Winston chats to us about burns and the treatment of these in the prehospital environment
Top 3 tips:
- Take a SAFE approach
- Stop the burning process
- Cool the burn but not the patient
Biography:
Dr de Mello undertook his medical training at Guy’s Hospital and Southampton. He served in the RAMC as a Regular and Reservist from 1976 to 2013 ending his military career as Colonel TA BATLS from 2007-2013. His NHS employment as an Anaesthetist and Pain Medicine Physician was at Mid Yorkshire and Manchester University Hospital. His clinical interests include pelvic pain, burns, pre-hospital care and trauma. He is a Founding Member of the Pre-Hospital Care Faculty at the Royal College of Surgeons Edinburgh and the College of Remote & Offshore Medicine at Malta. He retired in 2020 and is Trustee at the Vulval Pain Society UK and Chair of the Pre-hospital SIG at the British Burns Association.
Links and resources:
Clinical Pearls:
- Take a SAFE approach: Shout for help, Approach with care, Free from danger and Evaluate the ABCs
- Stop the burning process by getting the victim to drop to the floor and roll, remove clothing and jewelry
- Provide supplemental oxygen after clearing the airway
- Check both radial pulses
- If a burn patient is hypotensive within a couple of hours of the injury look for another source of blood loss – check the mechanism of injury
- Stop the burning process
- Cool the burn for a minimum of 20 minutes using cool water for up to 3 hours post burn
- Keep patient warm
- Loosely cover the burn with clingfilm
- Sit up (if permissible) especially in burns involving the head and neck to minimize the swelling
- Clingfilm also provides analgesia
- Beware circumferential burns
- The normal oximeter cannot detect carbon monoxide – and will falsely give a high saturation reading
- Fluid resuscitation in adults in pre-hospital burns can be simplified by adopting the “small man, small burn small bag; big burn, big man big bag” – which simplifies to either a 500 ml or 1000 ml bag of Hartmann’s Solution intravenously/intraosseously per hour
- TBSA calculation in the pre-hospital can be difficult and is usually overestimated
- Electrical burns may need 24hour ECG monitoring in vulnerable patients
- Chemical contamination needs copious irrigation with water ideally within 10 minutes of contact except for elemental sodium, potassium or lithium
- Alkali burns are worse than acid
