Burn Clinical Practice Guideline - TETAF

1 3400 Enfield RoadAustin, TX 78703 Phone: .teta .o burn Clinical PracticeGuidelineDeveloped byTexas EMS Trauma & acute Care Foundation Trauma Division 2 burn Clinical Practice GuidelineContriButorsrose Bolenbaucher, .., R , T R , T au a P o a Edu ation, T au a e i es, ni e sit ealth ste , an Antoniotracy Cotner-Pouncy, R , enio i e to , T au a e i es, ni e sit ealth ste , an AntonioCourtney Edwards, ..P.., R , n u P e ention ana e , Pa land ealth os ital ste , allasBonnie ac son, R , .., , u n P o a ana e , .. A u n ente , .. A nstitute o u i al Resea h, an Antonio ilita edi al ente , o t a ouston, Te as endy cnabb, R , i e to , T au a and u n e i es, ni e sit edi al ente , u o Col Eli abeth ann-salinas, Ph.., R , , Tas A ea ana e , ste s o a e o o le Patients.

2 A nstitute o u i al Resea h, o t a ouston, Te as enny oli er, .., R , Assistant i e to o T au a e i es, ni e sit ealth ste , an AntonioBrenda Put , R , .., i e to , Te as E T au a A ute a e oundation athy rod ers, R , .., , T R , R , E , T au a e i es i e to , R T t. Eli a eth os ital, eau ontsue ane , .., ..A., R , o e u n P o a ana e , Pa land Re ional u n ente , Pa land ealth and os ital ste , allasContEntThe ontent o this u li ation as de elo ed the TETA T au a i ision, led Rose a ie olen au he , .., R , T R , th ou h olla o ation ith Te as T au a P o a ana e s and Te as u n ente o a leade shi to o ide uidan e to hos itals in Te as. The ontent as e ie ed and edited . ian East id e and the ETA T au a ste s o ittee T au a edi al i e to s o ou.

3 This do u ent is intended to e used as uidan e onl in the de elo ent o u n t eat ent oli ies and oto ols ithin hos itals in Te as. This is a li in do u ent that ill e e ie ed annuall and u dated as needed to aintain the standa ds o a e set national e iden e ased findin by Texas EMS Trauma & acute Care Foundation Trauma Division o i ht a 201 the Te as E T au a A ute a e oundation. ndi iduals a do nload and int this u li ation o use ithin thei o ani ation. the uses in ludin ass o in and dist i ution o the o i ht u li ation a e ohi itE B Brian Eastrid e, .., T au a edi al i e to and T au a A ute a e u eon at ni e sit os ital in an Antonio Brenda Put , R , .., TETA , AustinGo ernor s E s and trau a d isory Council trau a syste s Co ittee trau a edical irectors or rou nn ard, APR, A.

4 A d t ate i o uni ations EsiGn B Barbara Battista, a hi esi n e i esP oto CrE itsPhoto a hs in this u li ation a e ou tes o ni e sit edi al ente , u o .3 ContentsBurn Clinical Practice Guideline T eat ent P oto ol onside ations ..4 Ad an ed T au a i e u o t P o ess Assess ent ..5 Ai a ith ine P ote tion ..5 eathin ..5 i ulation ..5 isa ilit ..5 E osu e ..5 luid Resus itation ..5 ete ination o Total od u a e A ea ..5 u n lassifi ation .. u n isto .. ia nosti s asi a o ato Tests .. e ial i u stan es ..7 Pediat i onside ations ..8 e iat i onside ations ..9 Ele t i al n u onside ations ..9 he i al n u onside ations ..9 i u e ential u ns onside ations.

5 9 Additional onside ations o All T es o u n Patients ..10 ound a e ..10 Pain and An iet ana e ent ..10 u n ente Re e al ite ia ..11 Ps hoso ial and i itual u o t ..11 Examples of Fluid Resuscitation and Wound Care and Tools for Documentation ..14 Education Recommendations ..15 Appendices ..1 Rule o ines ..17 24 ou u n a e heet ..18 References ..204T eat ent o u ns is not al a s st ai ht o a d. ational and inte national uidelines diffe o one e ion to anothe . o e e , all sou es a ee that ana in u n ases in the fi st 24 hou s is iti al and di e tl o elates to o idit and o talit .To deli e o ti al atient a e to u n i ti s, health a e o ide s ust unde stand the atho h siolo o u n in u ies, thei lassifi ation, the a o iate use o a ious t es o su i al t eat ent and the latest u dates in u n s ien e.

