Burns management in ER

Emergency Physician, Kauvery Hospitals, Alwarpet, Chennai

Background

Primary Goals at the ER

ABC Management: including early intubation and oxygenation
Stop the burning process: Remove burning/burnt clothes, wash the burnt area, and apply sterile wet dressing (Prevent Hypothermia) Remove jewellery/tight-fitting clothes
Fluid management: Calculation of the percentage of burns and initiation of IV Fluids
Analgesics

Management

Patient received in isolation/non-contaminated space Dedicated staff with proper patient handling technique

Initial Assessment and Stabilization:

Fluid Management

1. Calculation of percentage of burns

2. Identification of Depth of Burns

3. Calculation of Parklands formula for fluid resuscitation

Parklands Formula:

Total fluid calculated given as

1st 50% over 8 hrs from onset of burns

Remaining 50% over next 16hrs

Fluid of choice: Ringers Lactate

Wound Management

Jewellery/tight-fitting clothes removed from the affected area
Burns cleaned (removal of dirt/soot/burnt cloth with flowing NS)
Burns cooled with sterile saline-soaked Gauze for 5–10 min stopping further damage and providing pain relief. Care taken to avoid hypothermia
Topical gel-based colloidal dressing done to enhance faster recovery.

Pain Management

Along with topical sterile saline dressing for 10–15 min.

IV paracetamol or Opioid are given to alleviate pain and provide patient comfort.

Infection Control

TT 0.5cc IM stat
IV broad-spectrum antibiotic (Amoxicillin Clavulanic acid) for staphylococcus + streptococcus cover as prophylaxis
Strict glycaemic control

Continuum of Care

Journals