firedoc5 Posted July 30, 2008 Share Posted July 30, 2008 Call to a woman who had been burned. When arrived find an elderly lady laying on the ground. She had been burning a little brush and trash when it got away from her. Caught her rubber boots, over coat, and dress on fire. Rubber boots melted to skin, no socks on. Rule of nine's estimated just over 50% third and second degree burns. Fire possibly flashed up to her face with slight reddening first degree burns. No SOB. Needless to say, extreme pain especially to hands and legs. While running hand under her back prior to moving, skin still burning. Melted my rubber glove with slight blistering to finger tips. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 30, 2008 Share Posted July 30, 2008 first rule in burns, put the patient out and stop the burning process. Sounds like someone(not you Firedoc of course) didn't get the memo. Link to comment Share on other sites More sharing options...
streetsurgeon Posted July 30, 2008 Share Posted July 30, 2008 Quite traumatic. What was your following Tx? Link to comment Share on other sites More sharing options...
defib_wizard Posted July 30, 2008 Share Posted July 30, 2008 I agree! Stop the burning. then get some vitals and some lactated ringers going to keep her perfused so you can get her some pain meds. I carry morphine with standing orders up to 14 mg. Air transport should be considered to a burn center. Link to comment Share on other sites More sharing options...
firedoc5 Posted July 30, 2008 Author Share Posted July 30, 2008 first rule in burns, put the patient out and stop the burning process. Sounds like someone(not you Firedoc of course) didn't get the memo. That's one issue I was going to make, especially about wet vs. dry dressings. Actually the rubber from her boots and tissue on her back were still actively burning. That calls for the wet sterile dressings. STERILE, STERILE, STERILE. Can't stress that enough. However, along a fence row in a muddy field, rainy, about 35 degrees out, you can only do the best you can do. When going to lift her onto the cot that had a sterile burn sheet on it, one Medic saw just a smudge of mud on the edge. Since he didn't think it was sterile, he ripped it off exposing nothing but the bare mattress. She was about 80K's. Talk about yelling at the guy. He finally put another one down, but not until we had held her for about two minutes in the air. High flow O2 (15L NRM), only one IV site not burned on arms. Left antecubital. Stuck her with a 16g. NS. Adm. 5mg MS. repeat approx. 10 mins. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted July 30, 2008 Share Posted July 30, 2008 let me ask something regarding burns. I had a patient one day with nearly 80% burns on her body. There was no place on her body that was not either cooked or crispy. (the difference between original recipe and extra crispy if you get what I mean) I put two large bore IV's thru the burns. I know that you get what you can but what is the current conventional wisdom in doing this, putting IV's thru burns? The nurse was a little upset at the ER that I put ivs thru the burned skin but it was all I had. Any comments? Link to comment Share on other sites More sharing options...
Canadian Caesar Posted July 30, 2008 Share Posted July 30, 2008 Well ruff, if you have to get a line, you have to get a line. The books say that the IV through the burn drastically increases the risk of infection, but no line at all drastically increases the chance of DYING! Just find the least burned site that you have a chance with a large bore and go for it. (Was the Jugular a possibility for this one?) I definitely think the crew member with the best track record for IV's should take the shot, there's no time to be practicing on this patient. Although I have read that IV sites distal to severe burns can be poor choices because deep tissue swelling with soon cause a compartments syndrome that will keep fluids from making it to the body effectively. Maybe the nurse could be so kind as to recommend a better site when she critiques... In the interest of professional development and all... That is unless the Nurse is recommending fluid resuscitation via ET tube... :roll: Link to comment Share on other sites More sharing options...
streetsurgeon Posted July 30, 2008 Share Posted July 30, 2008 i agree. I.V. through burns.. fluid replacement in burns a must obviously...as well as pain management.. and can t forget a secure airway for possible inhalation injuries. Link to comment Share on other sites More sharing options...
BushyFromOz Posted July 30, 2008 Share Posted July 30, 2008 What do you blokes aim for when fluid resuscing burns?? We work of Percentage of burns x weight over 2 hours from the time of injury. Id be looking for some backup quick because this chick could probably use a tube Link to comment Share on other sites More sharing options...
AZCEP Posted July 30, 2008 Share Posted July 30, 2008 When available, the Parkland formula is useful, but not really necessary. Consider the amount of fluid that is administered prehospital will be subtracted from the total amount anyway. Airway management, pain relief, fluid replacement, and temperature control are priorities. If you can't get the pain controlled in the first hour, you never will be able to. I've been witness to fluid replacement being done to the point the airway became unmanageable also. Link to comment Share on other sites More sharing options...
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