Step by step: Thermal burns

Burns (Thermal):

1. Upon arrival on scene, perform EMCAP, observing for potential threats or clues.

2. Form a general impression of your patient, noting LOA, positioning, work of breathing, and skin colour/condition.

3. Perform the primary assessment, noting airway patency and presence or absence of soot around the mouth or nose, breathing for rate, rhythm, and volume, and pulse for rate, rhythm, and strength as well as cap refill. Make any corrections required prior to moving on. In all cases where patients have thermal burns to the upper body, especially if they were in an enclosed space during a fire, apply supplemental oxygen and monitor the airway carefully.

4. Stop the burning process, applying normal saline or sterile water liberally to the burn site.

5. Obtain baseline vital signs. ***Note SPO2 will likely read falsely high.

6. Determine the area burned (TBSA via rule of 9s or rule of palms), and the depth of the burns.

7. Cover all 1st degree burns and 2nd degree <15% TBSA with wet sterile dressings. Cover all 2nd degree >15%TBSA and all 3rd degree burns with dry sterile dressings. Dress digits individually.

8. Initiate IV fluid therapy and prepare for burn shock and potential hypovolemia.

9. Consider analgesic.

10. Initiate transport.

11. En-route, perform secondary assessment, obtaining HPI, PMHx, Medications, Allergies, last ins/outs, and reassess ABCs frequently.

12. Maintain patient warmth and monitor for evidence of hypothermia.