned with 2nd or 3rd degree burns it looses its ability to regulate the bodies temp. This can lead to hypothermia if they're not kept warm. This is also why you don't want to use damp/wet towls, sheets, whatever. It remotes heat faster, making them hypthermic faster, and the water also allows bacteria stick to the wounds and leads to infection. Never get 2nd or 3rd degree burns wet!! Warm and dry! Can't stress this enough.

If they've got a 1st degree, also called superficial, burns you need to remove any clothing around the area, flush with sterial water to get any junk off it, then cover the area with clean/DRY dressings.

If someone has sustained burns to their hands or feet and you're going to dress the areas, make SURE you put clean/DRY dressings between their fingers and toes. This keeps the skin from sticking together and tearing apart later when the burns are being treated.

Never put any kind of burn cream, neosporin, disinfectents, alchol, hydroden poroxide, etc on a burn (or any wound for that matter) out in the field. This just makes baceria and such stick to the wonders and promotes infection. This should only be done in a hospital setting in a controlled enviroment where they can make sure the wound is clean and stay that way.

3) Once you've got their airway maintained and patent, got them warm and dry, and of course away from the fire: Get them to a hospital ASAP. 911 should have already been called so they can get a bus ride there.

Try not to move them around too much if you can help it. Once the skin gets burned real bad, moving them can cause the skin to tear or rip off them. It's best if they can get them on a spine board and stap them down to minimize movement.

Any questions let me know ... I'll try to answer the best I can, or at least look them up in my book.

lady_jezebel · Jul 13, 2006

Wow, nerrollus -- great answer.

nerrollus · Jul 13, 2006

Wow, nerrollus -- great answer.

Thanks! =) Had my moment of clarity not too long ago and I'm still pretty pumped up about being in EMT school and starting nursing school in the fall. Was pretty excited to see a question I could answer!

Sorry for the spelling errors and such ... Between work, school, and clinicals I'm a bit out of it right now ..

:wakeneo:

moongirl · Jul 13, 2006

thank you all so much for the info! Wow nerrollus- thank you especially. they teach us alot about 'therpuetic communication" in school- which is great- to a point- then i realize that some of this "immediate need" training is not given.

He has 3rd degree on his chest, stomach and under his arms, and is in a major hospital in the burn unit. Praying he does not get infection. Luckily the fire was put out before his face burned. Thank you all for your help

smoo · Jul 13, 2006

quick question, playing devils advocate.....If say this happens at the scene of an accident, and the only thing you have is that dirty blanket you used on your last picnic, ballgame, whatever..... Is it better to cover person with the dirty blanket and risk infection, or not cover them and risk hypothermia? What can I say, I think to much;)

moongirl · Jul 13, 2006

quick question, playing devils advocate.....If say this happens at the scene of an accident, and the only thing you have is that dirty blanket you used on your last picnic, ballgame, whatever..... Is it better to cover person with the dirty blanket and risk infection, or not cover them and risk hypothermia? What can I say, I think to much;)

good question !!! I would say cover them....no matter what???

vampiregirl, BSN, RN · Jul 13, 2006

I would use the blanket because the hypothermia is the immediate concern.

nerrollus · Jul 14, 2006

quick question, playing devils advocate.....If say this happens at the scene of an accident, and the only thing you have is that dirty blanket you used on your last picnic, ballgame, whatever..... Is it better to cover person with the dirty blanket and risk infection, or not cover them and risk hypothermia? What can I say, I think to much;)

Time to get creative. =)

Depending on how dirty the blanket is, I'd take a few seconds to shake it out to get an large grass/dirt peices off it. I'd consider ripping off my own cloths (or others around me) and putting them between the patient and the blanket to help keep the direct contact to a minimum.

Out in the field you're not going to be able to keep their wounds 100% clean anyways. Hypothermia should take priority I think. If they're burned bad, their wounds are going to be all dirty anyways from the smoke/trash around the site. The hospital is going to clean them up and give them antibiotics anyways.