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Prehospital care of severe burns

Andrew J Bowman sumieb at compuserve.com
Thu Apr 13 17:16:26 BST 2006


But be careful with cooling.  ABLS teaches that if skin temp drops below 60F
than the Zone of Stasis can become a necrotic zone as well and you have lost
more tissue.

Put out the fire

Keep patient warm

Proper Fluid resuscitation

Morphine and more morphine

Andrew B
----- Original Message ----- 
From: "paul.middleton" <paul.middleton at usa.net>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Tuesday, April 11, 2006 11:17 PM
Subject: RE: Prehospital care of severe burns


>
> I think I need to do a little more reading on burn physiology, but the
> intentional local cooling, as distinct from the systemic unintentional
> cooling, is meant (as I remember) to lessen the transition from threatened
> to dead tissue by reducing the ongoing coagulation, denaturation of
proteins
> and microvascular changes, and thus shrink the burn penumbra. I can see
why
> there might be benefit in not cooling the patient, but I can't see the
> benefit in not cooling the burn (assuming that the unintentional
hypothermia
> thing is avoided). Given the recommendations that I quoted earlier from
the
> NZ article, perhaps the approach should be different for first aid and
> resuscitation. We give warmed fluids to major trauma patients generally
> (bearing in mind the low volume resuscitation debate:-)) as we recognise
the
> detrimental quality of cold in this instance, and we would clearly want to
> give similar treatment to burns trauma victims. Perhaps it should be
"first
> aid cold, resus warm" as far as fluids are concerned. I am aware of
research
> work into burns resus with hypertonic saline and starch solutions, but
maybe
> some of the lurking burns surgeons on the list might want to comment?
>
> Cheers
>
> Paul
>
>
>
> Dr Paul M Middleton
>
> RGN MBBS FRCS(Eng) DipIMCRCS(Ed) FFAEM FACEM
>
>
>
> Emergency Medicine
>
> Sydney
>
> Australia
>
>
>
>
>
> -----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 10:18 PM
> To: trauma-list at trauma.org
> Subject: RE: Prehospital care of severe burns
>
>
>
> Paul,
>
>
>
> I would love to have those pdfs.  But doing it, clinically, I think falls
>
> into the category of the randomized trial of parachute vs no parachute
when
>
> jumping out of a plane.  I think there's clear benefit in NOT cooling the
>
> wound and the patient.  I am almost certain that you will extend the zone
of
>
>
> ischemia to become the zone of necrosis AND, again, make the pt
hypothermic.
>
>
>
> But, I'm not sold on anything and always enjoy reading data.
>
>
>
> RD
>
>
>
>
>
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