EMERGENCYROOM INITIAL ASSESSMENT PRIMARY SURVEY A = Airway and C-spine immobilization B = Breathing and Ventilation C = Circulation D = Disability, Neurologic Deficit E = Expose (remove all clothing and jewelry) Environmental control (Keep Warm) F = Fluid SECONDARY SURVEY (HEAD TO TOE ASSESSMENT) *Remove all clothing and jewelry *Quickly assess percentage of skin involved and depth of burn *Cover patient with CLEAN, DRY SHEET *KEEP WARM: Hypothermia occurs rapidly *Avoid use of ice or ointments *If material is stuck to the skin, do not attempt to remove it *For circumferential burns, elevate burn extremity above the level of the heart *May consider clear plastic wrap to reduce heat loss CALCULATE THE PERCENT OF TOTAL BURN SURFACE AREA (EXCLUDE ERYTHEMA) *Use the Rule of Nines to estimate burn size for adult and pediatric patients. *Include only partial (second degree) and full thickness (third degree)burns. SEE CHART C:\Users\jrozwick\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ZZ6P4ZQT\ER pg 1.doc
NURSE DATE Check desired items: ORDER AND SIGNATURE RULE OF NINE S (Include partial and full thickness burns only. C:\Users\jrozwick\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ZZ6P4ZQT\ER with pic pg 2.doc
SCATTERED BURNS = (size of palm with fingers closed = 1% TBSA) BEGIN FLUID RESUSCITATION IF BURN SIZE IS > 10%PEDIATRIC OR > 15% ADULT INITIATE FLUID RESUSCITATION PATIENTS WITH > 30% TBSA BURNS REQUIRE 2 LARGE BORE IV S #18 (MAY BE INSERTED THROUGH BURNED SKIN IF NECESSARY) C:\Users\jrozwick\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ZZ6P4ZQT\ER pg 3.doc
PRE-HOSPITAL FLUID MANAGEMENT <5 YRS. 125ML LR/HOUR 6-13 YRS. 250ML LR/HOUR >14 YRS. 500ML LR/HOUR (AVOID FLUID CHALLENGE UNLESS PATIENT IS HYPOTENSIVE DUE TO TRAUMA) FLUID RESUSCITATION (THERMAL AND CHEMICAL BURNS) ADULT = 2ml LR x pt wt in kg x % TBSA 2 ND & 3 RD degree burns PEDIATRIC (<14yo & < 40kg) = 3ml LR x child s wt in kg x % TBSA 2 nd & 3 rd degree burns ½ of fluid is given in the first 8 hours of burn injury from the time the injury occurred. The balance of remaining fluid to be given over the next 16 hours. Pre-hospital fluids should be subtracted from the amount of fluids to be given in the first 8 hours. HIGH VOLTAGE ELECTRICAL INJURIES (If evidence of deep tissue injury or red pigments present in urine). ADULT = 4ml LR x pts wt in kg x % TBSA 2 nd and 3 rd degree burns PEDIATRICS = Consult Burn Center immediately for guidance URINARY CATHETER ALL PATIENTS WITH BURNS > 20% TBSA OR WITH BURNS TO THE GENITALIA SHOULD HAVE A URINARY CATHETER PAIN MANAGEMENT NO IM INJECTIONS EXCEPT TETANUS! Adult : MS 2mg q 3 minutes Slowly Titrate IV increments to desired effect Fentanyl 50mcg over 1-2 minutes Slowly Diluted IV titrated to desired effect Pediatrics : MS 0.1mg/kg q 5 minutes Slowly Titrate IV increments to desired effect Fentanyl 1mcg/kg, q 3-5 minutes Slowly Diluted IV titrated to desired effect C:\Users\jrozwick\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ZZ6P4ZQT\ER pg 4.doc
C:\Users\jrozwick\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ZZ6P4ZQT\ER pg 4.doc