Burns injury - PACT - ESICM

1/ PRE-HOSPITAL/IMMEDIATE CARE
Priorities including the primary survey
The main responsibilities in the pre-hospital setting are safety for the patient(s) and
the rescue crew, to stop the burning process and to perform ABCDEF (airway,
breathing, circulation, disability, environment, fluid) assessment and treatment.
Thereafter a gross estimation of the burned surface (%TBSA) should be carried out.
Pre-hospital estimation of %TBSA is difficult and frequently an overestimation of
smaller burns and an underestimation of larger burns takes place. For detail of the
estimation of the %TBSA burned, see Task 2.
Hettiaratchy S, Papini R. Initial management of a major burn: I--overview. BMJ
2004; 328(7455): 1555–1557. PMID 15217876
Allison K, Porter K. Consensus on the prehospital approach to burns patient
management. Emerg Med J 2004; 21(1): 112–114. PMID 14734397
Collis N, Smith G, Fenton OM. Accuracy of burn size estimation and subsequent
fluid resuscitation prior to arrival at the Yorkshire Regional Burns Unit. A
three year retrospective study. Burns 1999; 25: 345–351. PMID 10431984
Cooling
Most textbooks advocate cooling of the burn injury until pain relief with 12–15 C
(never ice) clean water. It is claimed that cooling stops the thermal injury, reduces
oedema and relieves pain. Studies have shown that the most significant reduction of
temperature in burned tissue takes place within few minutes after the start of
cooling. Cooling beyond two to three minutes is therefore of questionable value.
Remember that cooling often causes hypothermia in patients with large burns.
Herndon DN, editor. Total Burn Care. 3rd edition. Edinburgh: Saunders-Elsevier;
2007. ISBN 978-1416032748
Trupkovic T, Hoppe U, Kleinschmidt S, Sefrin P. Correspondence (letter to the
editor): benefits of cooling are not known. Dtsch Arztebl Int 2010;
107(6): 101. PMID 20204125
Hypothermia
Hypothermia, defined as a core body temperature 70% TBSA) the
incidence may increase to 35%. Hypothermia is associated with increased fluid
requirement, coagulopathy, depressed cardiac function, dysrhythmias, ventilatory
depression, decreased oxygen delivery, acidosis, and a higher mortality.
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