burn sites and IV's

[Ridryder 911]

I used to work as a Burn Nurse at the Burn Center Brock works at. It was the third largest in the nation. So we seen quite a few burns. Personally in the field, one should attempt to avoid a burn site.. (common sense) however; I much rather see a line than no line at all.

Yes, it is a site for infection..yadda.. yadda.. Realistically, they are going to (or at least should) to specific cultures and place these patients on high doses of antibiotics. Remember, people do not die from burns, rather burn complications (infections, respiratory involvement, shock, etc). So your bi-lateral IV is not going to cause any more damage, as well doubtful will be strong enough for the fluid resuscitation as well. Although, again it is a patent line, so med.'s, analgesics can be administered.

I have started lines, where no one would ever guess.. (yes, especially on males.. hey: it has veins!) Burns so serious, that central lines were difficult to near impossible to track and cannulate.

Like most of EMS, use common sense. Avoid burn sites, use alternative, if using site, cleanse and observe closely for contamination and infiltration.

R/r 911

[JakeEMTP]

Sounds like patients with burns to the upper torso would be excellent candidates for the latest "toy" we have been signed off on, that being the EZ-IO.

disclaimer- I know it's not a toy, but a excellent tool.

[Spock]

We change the small endo tubes as soon as possible. We have had to many cases of a 6'2" 260 pound male with a 6.0 endo tube. Ventilations become very difficult over the next few days. It is best to change the tube early before the patient swells. We usually do it in the trauma bay but sometimes will wait until the patient is in the trauma/burn unit. The ER docs (residents) are usually quick to jump at intubating but they run in the opposite direction with changing a burn patient's tube.

My previous post said we change the IV's within 2 hours. Sorry for the typo but I meant 24 hours.

We tried the subglottic suction endo tubes for a while but the hospital decided not to use them because of the cost ($13 vs $1.50) Of course one less case of ventilator acquired pneumonia would more than make up for the increased cost but we couldn't convince the bean counters of that.

Rid hit the nail on the head. If the patient survives the initial injury the burn won't kill him but the sepsis later on will. Rule of thumb: Age + % total body surface burn = mortality. Not scientific but it seems to be accurate.

Live long and prosper.

Spock