6 O e atients a e t eated effe ti el in the hos ital e e en de a t ent hile othe s a e ui e hos itali ation o sta ili ation t ans e to a u n ente as ui l as ossi le. The lini al situation o t eatin u n ases needs lea uidelines to o e all as e ts o a e du in the t eat ent o ess. Th ou h a olla o ation o Te as e ified u n ente s and the Te as E T au a A ute a e oundation TETA , this u li ation as eated to o ide lini al a ti e uidelines o hos itals in Te as o assessin , lassi in and t eatin the atient e e ien in a u n in u . tili ation o these uidelines o ides the a e o to de elo u n a e oli ies in Te as hos itals and ensu e onsistent, a o iate a e o u n atients a oss the ob ecti esTETA s oals ith this u li ation in lude the ollo in :1. P o ide esou es and e e en es o u n a e in Te as ased on nationall a e ted standa ds o a P o ide uidelines and assistan e o the de elo ent o oli ies and ensu e onsistent a ti e a oss Te as o all u n Clinical Practice Guideline3.

7 Add ess uidelines s ste ati all and in lude:a A E as in all t es o t au a ases, luid esus itation, ound a e,d Pain ana e ent,e T ans e uidelines, and Ps hoso ial and s i itual su o ent Protocol ConsiderationsAll t au a ases in ludin atients ith u n in u ies should e t eated initiall ollo in the uidelines o Ad an ed T au a i e u o t to ensu e that li e th eatenin in u ies a e add essed i ediatel . A s fi st The a o iate assess ent and ana e ent o u n atients in the fi st hou s ollo in in u ha e esulted in the 9 e ent national su i al ate o atients t ans e ed to a e ified u n ente in 2011, as e o ted Ad an ed u n i e u o t. This u li ation o ides in o ation and uidan e in de elo in oli ies o t eatin u n atients. n o ation is esented in the o de in hi h assess ent a e should e o ided.

8 A te add essin the A s o li e su o t, o us tu ns to u n in u ies. Re la in fluid lost o the u ns is iti al, and an a u ate assess ent o the se e it and e tent o the u ns is needed to al ulate the a ount o fluid to o ide. ound a e and ain ana e ent a e add essed ne t. an o these a ti ities a e o u in al ost si ultaneousl , es e iall i the e tent o the u n in u ies indi ates t ans e to a u n ente is needed. Ps hoso ial and s i itual su o t a e o ided th ou hout the assess ent, t eat ent and sta ili ation o d anced trau a i e su ort Process ssess ent irway with C-s ine Protection As in all t au a ases, ea l e o nition o ai a o o ise ollo ed o t inte ention to ensu e ai a aintenan e should e o leted. the e is soot in the outh, onside ea l intu ation e en i the atient is eathin no all.

9 Ollo AT uidelines and ensu e the atient has a definiti e ai a esta lished and ontinue assess ents to onito entilation. Assess ent o the ai a in ludes:a. Re o in an u nin a ent, in ludin he i als.. ns e tin o sin ed nasal, a ial and e e o hai s.. oo in o u ns and ede a a ound the head and ne .d. ete inin i the e a e i u e ential u ns to the hest hi h a inhi it entilation and e ui e es ha oto .Breathin ete ine i the atient is o in ai o not. ollo AT uidelines. Assess ent o eathin in ludes:a. Aus ultatin eath sounds, . onito in ate, de th and o o eathin , and . onito in o d s nea and st ido .Circulation onito i ulation and a dia status ith he o ha e ont ol. tain a o iate as ula a ess and use a de i e to onito hea t ate and lood essu e. annulate t o eins ith la e ali e int a enous athete s and initiate a ed fluids.

10 A oid u ned a eas hen ossi le. n la e u ns he e the has een la ed th ou h u ned s in, the s should e sutu ed. nse t int a enous athete s to initiate int aosseous in usion hen una le to o tain as ula a ess. ote: luid esus itation ontinuesin the ne t olu n and e o endations s e ifi u n ente s a e dis ussed on a es 12 and 13. n oin fluid e ui e ents a e ad usted ased on the indi idual atient s es onse to the esus itation as e iden ed u ina out ut in addition to he od na i a a ete s. Assess e usion status the ollo in te hni ues:a. Pulse he , . a illa efill, and . ina out ut see additional a a ete s in the se tion ete ination o Total od u a e A ea, elo and on a e . isability ete t i the e a e an ani estations o neu olo i al defi its. E osure E iden e ased esea h su o ts total e osu e o the atient to assess the se e it o u ns and initiate t eat Re o e an u nin a ent, in ludin he i als.