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All other burn patients should receive Alert Activation at
the discretion of the ED attending.
On
non-activated patients that will require EITHER ICU admission or TRANSFER, the
Blue Surgery Service should be consulted immediately to assist with
resuscitation and/or transfer.
Consideration for Transfer
vs Admission with consultation to PLASTICS:
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PLASTICS consultation:
If a burn patient did not
require critical care from the Blue Surgery Service and has no other traumatic
injuries, the plastic surgery consult resident should be notified to evaluate
the patient prior to discharge/transfer.
If, however, the burns are
very minor and the ED attending feels the injuries can be treated as an
outpatient without a plastic surgery consultation, clear wound care
instructions, plastic surgery contact information, and follow-up appointments
should be made prior to discharge.
Patient Care:
Evaluate the Airway &
Breathing: All
patients receive 100% FIO2. If the patient has singed nasal hairs, suspect an
inhalational injury and consider intubation vs close
observation. Document the ETT size.
Evaluate the Circulation: Obtain a manual blood
pressure and place monitors as able to the skin. The monitors may be
stapled to the skin if necessary.
Evaluate the Burn Size: Notate the
degree and location of all burn area preferably with a burn
diagram. Turn the patient to evaluate the back and
perineum. Look for areas of circumferential burn and assess distal
pulses. Calculate the TBSA%; obtain the patient’s weight in kilograms, and the
time of injury.
Wound Care: Cover the
burns with sterile sheets and ensure that the burns are evaluated by the
plastic surgery team. Do not cover the wound with any topical agents
until ordered by the plastic surgery team.
Fluid Resuscitation: If >20%
TBSA burn, recommendations
from the American Burn Association are that referring facilities and EMS no
longer need to calculate the Parkland Formula. The current guideline is
to run LR at 500ml/hr for people over 14 yrs, 6-13 years of age 250 ml/hr, and
under 5 years of age 125 ml/hr.
Pain Control: If intubated and
normotensive, consider fentanyl and propofol gtts. If intubated and
hypotensive, consider fentanyl and versed or ketamine gtts.
Intubation RSI: Consider
etomidate and rocuronium. Succinylcholine is acceptable if the burn
is within 12 hrs.
Procedures: The following
procedures should be performed by a resident or attending in the ED as part of
the initial resuscitation if the patient is a red alert and intubated:
1. CVL
in nonburn area (mandatory only if 20% TBSA or greater)
2. Arterial
Line
3. NGT
4. Bronchoscopy
to evaluate degree of inhalational injury if consideration of admission
6. CO
level should be ordered on all burn patients.
Escharotomies: If the
patient has circumferential extremity burns especially with diminished distal
pulses, notify the plastics or critical care teams to consider escharotomies. If
the patient has circumferential torso burns especially with difficult
ventilation, notify the plastics or critical care teams to consider
escharotomies.
Imaging: Burn patients
should be evaluated for other traumatic injuries especially if involved in an
explosion mechanism, MVC with fire or leapt from height. These
patients should be given consideration for pan-scan.
Disposition:
The intubated and
critically ill severely burned patient should be transferred.
If not severely burned but
critically ill from polytrauma or inhalation injury, the patient may be
admitted by Blue Surgery with Plastic Surgery consultation for wound
management.
Otherwise, the patient
will be admitted to Plastic Surgery.
For more on standard burn care, see this web-based
tutorial: http://www.basicburnsmanagement.com/
Transfer Facilities:
1. University
of Louisville (First Call)
2. University
of Cincinnati Burn Center, Cincinnati, OH
3. Vanderbilt
University Burn Center, Nashville, TN
Facility Contact Information
First Call: University of
Louisville Access Center 502-562-8008
Michelle
Broers, PT, DPT, CWS, FACCWS
Burn Program Manager
Trauma and Burn Institute, UofL Health - UofL Hospital
O: 502-562-BURN (2876) Option 3
F: 502-813-6229
Michelle.broers@uoflhealth.org
C. John Luttrell, BSN, RN
Trauma & Burn Performance Improvement
Coordinator
Trauma Institute, UofL Hospital
O: 502-562-7536
C: 270-703-2971
F: 502-562-4197
charles.luttrell@uoflhealth.org
Haily Smith BSN, RN, CCRN
Burn Educator and Resource Nurse Burn Program
O: 502-562-3618
C: 502-528-7306
F: 502-813-6229
Medical
Director
Matthew
Bozeman, MD
matthew.bozeman@louisville.edu
University of Cincinnati Transfer Center 513-584-2337
University
Hospital Burn Center
UC
Medical Center
3188 Bellevue Avenue
Cincinnati, Ohio 45219
Medical
Director
Julia
Slater, MD
For patients up to 18 years of age:
Shriners Children’s of Ohio Burn Referrals 866-947-7840
One Children’s Plaza
2 West
Dayton, Ohio 45404
Vanderbilt University Transfer Center 615-875-4000
Vanderbilt
Burn Center
1211
Medical Center Drive, Suite 11234
Nashville,
TN 37232
For
outpatient clinic visits: 615-936-2876.
Vanderbilt
Outpatient Burn Clinic
1211
Medical Center Drive, Suite 11201
Nashville,
TN 37232
Medical
Director
Anne
L. Wagner, MD
Transfer Facility Communication: The responsibility
of the transfer of critically ill burn patients rests with the Trauma or EM
Junior, Chief, Fellow or Attending who will speak with an accepting physician
at a transfer facility in order to relay clinical data and arrange
transportation.
Transfer Patient Care: The patient will
remain in the UK Emergency Department until transport facility arrives with
continued fluid resuscitation and patient care as recommended by the receiving
facility but directed by the Trauma & Critical Care Attending along with
the Plastic Surgery physicians.
If arrival of transport team is greater than 1 hour, consider
admission to the ICU for continued resuscitation.
Drafted December 22, 2011; Revised February 2024
