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Prehospital care of severe burns

paul.middleton paul.middleton at usa.net
Tue Apr 11 11:28:37 BST 2006


Roy

Your quote " Skin will cool to normal temp with about 30 sec to 1 min of
lavage"

What about this:

"What constitutes adequate BFAT? Considerable divergence of opinion exists
regarding immersion duration and water temperature; for example, studies
involving experimental burn work with animals have resulted in
recommendations of 0–3°C for 5–30 minutes (4,5) 8°C for 5–30 minutes (6,7)
22–30°C for 30–45 minutes (8,9) The general advice seems to be the use of
water temperatures between 10–15°C or cold tap water for 10–30 minutes."
 
From: Skinner A, Peat B. Burns treatment for children and adults: a study of
initial burns first aid and hospital care. N Z Med J 2002; 115:U199.

PDF (big) available if anyone needs it
Paul



Dr Paul M Middleton
Emergency Medicine
Sydney

 
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Roy Danks
Sent: Tuesday, 11 April 2006 4:57 AM
To: trauma-list at trauma.org
Subject: RE: Prehospital care of severe burns

1.  Stop the burning process.  If this takes a cup of water or a firehose, 
get the job done.

2.  Otherwise, don't cool a burn of more than 5% TBSA, or so.  Most burns 
will be hosed down before EMS arrives, certainly before they arrive at a 
facility.  You'll only make them very cold and very difficult to re-warm.  
Skin will cool to normal temp with about 30 sec to 1 min of lavage.

3.  Even though you didn't ask:  More fluids are not better for burns.  Pick

a formula, calculate the TBSA burned and give what is called for.  Majority 
of burn patients requiring fluid resuscitation (those with burns >10-15% 
TBSA) will have their burn size miscalculated by 50-100% (over) thus 
resulting in more fluids being given than necessary.  This will lead to 
increased ext. compartment pressures, abd pressures, ocular pressures...all 
bad.  Finally, avoid bolusing to increase UOP.  Titrate instead.  Rapid 
boluses in this type of shock (it's a Distributive shock) will wash out of 
the leaky capillaries very quickly causing an increase in tissue imbibition 
pressure.  This generates a negative fluid force, pulling more fluid out of 
the vascular space...and the cycle repeats.  Similar in thinking, to a 
point, to what Dr. Mattox has called "Cyclic Hyper-resusciation" albeit with

a different type of shock physiology.

Thanks for letting me climb to the soap box.  Burns are my passion.

RD


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