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Welcome to BASICS Scotland Podcasts - Conversations with a wide range Pre-hospital Emergency Care experts talking about medical topics that relevant to BASICS Scotland Responders and anyone interested in immediate care. Our podcasts are released weekly make sure to subscribe to listen to our latest releases. Do get in touch with your feedback, questions & ideas for future podcasts. More info here: https://basics-scotland.org.uk
Episodes
Monday Feb 14, 2022
Winston de Mello - Prehospital management of burns
Monday Feb 14, 2022
Monday Feb 14, 2022
Winston chats to us about burns and the treatment of these in the prehospital environment
Top 3 tips:
- Take a SAFE approach
- Stop the burning process
- Cool the burn but not the patient
Biography:
Dr de Mello undertook his medical training at Guy’s Hospital and Southampton. He served in the RAMC as a Regular and Reservist from 1976 to 2013 ending his military career as Colonel TA BATLS from 2007-2013. His NHS employment as an Anaesthetist and Pain Medicine Physician was at Mid Yorkshire and Manchester University Hospital. His clinical interests include pelvic pain, burns, pre-hospital care and trauma. He is a Founding Member of the Pre-Hospital Care Faculty at the Royal College of Surgeons Edinburgh and the College of Remote & Offshore Medicine at Malta. He retired in 2020 and is Trustee at the Vulval Pain Society UK and Chair of the Pre-hospital SIG at the British Burns Association.
Links and resources:
Clinical Pearls:
- Take a SAFE approach: Shout for help, Approach with care, Free from danger and Evaluate the ABCs
- Stop the burning process by getting the victim to drop to the floor and roll, remove clothing and jewelry
- Provide supplemental oxygen after clearing the airway
- Check both radial pulses
- If a burn patient is hypotensive within a couple of hours of the injury look for another source of blood loss – check the mechanism of injury
- Stop the burning process
- Cool the burn for a minimum of 20 minutes using cool water for up to 3 hours post burn
- Keep patient warm
- Loosely cover the burn with clingfilm
- Sit up (if permissible) especially in burns involving the head and neck to minimize the swelling
- Clingfilm also provides analgesia
- Beware circumferential burns
- The normal oximeter cannot detect carbon monoxide – and will falsely give a high saturation reading
- Fluid resuscitation in adults in pre-hospital burns can be simplified by adopting the “small man, small burn small bag; big burn, big man big bag” – which simplifies to either a 500 ml or 1000 ml bag of Hartmann’s Solution intravenously/intraosseously per hour
- TBSA calculation in the pre-hospital can be difficult and is usually overestimated
- Electrical burns may need 24hour ECG monitoring in vulnerable patients
- Chemical contamination needs copious irrigation with water ideally within 10 minutes of contact except for elemental sodium, potassium or lithium
- Alkali burns are worse than acid
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