1. Burn Nursing Care from EMS to ICU: an overview
Amanda Richard, RN, CNS, CCRN
Adrienne Costello, RN, CCRN
UNM Burn Center
Adult & Pediatric Injury
from tragedy… hope!

2. Course Objectives Identify the 3 main concerns for burn patients.
Discuss interventions to prevent each of these.
Address adequate pain management strategies.
Resuscitation evaluation.
Basic review of wound care for each stage of admission.

3. 3 CONCERNS FOR A BURN PATIENT
Hypothermia
Pain
Infection
These are the 3 main concerns we are going to discuss for the burn patient. Each step of the process in the health care system has a part in treating or preventing these issues.

4. HYPOTHERMIA Easier to prevent than treat
Increases metabolic and oxygen demands
Proportional to degree of injury
Tissue ischemia
When burn patients are allowed to chose their own environment temperatures, they opt for ambient temp of about 32/90. This minimized the metabolic expenditure. However, their CNS is trying to get them higher – increasing metabolic demand.

5. AT THE SCENE Warm the rig Keep patient covered
Pain medication per protocols
Avoid IV access in burn unless necessary
We are going to assume that the ABC’s have been addressed in each of these phases as have been discussed in previous lectures.

6. ER OF TRANSFERRING FACILITY
Warm room
Adult – minimum of 80 degrees
Children – minimum of 85 degrees
Warm IV fluids and blood products
Remove clothing
Place in dry dressing/sheet
If you have warning of the patient coming – make sure to warm the room

7. ER OF TRANSFERRING FACILITY
Pain is inversely proportional to burn degree
Pain is often severe
IV route only
Morphine/Fentanyl
Anxiolytics
Dosage

8. ER OF TRANSFERRING FACILITY
Debridement not necessary
Dry dressing/sheet
Limit flow into room
Asceptic technique with all procedures
Avoid IV access through burns unless necessary
UNM Burn Center

9. PRIOR TO TRANSFER…
Make sure the family sees the patient prior to transporting to the burn center!!

10. ARRIVAL TO THE BURN CENTER
Room warmed
Continue warm fluids
Minimize exposure
Hot line
Cool guard
Lighting
Bair Hugger

11. ARRIVAL TO THE BURN CENTER
Room warmed
Continue warm fluids
Minimize exposure
Hot line
Cool guard
Lighting

12. ARRIVAL TO THE BURN CENTER
Room warmed
Continue warm fluids
Minimize exposure
Hot line
Cool guard
Lighting

13. ARRIVAL TO BURN CENTER Morphine/Fentanyl drip Ativan/Propofol drip
Riker scale
Plan on increasing dosage over time
Dosage

14. ARRIVAL TO BURN CENTER Clean lines Limit flow in room Precautions
Daily tubbing
Daily dressings
Family education
Nutrition

15. Or…. How to give more fluid than you ever thought possible.
RESUSCITATION
Or…. How to give more fluid than you ever thought possible.

16. RESUSCITATION

17. RESUSCITATION Fluid resuscitation goals maintain vital organ function
avoid excessive or insufficient fluids

18. RESUSCITATION Formulas are guidelines Monitor urine output Labs
Monitor vital signs
Monitor distal pulses
Warm Warm Warm
Special Circumstances
The goal of fluid resuscitation after burn injury is to mainatain vital organ perfusion while avoiding inadequate or excessive therapy.
Special Cirsc – Inhalation, delay in initiation, additional trauma, electrical, extreme ages.

19. DRESSINGS AND WOUND CARE
Burn Nursing

20. FIRST DEGREE Superficial…. “sunburn”
Clean
PAINFUL!!
Topical
Bacitracin
Vaseline gauze
Xeroform
KEEP MOIST

21. SECOND DEGREE Partial Thickness - Superficial
Debride
Dressing
Silvadene
Sulfamylon/Mafenide
Acticoat
Monitor

22. SECOND DEGREE Partial Thickness - Superficial
Debride
Dressing
Silvadene
Sulfamylon/Mafenide
Acticoat
Monitor

23. SECOND DEGREE Partial Thickness - Superficial
Debride
Dressing
Silvadene
Sulfamylon/Mafenide
Acticoat
Monitor

24. SECOND DEGREE Partial Thickness - Superficial
Debride
Dressing
Silvadene
Sulfamylon/Mafenide
Acticoat
Monitor

25. THIRD DEGREE Full Thickness
Excise early
24-48 hours
Graft
Mepitel/Xeroform
Wound vacs
Assessment
Day 3
Day 5

27. Adult & Pediatric Injury
Resources For Tubbing RT
2 RN’s
PT/OT
Tech
Supplies
Adult & Pediatric Injury

28. UNM Burn Center: from tragedy… hope!
SUMMARY
WARM
RESUSCITATION
PAIN MEDICATION
CLEAN
DRY
UNM Burn Center: from tragedy… hope!

29. Amanda Richard, RN, CNS, CCRN Adrienne Costello, RN, CCRN
Questions…
one child burned, is one child too many!
Amanda Richard, RN, CNS, CCRN
Adrienne Costello, RN, CCRN
UNM Burn Center
Adults & Pediatrics
from tragedy… hope!