In this podcast episode, Dr. DeMello discusses the management of burns in a pre-hospital setting. He emphasizes the importance of following the MARCH approach and not letting the burn distract from other life-threatening injuries. He also highlights the challenges of accurately calculating the total body surface area (TBSA) affected by the burn and recommends using the serial halving method. Dr. DeMello advises against over-resuscitating with fluids and suggests using a simple fluid resuscitation protocol. He also discusses the use of oral fluids and the benefits of allowing patients to have clear fluids. Other topics covered include pain control, escharotomies, cooling the burn, and monitoring urine output.
Takeaways
Follow the MARCH approach and prioritize life-threatening injuries over the burn.
Use the serial halving method to estimate the TBSA affected by the burn.
Avoid over-resuscitating with fluids and use a simple fluid resuscitation protocol.
Allow patients to have clear fluids if there is no upper airway burn or evidence of inhalational burn.
Consider using ketamine for analgesia in burn patients.
Cool the burn as quickly as possible, but not the patient.
Monitor urine output and look for trends in color to assess for rhabdomyolysis.
Provide compassionate care to reduce anxiety and pain requirements.
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