Magazine article American Nurse Today

The ABCDEs of Emergency Burn Care

Magazine article American Nurse Today

The ABCDEs of Emergency Burn Care

Article excerpt

Consider this scenario. You're driving home from work after a busy shift and there has been an accident ahead on the freeway. As you approach, you see that a vehicle has been rear-ended, causing a fire. The occupant of the car, an elderly man, is sitting on the side of the road. He looks shaken, but tells you his name and asks you to call his wife. He has visible burns to his face, neck, upper chest, and both arms. Do you know what the first priorities are for assisting this man?

Each year in the United States 3,400 people die from burns and smoke inhalation and 450,000 patients require treatment for burn injuries. Burns are among the most devastating and life changing of injuries because of the unpredictable nature of the initial wound(s), the overwhelming systemic inflammatory response, and the potential need for extensive rehabilitation and psychosocial adaptation. Burn injuries involve multiple etiologies, and the initial treatment required varies with each. (See Burn etiologies.)

Emergency burn response: Following the ABCDEs

The first hours after a burn injury occurs are a critical time. Decisions made and treatments rendered during this time can mean the difference between life and death. In 2012 the American Burn Association's (ABA) Advanced Burn Life Support (ABLS) course included revised guidelines for emergency burn care. ABLS is a comprehensive 8-hour course that covers initial assessment and management of burns, evaluation of burn size, fluid resuscitation, transport guidelines, and other topics pertinent to emergency burn treatment in the first 24 hours after a burn injury.

Burns vary in size (percentage of total body surface area burned) and severity (depth) based on temperature and time of exposure to the burn source. Familiarize yourself with the appearance of first, second, third, and fourth degree burns, shown in the images below. Note the remarkable differences in appearance based on severity/degree of burn.

Severity of burns

Source: Images are used with permission of the University of Texas Medical Branch, Galveston, TX.

It's important to recognize that the first priority for burn patients is not the treatment of the wound. This can be a difficult concept to understand because burn injuries may be visually distracting and extremely painful for the patient. Rather, the priority is to implement the ABCDE approach, a methodical response that ensures life-threatening complications of burn emergencies are addressed rapidly and effectively. (See The ABCDEs of emergency burn care.)

The ABCDEs of emergency burn care

Airway maintenance with cervical spine protection

Breathing and ventilation

Circulation and cardiac status with hemorrhage control

Disability, neurological deficit, and gross deformity

Exposure to Examine for major associated injuries and maintain warm Environment

Source: American Burn Association. Advanced Burn Life Support course provider manual. Chicago, IL: American Burn Association; 2011.

Airway evaluation and maintenance with cervical spine protection must always be your first priority. It is also important to protect the cervical spine if there is obvious or suspected traumatic injury. Burn patients frequently become edematous because of the marked increase in capillary permeability, which occurs as a response to the burn injury. Edema is a frequent culprit in compromising the airway of burn patients. Therefore, once emergency medical services (EMS) have arrived, intubation will be required if the airway is compromised.

Breathing and ventilation is the next step. Burns of the chest may restrict the expansion of the chest wall because of the stiffening of the dermis in deep burns, which can impact respirations. Inhalation of smoke impairs gas exchange (oxygen and carbon dioxide) at the alveolar level. Any patient with suspected smoke inhalation injury must be started on high-flow oxygen (15 L/min at 100%) using a non-rebreather oxygen mask. …

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