Burn Care

Primary Survey	(index)
1. Airway with C spine control - open the airway, remove foreign body or debris, suction, 100% O2 by mask, for inhalation injury, naso - or oro-tracheal intubation to protect the airway, EtCO2 and pulse ox 2. Breathing - confirm bilateral air entry, breath sounds & CXR 3. Circulation - insert 2 large bore IV's, insertion through unburned skin is preferred to burn skin, site preferences are in peripheral vein, femoral vein, internal jugular vein, then subclavian vein, weigh patient in kg, estimate the % BSA of the burn; Burn Resuscitation formula = 2-4 ml of LR x wt in kg x % BSA with 2nd and 3rd deg. burns, give 50% of this volume over the first 8 hours, 25% over the second 8 hours, and 25% over the third 8 hours. VS, insert a catheter and maintain urine output > 0.5 cc/kg/hr. Consider CVP monitoring. 4. Disability - assess level of consciousness using the AVPU method (A - alert, V - responds to verbal stimulus, P - responds to painful stimulus, U - unresponsive), the pupils, note which extremities are moving, AVPI & pupils 5. Exposure and Environmental Control - remove all clothing and jewelry if not yet done, patients become hypothermic very quickly, wrap patient in clean sheets and warm blankets, core body temparatures and identify associated injuries.
(index)