This is a guest post by Michael Fraley. If you want to guest post on this blog, check out the guidelines here.

This post in the 31 Days of CE series comes from paramedic and EMS educator Michael Fraley. Michael writes:

The prevention of thermal burn injuries in children has come a long way. A recent article published in the journal Pediatrics shows that injury prevention programs have reduced burns in kids by 31 percent in the 17-year period studied.

But there are still over 120,000 burns each year in children under the age of 6 so it makes sense for EMS professionals to be prepared to manage them.

The first priority in the management of thermal burns is to put out the fire. In other words, stop any burning that is still occurring. That is best done with some tepid water. Not cold water! Aggressive cooling can actually cause more damage to some of the burn tissue. It may feel better but as burn physician Jeffrey Guy (BurnDoc.net) says, “just because it feels good doesn’t mean it is good for you!”

Next apply a sterile dressing. Most burn authorities agree that salves, gels, ointments and other home remedies are contraindicated in any burn that is going to be assessed at the hospital. The dressing should also be dry. Moist dressings may feel good but can promote excessive heat loss and hypothermia. Even if the burn isn’t that bad looking consider covering it. Just being exposed to air can be painful in many burns.

As you manage a burn don’t overlook any other trauma the patient may have. Burns are ugly and painful but other injuries will kill the patient faster especially if they involve airway or breathing compromise or internal bleeding. Do a thorough primary and secondary survey on every patient.

Whenever possible ALS should be included in the care of burn patients. For one thing, ALS can provide intravenous and intramuscular pain medications. Burns can be very painful and liberal use of pain medications is recommended by most protocols. ALS should also be considered if there is any chance that the patient suffered an inhalation injury. This would be suspected if there are any burns on the face, singing of facial hair, soot in the mouth or nose, reddening of the oral or nasal mucosa, or vocal hoarseness. These patients may require aggressive advanced airway management.

Thermal burn injuries can be intimidating cases to handle. They cause a lot of pain and they look bad. But by sticking with a good standard assessment and keeping these tips in mind, you’ll put the patient at ease and do a good job managing the injury.

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To learn more about burn injuries check out these continuing education opportunities:

Burn Injury Assessment and Treatment Lesson from RapidCE.com. The lesson reviews anatomy of the skin, estimating injury severity and extent, and the treatment principles Michael describes. There is an ALS and a BLS version. Each are approved for 1.0 hours of CECBEMS credit.

Burn Injury Assessment and Treatment of Pediatric Patients. A podcast I recorded with Trauma Surgeon and EMS Medical Director Lee Faucher for the North Central Regional Trauma Advisory Council. (view and listen to all NCRTAC Live! episodes).

For more information on pediatric burn prevention and fire prevention program visit these websites:

• Burn Institute Public Education Programs http://www.burninstitute.org/fbp/programs/
• Burn Institute Curriculum Guides http://www.burninstitute.org/fbp/curriculum/
• Safe Kids USA http://www.usa.safekids.org/index.cfm
• Sparky the Fire Dog http://www.sparky.org/
• NFPA Fire Prevention Week http://www.nfpa.org/categoryList.asp?categoryID=1438

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This statement in a recent CDC MMWR caught my eye, “Adults aged ≥65 years have a worse prognosis than younger patients after scald burns because of age-related factors and comorbid medical conditions, and they are subject to more extensive medical treatment than younger adults.”

When assessing burn patients – of any age – remember assessing and managing ABC life threats is more important than the burn injuries. Unless those burn injuries are causing ABC life threats. The fluid shift associated with significant burns does not develop immediately. If the burn patient is hypovolemic there is trauma or medical cause that needs to be found and treated.

Learn more in two related RapidCE.com continuing education lessons:

• Burn Injury Assessment and Treatment
• Geriatric Patient Assessment

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