Updated: Dec 29, 2019
1. Burn Fluid Resuscitation
· Fluids prior to calculation as starting point:
o 500 ml/hour for 14 and older
o 250 ml/hour for 6-13 years of age
o 125 ml/hour for 5 years and younger
· Based on partial, deep, and full-thickness burns (not superficial).
· LR is fluid of choice, half of total amount in first 8 hours from time of burn.
· ABA guidelines (Modified Parkland)
o Adult thermal = 2ml x kg x BSA for 24-hour calculation
o Child thermal = 3ml x kg x BSA for 24-hour calculation
o Electrical = 4ml x kg x BSA for 24-hour calculation
· Adjust fluid based on urinary output, need 0.5-1.0 ml/kg/hour adult, 1-2ml/kg/hour in pediatrics.
2. Electrical Burns
· Do not document entrance and exit wound.
· Hand-to-hand – increased risk of heart damage (across the heart).
· Risk of rhabdomyolysis (increased K+), so increase IVF’s to get UO of 75-100 ml/hr.
· Lightening – lace or feathering appearance (Lichtenberg figures).
3. Chemical Burns – first goal is to reduce exposure to others, Don PPE.
· Decontaminate – Hot zone only for suited, warm for decontamination, cold for treatment.
· Brush off dry chemicals (lime powder).
· Hydrofluoric acid – calcium to inactivate fluoride.
· Asphalt (tar) – apply fat emollient and cool immediately.
· Phenols (carbolic acid) – irrigate with 50% PEG (Miralax) to neutralize.
4. Radiation exposure – decontaminate ASAP. S/S: nausea, vomiting, diarrhea, malaise, anorexia, GI bleed; skin red, but without blisters.
· Emergency Nurses Association. Trauma Nursing Core Curriculum, 8th ed., 2019.
· Kent, Kendra. Trauma Certified Registered Nurse Examination Review. Springer, 2017.
· Sheehy, S. Sheehy’s Manual of Emergency Care, 7th ed. Elsevier, 2013.