Emergency Department Management of Patients With Thermal Burns -
Publication Date: February 2018 (Volume 20, Number 2)
Juliana Tolles, MD, MHS
Assistant Professor of Emergency Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA; Harbor UCLA Medical Center, Torrance, CA
Boyd Burns, DO
George Kaiser Foundation Chair in Emergency Medicine, Associate Professor and Program Director, Department of Emergency Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK
Christopher Palmer, MD
Assistant Professor, Department of Anesthesia, Division of Critical Care & Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care. Special populations, including children and pregnant women, require additional treatment considerations. Referral to specialized burn care for select patients is necessary to improve long-term outcomes. This article reviews thermal burn classification and evidence-based treatment strategies.
Excerpt From This Issue
A 35-year-old chef presents to the ED after burning his right hand on a cooking surface at work. His vital signs are normal and his hand is blistered over half of the palmar surface. You place a nursing order for pain medication and a tetanus booster. As you leave the bedside, you try to recall whether he should be referred to a burn center and whether there are any evidence-based guidelines to help you select a dressing…
As you put down his chart, the nurse calls you to the resuscitation bay for a 22-year-old woman brought in by EMS from a house fire. Paramedics report that she required extrication from the collapsed house. She is minimally responsive, with soot visible in her oropharynx and extensive burns to her abdomen, back, and right upper extremity. Her vital signs are: temperature, 37.5°C (99.5°F); heart rate, 140 beats/min; blood pressure, 85/40 mm Hg; respiratory rate, 35 breaths/min; and oxygen saturation, 88% on room air. As you prepare to intubate her and start IV fluid resuscitation for her hypotension, you wonder which resuscitation fluid you should select and how to best monitor the patient’s response. You wonder whether anything other than her extensive burns may be causing her hypotension and altered mental status…
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