Burn Injury Management - Phase

1. EMERGENT PHASE
The emergent phase begins at the time of injury and ends with the restoration of capillary permeability (fluid resuscitation): 48-72 hrs following the injury. Key point is to prevent hypovolemic shock and preserve vital organ functioning. It includes prehospital and emergency room care.

Pre-hospital Care

• Remove source of the burn
• Assess airway, breathing, and circulation,
• Conserve body heat
• Cover burns with sterile or clean cloths
• Remove jewelry and clothing
• Intravenous fluid (if needed)
• Quick transport

Emergency Room Care
It is a continuation of care administered at the scene and implemented as the hospital policy or standard procedures.


For Major burns:

• Assess the degree and extent of the burn area
• Ensure a patent airway and administer 100% oxygen, assess for respiratory distress, blisters and edema on oropharynx
• Check arterial gases and carboxyhemoglobin level
• Peripheral intravenous access
• Monitor vital sign closely
• Keep NPO
• Insert nasogastric tube as prescribed
• Tetanus Toxoid and Pain medication as prescribed
• Escharotomy or fasciotomy as prescribed

For Minor Burns:

• Pain medication (morphine sulfate or meperidine)
• Oral analgesic and Tetanus toxoid as prescribed
• Wound Care

2. RESUSCITATIVE PHASE

It begins with the initiation of fluids and ends when capillary integrity returns to near normal. Keys point is to prevent shock by maintaining adequate circulation blood volume and vital organ perfusion. And the successful fluid resuscitation is evaluated by stable vital signs, adequate urine output (30-50 mL/hr) palpable peripheral pulses, and a clear sensorium.

Fluid replacement is calculated from the time of injury not from the time of arrival at the hospital. The amount of fluid given is based on the body weight and extent of the injury.

Common Fluid Resuscitation Formulas (24 hours after burn injury)

Parkland (Baxter) Formula:

• 4 mL/kg per percent TBSA burned.
• Half is given in first 8 hours
• One-quarter each next 8 ours
• Solution: Lactated Ringer’s

Modified Brooke Formula:

• 2.0 mL/kg per percent TBSA burned
• Half is given in first 8 hours
• Half in next 16 hours
• Solution: Lactated Ringer’s

3. ACUTE PHASE

It begins when the client is hemodynamically stable, capillary permeability is restored, and diuresis has begun, usually 48-72 hours after the time of injury. Key point is on infection control, wound care, wound closure, nutritional support, pain management, and physical therapy.