![]() In the burn patient, attention should focus on the airway looking for oral burns that might cause swelling and obstruction, breathing problems from smoke inhalation or lung injury, and bleeding or circulation problems by looking for life-threatening bleeding and checking blood pressure, heart rate, and pulses. ![]() The primary survey assesses the A.B.C.s for life threats. history (allergies, medications, past medical history, last oral intake, events of injury). Providers should obtain an initial A.M.P.L.E. However, for the burn patient, the very first step is to immediately stop the burning process and remove burning or hot items from skin contact. The initial assessment and management of severely burned patients should be similar to the approach of a major trauma patient. ![]() If the patient is profoundly hypotensive initially, other causes of hypotension should be sought.īurns are dramatic injuries that can draw healthcare providers’ attention away from more immediate life or limb-threatening problems. It is important to remember that burns by themselves do not cause significant hypotension initially and “burn shock” develops over the first few hours. This response, along with decreased cardiac output and increased vascular resistance, can lead to marked hypovolemia and hypoperfusion called “burn shock.” This can be managed with aggressive fluid resuscitation and close monitoring for adequate, but not excessive, IV fluids. These responses occur mostly over the first 24 hours peaking at around six to eight hours after injury. Inflammatory and vasoactive mediators such as histamines, prostaglandins, and cytokines are released causing a systemic capillary leak, intravascular fluid loss, and large fluid shifts. Severe burns cause not only significant injury at the local burn site but also a systemic response throughout the body. Several factors may predispose the specific group of patients to more complicated injuries. Other factors that should be considered and will increase the patient’s morbidity and mortality include associated inhalation injury, associated traumatic injury, and the patient’s baseline medical conditions like heart disease or lung disease. Significant burns to the face, eyes, ears, joints, or genitalia
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