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On The Scene

Volume 7, Issue 2


ABCs of burn care

For burn patients, mind the ABCs (airway, breathing and circulation) and note the situation. Patients burned in closed spaces such as houses or vehicles are more likely to have airway or inhalation damage in addition to external burns. They may require intubation.

  • Signs of airway damage include swelling, raspy voice, singed nasal hair or soot in the pharynx. If in doubt, especially for children, intubate immediately.
  • Unconscious patients: 100% O2 per BVM and consider intubation.
  • Remove clothing and jewelry. Metal jewelry can remain hot for a long time. Smoldering clothing can continue to burn.

When to begin IV fluid resuscitation
Determine the burn size. Use the rule of 9s for large area burns and the rule of palms for small or scattered burns. Do not include 1st degree burns. Begin IV fluid for adults with burns ≥15% TBSA or children with burns ≥10% TBSA.

  • Patients age 14 and older: LR at 500 ml/hr
  • Children age 6-13: LR at 250 ml/hr
  • Children age 5 and younger: LR at 125 ml/hr
Precautions
  • For patients age 70 and older or those with cardiopulmonary disease, start fluids at 250 ml/hr LR and monitor BP and pulmonary response.
  • Resuscitation needs may be greater for patients with concurrent trauma such as fractures, TBI, chest trauma.
  • Use large fluid boluses only if patient is hypotensive from concurrent trauma.
  • Report fluid volumes to ED staff on arrival.
Treat for pain – unless allergic or contraindicated
  • Adults: Fentanyl – 50 mcg every 1-2 minutes. Morphine – 2 mg every 3 minutes. Titrate both to desired effect.
  • Children/adolescents: Fentanyl – 1 mcg/kg every 3-5 minutes. Morphine – 0.1 mg/kg every 5 minutes, titrated to desired effect.
Dressings
  • Cover small burns with loose, dry dressings.
  • Don’t apply ointments, creams or water to patient’s skin or dressings.
  • Burn patients become cold easily. Keep patient warm with clean sheets/blankets.

Outpatient burn and wound care
We're on the ground floor of the main hospital. Patients of all ages receive a continuum of care for complex burns and wounds. Our staff includes plastic surgeons, general surgeons, nurse practitioners, physician assistants, nurses, occupational therapists and hydrotherapy technicians. For more information, contact Karla Oberle, clinic manager, at 913-588-4058 or koberle@kumc.edu.

Hyperbaric oxygen therapy
Our hyperbaric oxygen facility was accredited in June 2015 by the Undersea & Hyperbaric Medical Society. This demonstrates our commitment to the highest standards of care and patient safety for hyperbaric medicine. Patients receive care for conditions including diabetic wounds, decompression illness and, most commonly, acute carbon monoxide poisoning.

Jennifer ParksJennifer Parks, RN, BSN
Jennifer is nurse manager of the Burnett Burn Center. She has nine years of experience in burn care and is an instructor for the Trauma Nurse Core and Advanced Burn Life Support courses. She is published in the American Journal of Critical Care for her project on improving nutrition for burn patients.

 

Karla Oberle, RN, BSN, CHRNKarla Oberle, RN, BSN, CHRN
Karla is nurse manager of the Outpatient Burn, Wound and Hyperbaric Clinic and manager of the Inpatient Wound and Ostomy Clinical Excellence Team. She has 12 years of experience in burn/wound care and carries a professional nursing certification in hyperbaric medicine.



Meet LifeNet Air Medical Services

Owned and operated by Air Methods, LifeNet Air Medical Services has been dedicated to air medical transport since 1980. As part of the air medical critical care services in the Kansas City area for more than 16 years, LifeNet responds to traumatic injuries and critically ill patients with time-critical diagnoses including strokes, heart attacks and sepsis.

Operating out of Rosecrans Airport in St. Joseph, Missouri, LifeNet 2-2 provides 24-hour air medical critical care services to a 150-mile area around St. Joseph. LifeNet 2-2 flies a Bell 407 GX and is staffed with a paramedic, nurse and pilot. Patient-care equipment on the aircraft includes a Revel ventilator, propaq MD monitor with defibrillator and invasive monitoring capabilities, and IV pumps with the ability to maintain 6 infusions at a time.

To learn more, visit www.airmethods.com/lifenetheartland.

Thanks for attending the EMS celebration

It was a beautiful day for the 17th annual EMS celebration May 19 at Rosedale Park. EMS personnel and their families from throughout the Kansas City metro area came out for the event. The celebration was sponsored by The University of Kansas Hospital.

Save the date

2016-17 Events and CEUs
Refresh your skills and meet your colleagues.

  • Topics in Trauma - Friday, October 7, 2016
  • Advanced Burn Life Support - Friday, October 21, 2016
  • Regional Burn Conference - March 2017

For more information on trauma and burn courses and educational opportunities at The University of Kansas Hospital, email TraumaEducation@kumc.edu.