a. History.

Observe the scene of the injury. Find out how long the burn occurred before help arrived. Try to obtain the answers to the following questions.

(1) What has the patient or bystanders done for the injury?

(2) Was the patient in a closed space with smoke, steam, or other products of combustion? If so, for how long? Did the patient lose consciousness?

(3) What was the cause of the burn? Open flame? Hot liquids?

(4) Does the patient have any history of significant heart disease which might complicate fluid therapy? Pulmonary problems which might cause a reaction to smoke inhalation? Other underlying illnesses?

b. General Treatment.

(1) Remove the casualty from the source of the burn. Smother any flames and turn off the electrical source. Extinguish and cut off burning clothes. That is, generally, eliminate the cause of the burn.

(2) Maintain the airway, continually assessing for patency (making sure the airway is open).

(3) Administer humidified oxygen.

(4) Assess vital signs.

(5) Remove the patient’s clothing and constrictive articles such as rings and bracelets. Clothing may continue to smolder, so cut it away. DO NOT pull away clothing that is stuck to the skin. Cut around the stuck clothing.

(6) Evaluate the casualty for other injuries such as hemorrhage or central nervous system injury.

(7) Treat for shock. Start an IV to replace body fluids. Use a large-bore catheter. For burns that are greater than 20 percent of the TBSA and for significant electrical burns, perform gastric intubation. (Later in this lesson, you will be instructed how to determine the amount of fluid to give, depending on the casualty’s body weight and the total body surface area burned.)

(8) Perform urinary catheterization if the burns are greater than 20 percent of the body surface and the patient has significant electrical burns.

(9) Keep the casualty warm at all times.

(10) Dress any wounds and provide psychological support, and pain control with narcotics if possible.

CAUTION: NEVER USE ointments, butter, cream, salves, sprays, or any other covering on any type of burn. These will have to be scrubbed off later and will further irritate the burn and cause the patient pain.