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Wilderness Medical Society - snowmass 2005 (Page 198)

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Wilderness Medical Society - snowmass 2005
28
hypothermia in an extensively burned patient. Remove clothing and all jewelry,
especially rings or other constricting items. Remove rings even if the hands are not
burned. Do not try to remove anything that has stuck to the wound.
(2) Manage airway, breathing, circulation (the ABCs) with particular attention to the
possibility of thermal injury to the airway. Signs and symptoms of thermal airway injury
include: a) hoarse or muffled voice; b) soot in mouth; c) carbonaceous sputum; d) singed
nasal hair; and e) significant burns to the face. If there is any suspicion of airway injury,
early definitive management of the airway is needed and initiate emergency evacuation.
Administer oxygen to all suspected airway burn victims, those with smoke inhalation,
and to all others with critical burns.
(3) Assess for associated injuries such as fractures or lacerations and inhalation injury.
(4) Evaluate the burn (depth, extent, pain, and location).
(5) General treatment for the patient:
a. Stabilize the body temperature. When skin is lost, so is the patient's ability to
thermoregulate and prevent heat loss.
b. Elevate injured parts.
c. Hydration is of critical importance in long-term care. Have the patient drink as
much fluid as he/she can tolerate, unless the patient complains of nausea. Avoid
vomiting, if possible. Include some salt in the oral fluids, but do not make these
solutions stronger than 0.9%.
d. Remember: In the early stages of burn injury, altered consciousness is due to a
cause other than the burn.
C. General Treatment of the Burn:
Caring for the wound itself is often the least important aspect of burn care. All burn
wounds are sterile for the first 24 to 48 hours. Burn management is aimed primarily at
keeping the wound clean, reducing the pain and regulating fluid status and body
temperature.
a. Gently wash the burn with slightly warm water and mild soap, if needed, to
remove any debris and to clean the skin surface around the burn site. Pat dry.
Remove the skin from blisters that have popped open or are hemorrhagic (but do
not open blisters).
b. Cover the patient with a dry sterile dressing and do not use topical antibiotic
ointments if the patient can get to a burn unit within 24 hours. Otherwise, dress
burns with a thin layer of antibiotic ointment.
c. Cover the burn with a gel dressing if the burn is small enough, or cover with a
thin layer of gauze, or with clean, dry clothing. Covering wounds reduces pain
and evaporative losses. Superficial burns can benefit from inexpensive
moisturizing cream or aloe vera creams.
The use of hyperosmolar solutions such as honey or sugar is acceptable as a field
expedient dressing
e.. When evacuation is imminent, do not re-dress or re-examine the injury. If
evacuation is prolonged, re-dress once daily. Remove old dressings, re-clean
(removing the old ointment), and apply fresh ointment and a clean dry covering.
(Note: soak off old dressings with clean, tepid water.)

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