This article was originally published on trauma-news.com by DAVID W. VOIGT MD, CHRISTI CHAVES MA RN FACHE AND ESTHER RATHJEN MSN RN APRN-CCNS. View the original article by clicking here.
About 486,000 people receive medical treatment for burn injuries in the United States every year. For the most seriously burned patients, this involves transfer to one of the nation’s 66 verified burn centers. But the vast majority of burn patients are treated in trauma centers and emergency departments without a specialized burn unit.
As burn specialists, we see the most serious end of the thermal injury spectrum every day. Our hospital, CHI Health St. Elizabeth in Lincoln, Neb., became one of the first verified burn units in the U.S. in 1973. Today, we treat more than 150 seriously burned patients every year.
Recently, we were asked what trauma centers, non-trauma EDs and prehospital providers can do to improve their care for burn patients. The short answer, in our view, is greater collaboration with your regional burn center. Verified burn centers offer expertise that can improve outcomes for burn patients — even if those patients never set foot in a specialized burn unit.
Strong collaboration requires information sharing. Based on best practices and available resources, following are four ways that trauma providers can leverage burn center expertise to improve care for burn victims in every setting.
1. Avoid “fluid creep”
In many regions, one of the biggest opportunities to improve burn care is to more carefully manage fluid resuscitation for burn victims. Too often fluids are run “wide open” in burn patients. This can lead to the phenomenon referred to as “fluid creep”. The result is increased lung water, which leads to increased ventilatory time and all its associated consequences. Fluid creep has also been linked to abdominal compartment syndrome.
How can trauma providers avoid fluid creep? First, make sure you are following current guidelines from the American Burn Association (ABA) for calculating fluid needs. The best way to learn these guidelines is to take the ABA’s Advanced Burn Life Support (ABLS) course. This course educates trauma and emergency department staff on the most current practices for resuscitating and treating burn victims.
Second, make sure you understand how to estimate burn size. Research has shown that inexperienced practitioners often overestimate the size of a burn. Since burn size is a key factor in fluid resuscitation formulas, burn overestimation will result in patients receiving too much fluid, even if the current resuscitation guidelines are used.
Fluid resuscitation guidelines are constantly evolving, so we also encourage trauma centers and non-trauma EDs to maintain ongoing communication with their regional burn center to stay up to date on the latest recommendations.
2. Do not delay intubation for burn patients
In our experience, providers are sometimes reluctant to intubate a burn patient. Verified trauma centers are usually very good about this aspect of care, but many ED staff in smaller communities do not feel comfortable with intubation. As a result, they will often wait for the transport team to intubate the burn victim.
Clearly, however, delaying intubation can have disastrous effects. At St. Elizabeth, we would rather take an endotracheal tube out of a burn patient who didn’t need it than to have the patient arrest two blocks from our hospital.
Our recommendation: If there is any doubt, intubate the patient. The airway is only going to get worse as the resuscitation continues and the tissues swell, so early intubation is a critical component of care.
Again, for all of the clinical management issues surrounding burn care, the best overall solution is to make sure trauma providers take the ABLS Course.