Burns damage the skin and deeper tissues through heat, chemicals, electricity or radiation, and large burns cause fluid loss, infection and breathing problems. Depth and total body surface area guide fluid needs and decide who goes to a burn center.
Key symptoms
- Painful red skin or blisters in partial thickness burns
- White, leathery or charred skin with little pain in full thickness burns
- Hoarse voice, cough or trouble breathing after a fire
- Swelling of the burned area
What you find on exam
- Stop the burning process and check scene safety
- Airway: singed nasal hair, soot in the mouth, stridor, facial burns
- Burn size with the rule of nines or the patient's palm (about 1 percent)
- Depth of the burn and circumferential burns around limbs or chest
- Other injuries from a blast, fall or electrical current
Tests
- Carbon monoxide level and blood gas after smoke exposure
- Electrolytes, kidney function, blood count
- ECG after electrical burns
- Urine output to guide fluids
Treatment basics
- Cool the burn with running water for up to 20 minutes; avoid ice
- Cover with dry, clean dressings and keep the patient warm
- Early airway control if there are signs of airway burn
- IV fluids for large burns using lactated Ringer's and a burn formula
- IV pain relief such as fentanyl or morphine; transfer to a burn center when needed
Red flags
- Stridor, hoarse voice or soot in the airway
- Burns over more than 20 percent of the body, or of face, hands, feet or genitals
- Circumferential burns limiting breathing or blood flow
Practice it in Making Synapses
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.