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Ems lecture


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  • 1. Department of Plastic and Reconstructive Surgery and Burns Outreach Programme Kimberley Hospital Dr. Maria Giaquinto-Cilliers
  • 2.  Management of the Burn Victim at the Scene Initial Management Transport to Facility for Further Care
  • 3.  Management of the Burn Victim at the Scene Stop the Burning Process Flame: smother the fire with water or a blanket + remove burned clothing Scald: cool the are with water immediately (within 30 sec after injury) + keep patient warm and dry Chemical: wash with copious amounts of water (especially eyes) Electrical: make sure patient is not still in contact with source before touching; patients down: CPR/ shock (cardiac dysrhythmias)
  • 4.  Initial Management Airway Management Fluid Resuscitation Dressings Pain Management
  • 5.  InitialManagement Airway Management Mechanism of injury: inhalation injury findings= singed eyebrows or nasal hairs, black nasal/oral discharge, grossly swollen lips, hoarse voice, carbonaceous soot in back of throat or sputum, facial burns, abnormal oxygenation, history of enclosure ina smoked filled location
  • 6.  Initial Management Airway Management Anxiety+ fear+ hypoxia in a patient victim of house fire: rapid breathing of inhaled smoke, with carbon monoxide + other toxic gases in superheated temperatures + airway tissue oedema= life-threatening airway emergency
  • 7.  Initial Management Airway Management If needed: intubation of the patient (patient in arrest or unconscious without gag reflex; If not prepared for intubation (skills): bag- valve-mask ventilation; Other cases: give oxygen by mask
  • 8.  Initial Management Fluid Resuscitation Get venous access (even in burned tissue) Secure the IV line (bandage) Start fluid replacement with Lactated Ringer’s Criteria for IV placement in pre-hospital: burns >20% with transport>60 min hypovolaemic shock from associated injuries potential for life-threatening airway obstruction/cardiac arrest Record the fluid given
  • 9.  Initial Management Dressings Remove patient’s clothing Remove jewellery Keep environment warm to avoid hypothermia Cover burns with dry dressings/ dry sheets + blanket on top; do not apply other ointments
  • 10.  InitialManagement Pain Management Do not give oral or IMI pain medication If possible, give IV morphine (5-10mg for adults). Keep bag-valve-mask available for respiratory depression
  • 11.  Transport to Facility for Further Care Burn patient is a multiple trauma patient Remember the ABC Remember to stabilize spine (cervical collars) Bring along someone to report history for unconscious patients Report history to receiving facility