BASIC BURNS LIFE SUPPORT

-Dr Annitha Annathurai

Department of Emergency Medicine

Singapore General Hospital

BBLSupport--Definition

• Providence of appropriate , emergent definitive treatment within 1st 24hours of injury

• Understand the mechanism of injury: Explosion,Fire ( thermal), Chemical Burn, Electrical Burn,Lightning injury.

• Recognizing type of burns: Airway Burns ( Inhalational)Injuries• Looking for associated injuries : multitrauma esp if

explosion Blast injuries• Recognizing which types of burns need to transfer to a

Burns Centre for specialised care• This is a standard Protocol driven Management which

should be agreed upon by medical personnel across the region to ensure standardised care

BBLS—Important considerations

• Airway : Ensure patency

• Breathing: High flow oxygen

• Circulation: Good Intravenous access, give fluids

• Removal of soiled clothes

• Cooling of burn sites

• Immediate evacuation from site of incident

Carbon monoxide poisoning Inhalation injury above the glottis Inhalation below the glottis Any victim, burned in a closed area, like a house fire, should be presumed to have an inhalation injury until proven otherwise

Give HIGH FLOW OXYGEN

Scene

Survey

•Cause of burns may still be active eg explosive, live wires, chemical agents•Fires in enclosed spaces increases risk of inhalational injury, smoke may contain toxic gases CO, cyanide•Stop ongoing burning process, remove clothes if possible, rinse copiously with water

Patient

Assessmt

•Primary survey as for trauma patient, ABCs•Signs of A/w burns•Note %BSA and depth quickly •Assess RR, chest wall, auscultation, neurological

Critical

Interventn

•Oxygen•Cooling•Stop Bleeding•Ventolin nebulization if pt is wheezing

Identify

LOAD & GO

•Inhalational injury•>= 20% BSA second degree burns•Send to burns centre

NOTIFY • Inform the receiving hospital early so that they are prepared to receive patient

Secondary

Survey

•Signs of inhalational injury•Signs of shock•Extent and depth of burns•Arrhythmia•Cause of burns if not elicited earlier

IV Fluids

Wound care

•Start fluid management•Cover burns sites with dry sterila nonstick dressing•Cooling body sites with water ( 10mins at least)

Analgesia Entonox contraindicated in inhalational injury

Cooling and evacuate ASAP

Indications:

SUSPECT

Chemical

Contaminatn

•An incident when 1 or more persons is exposed to known release of chemical•Suspicion of possible chemical contamination•Multiple persons suffering fits or loss of consciousness or breahtlessness simultanously in an enclosed area

Scene

Survey

•Look for obvious fumes, chemical spill•Don’t touch spilled chemicals•Look for number of casualties•If mass casualty then look for First Aid Post

DON PPE •Ambulance Crew not expected to work in contaminated area•Wear gloves, aprons, mask•Then examine patient

Patient Assessment

•If whole body exposed or contaminated with chemical agent, then for decontamination first•Then re-evaluation for injuries.

For chemical burns, you must wash with copius water, very often, U can get reaction if small amt is used.Esp to eye alkali or acid wash copiously.

Complicated with cardiac arrest, VFEnsure scene safe and no more current Before touching the casualty

Lightning injuries

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