Burned

[mshow00]

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.

I was told sterile was not such a big concern anymore when I preping for ITLS. The pt just needs dry "clean" sheets. Was I told wrong, or is this acceptable seeing as how I have two level 1 trauma centers (Barnes Jewish and SLU) about 15 mins from everywhere? The rational behind why we were told that was one of the first things the Drs. are going to do is put on a thick layer of anti-biotic cream and dry dress everything. We also have critical care support by air (Arch, Airevac) and by ground (a CC transport truck). I am just trying to figure out what is truely proper?

[firedoc5]

I was told sterile was not such a big concern anymore when I preping for ITLS. The pt just needs dry "clean" sheets. Was I told wrong, or is this acceptable seeing as how I have two level 1 trauma centers (Barnes Jewish and SLU) about 15 mins from everywhere? The rational behind why we were told that was one of the first things the Drs. are going to do is put on a thick layer of anti-biotic cream and dry dress everything. We also have critical care support by air (Arch, Airevac) and by ground (a CC transport truck). I am just trying to figure out what is truely proper?

We're in the same neighborhood. BJC was our main destination usually from Mt.Vernon, IL. Barnes is where I got most of my experience with burn patients in a clinical setting.

Keeping things sterile is very difficult, especially in the field. But I was always told to strive to do your best to keep things as sterile as you could when it came to burn patients. You may not be able to keep things absolutely sterile, but considering the circumstances keep things as clean as you can.

[letmesleep]

I learned from St John's Mercy Med Center to keep things as clean as possible, but to remember that aseptic technique is about all we can do in the field. The biggest thing that stuck in my head about burns (besides fluid replacement and airway management) is DO NOT put anything on a burn that is going to have to be removed by the Burn Unit. The process of cleaning a burn in the Unit is very painful for the Pt, and the less they have to PICK and SCRAPE off of them, the better.

Put the fire out, manage the airway as needed, O2 therapy (always), IV where you can get it and secure with dressings instead of tape or the such, cool the burn with water, but maintain their core temp (tricky), and continue to access throughout transport to a Burn Center. Burns = pain control.