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Discussion

Initial care

Need to hear from the "pros"...... what do you expect to have completed when you receive a pt from an ER??? We recently had a serious burn patient come in. Got him intubated, IV lines, Tetorifice, fluids, and choppered out to burn unit, within 1 hour. covered with blankets for warmth, but now i wonder about sterile saline soaked towels on hands, face etc???? anything else you want done right away?????

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  • Experts

I found some great sites that cover initial care of burns and I put them in the "sticky" thread at the top of the forum. Personally unless instructed directly by the recieving hospital I would not cover the burns with wet cloths. Initially at least one of your major problems especially, with large surface area burns, is heat loss. Wet towels in a cold air-conditioned plane will only exacerbate that problem. Plus cotton fibres have been shown to cause an inflammatory response on the raw wound surface. A "space" blanket is usually a very good idea for burns patients.

PS sounds like you did VERY well. I gather you are not a large facility?? There is often an over expectation in the larger facilities in relation to what the smaller places can manage. I remember recieving a patient from a very small country hospital here and all my colleagues could rave on about was what was NOT done in relation to the dressings. Sick of it I turned and told them that said town only consisted of two men and a big black dog and at that the dog only had three legs. The patient had an IV (essential) and IDC (also essential) and was in a space blanket to maintain the temperature. That hospital did not even manage to have the patient tubed but given the size of the place and the fact the patient was still talking when he got to us it was not really neccessary.

  • Experts

:imbar: Sorry! I just found out that I will have to revise at least half of those links in that resource thread - they have shifted!!

Anyway you might find this link useful it is the NSW (Aust) goverment guidelines for transfer of burns patients. (See with a sporifice population we have to do a LOT of transfers!!)

http://www.health.nsw.gov.au/pubs/2004/pdf/burninjury_guidelines.pdf

If the PDF link does not work try http://www.health.nsw.gov.au/pubs/2004/burninjuryguidelines.html

and the burn injury model of care

http://www.health.nsw.gov.au/pubs/2004/burninjurymoc.html

  • Author

thanks for your help, I will look at all that info. You bring up an interesting point about small hospitals....something I have been meaning to address. Yes, I work in a very small hospital. We do not have Neuro, Burns, Vascular, and sometimes don't even have coverage for simple things. We do not have residents or back up education types to help out. It is not that we don't know how to care for these pts..... As for myself, I have 30 years experience, 20 in ER including Level 1. Several other nurses have the same. We choose to work near our homes. Many times very serious pts, trauma and otherwise, arrive at our back door by private vehicle. Ones that would have been flown out if they had called 911. We do a great job at stabilizing these patients, but don't have the "extras". We may only have 2 RN's for the whole department. Sometimes it takes hours and hours of the charge nurse's time making phone calls all over the state to find a place to send them. Then when you call report, you sometimes get a derogatory attitude. As if we are sub-par. We don't have the luxury of all the ancillary services that large med centers do, but we do know our ABC's. I think that our kind of nursing is even HARDER, because you have to fly by the seat of your pants and improvise, use all your faculties to treat something that would be turfed to a specialty unit in a larger med center. So lighten up guys, try walking a mile in our shoes!!

  • Experts

I know what you are talking about - yes it is very fustrating for rural health workers to hit this sort of behaviour. I did a LOT of "country inservice" when that was running here in QLD and found that a common complaint was that many smaller hospitals were not considered appropriate for training in major trausma as "you will always just ship them out". The larger metropolitan hospitals do not realise the importance of the word "until". You have to look after that patient "until" and depending on the time of day, the weather, the availablity of aircraft that "until" could be a considerable length of time with sub-optimal equipment and not enough staff. Believe me you have a sympathiser here. If there is anything else you need like this emergency care protocol ask and I will see what I can dig up - you just have to accept half of it will be Australian:D

I found some great sites that cover initial care of burns and I put them in the "sticky" thread at the top of the forum. Personally unless instructed directly by the recieving hospital I would not cover the burns with wet cloths. Initially at least one of your major problems especially, with large surface area burns, is heat loss. Wet towels in a cold air-conditioned plane will only exacerbate that problem. Plus cotton fibres have been shown to cause an inflammatory response on the raw wound surface. A "space" blanket is usually a very good idea for burns patients.

According to ABLS, cover the patient with CLEAN DRY SHEETS only, unless directed to do otherwise by the burn center. Do not dress with silvadene, saline gauze, etc., etc. When I got my ABLS certification and instructor certification, that was repeatedly pounded in our heads - CLEAN DRY SHEETS.

  • Experts

Do you have a link for us? The NSW guidelines say to initially cool the burn with wet cloths for pain relief puposes only (and they limit that) but to transfer them in either plastic cling film wrap (believe me that might be all you have in one of our smaller centres) or clean sheets or a space blanket.

http://www.health.nsw.gov.au/pubs/2004/pdf/burninjury_guidelines.pdf

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