First Aid in Burns

Dr KK Aggarwal
Padma Shri and Dr B C Roy National Awardee
President, Heart Care Foundation of India
National Vice President Elect IMA

1. Patients with severe thermal burns are at significant risk of death and major morbidity.

2.Look for evidence of respiratory distress and smoke inhalation injury, a common cause of death in the acute burn victim.

3.Laryngeal edema can develop suddenly and unexpectedly.

4.Burn depth and size determine fluid resuscitation and the need for transfer.

5.Vascular collapse from burn shock is a critical component.

6.Rapid, aggressive fluid resuscitation to reconstitute intravascular volume and maintain end-organ perfusion is crucial.

7.The fluid requirement during the initial 24 hours of treatment is 4 mL/kg of body weight for each percent of TBSA burned, given IV. Superficial burns are excluded from this calculation. One-half of the calculated fluid need is given in the first eight hours, and the remaining half is given over the subsequent 16 hours.

8.Monitor urine output is important

9.Hourly urine output should be maintained at 0.5 mL/kg in adults.

10.Carbon monoxide and cyanide – Burn patients may be exposed to carbon monoxide, requiring immediate treatment with high-flow oxygen.

11.Cool and clean wounds, but avoid inducing hypothermia.

12.Remove any jewelry and any hot or burned clothing and obvious debris not densely adherent to the skin.

13.Irrigation with cool water may be used.

14.Topical antibiotics are applied to all non superficial burns.

15.Give opioids (morphine) to treat pain and give tetanus prophylaxis.