I had a great chance to listen to an old friend talk about burn care last night. Kristen Murphy is a CCRN and coordinator at URMC’s Kessler Burn Center. With so little time spent learning about burn patients, it was nice to have a refresher. So while most of this will serve as just that, I hope you can take something away.
The lecture covered the typical types of burns, from the 2% electrical burns to the 75% thermal burns. Some very controversial emerging treatments were covered. While this may not directly help us in the field, I have seen some bewildered faces in the outlying ED’s. Ointments: do or do not? Coming form the mouth of the burn center, ointments have made their way back in. Polysporin is a recommended intervention for most of the body surface. Where the face or genitals are involved, Vaseline is the preferred ointment. Last I had heard, this was not a recommended practice as it “seals in the heat,” but as so often happens in medicine, this treatment has made a comeback.
There are a few ways to determine the total body surface area (TBSA) of the burn. Rule of Nines, rule of palms, and the list goes on. For this training we worked with the Rule of Nines and the parkland burn formula. By way of refresher, the formula is 4cc x TBSA x wt (kg). The first half of this number should be administered over the first eight hours, with the remainder infused over the following 16 hours. A strong preference for lactated ringer’s over saline was expressed by the burn center. Most of the formulas and treatment guidelines are based around the administration of LR.
If calculation of the Parkland formula is impractical, another guideline from the American Burn Association:
- <5 yrs old Run LR at 125 ml/hr
- 6-14 Yrs Run LR at 250 ml/hr
- 15 and up Run LR at 500 ml/hr
And if you missed it, the formula advocated in the most recent TCCC Handbook is the “Rule of Ten”:
- For patients between 40 and 80 kg, BSA (to nearest 10%) x 10 cc/hr.
- For each 10 kg over 80, add 100 cc/hr.
A special thanks again to Kristen Murphy, CCRN for the training.