First 48 Hours of Burn Care Treatment
Upon arrival to the hospital, the injured person is admitted directly to the Burn Treatment Center. During this time, vital body functions are assessed and treated. Breathing and circulation are maintained first. Patients with burns to their face, neck, or lungs may require a breathing tube, which is placed in their mouth or nose. This tube is connected to a ventilator to assist with breathing. Patients are unable to talk because of the tube through their mouth or nose. If a patient does not need to be placed on a ventilator, additional oxygen may be necessary to increase oxygen intake. A pulse oximeter may be placed on the patient to monitor the amount of oxygen in the blood.
An intravenous (IV) access line is also vital for proper treatment of the burned patient. Frequently, a patient will have more than one IV line. The IV delivers extra fluid and medication rapidly into the bloodstream. The extra fluid is needed to prevent dehydration and shock. As a result of the burn injury, the body releases chemicals that cause fluid to leave the blood vessels. This fluid accumulates in and around the burn causing swelling. Fluid leaving the blood vessels also causes shock in burn patients. In forty-eight to seventy-two hours, this process will reverse-fluid comes back into the bloodstream and the swelling goes down. Medication is given in the IV line for pain and to maintain vital body function. Occasionally, what is known as an arterial line is placed in the wrist, groin, or foot of the patient. This specialized line is placed in an artery to record the patient's blood pressure on a monitor. Blood samples can be easily and frequently drawn from this line in order to decrease multiple needle sticks.
The patient may be placed on a cardiac monitor to observe the heart rate and rhythm at all times. Alarms and limits are set on these monitors to notify the nurse immediately of any change.
A Foley catheter will be placed into the bladder to monitor kidney function so IV rates can be adjusted appropriately.
A nasogastric (NG) tube may be placed into the patient's nose and down into the stomach to aid in removing stomach contents. This helps in preventing nausea and vomiting. Because of the stress of the burn injury, stomach activity decreases and the patient is unable to digest food or fluid. The patient should not be given anything to eat or drink during the first twenty-four hours. Later, during the hospitalization, this tube will be replaced with a small pliable tube to receive high protein-high calorie feedings.
As with any hospital admission, blood and urine samples will be obtained along with admission X-rays, EKGs, and photographs of the wounds. Photographs are taken upon admission to document the initial appearance and size of wounds.
The patient is first stabilized in the admission area, and then taken to the hydrotherapy room. There all wounds are cleansed, broken blisters are debrided, and hair is shaved within two to three inches of the burn wound. Burns that circle around the torso, leg, or arm completely (otherwise known as circumferential) may act as a tourniquet on the limb and obstruct blood flow. If the blood flow is obstructed, an escharotomy (cut) is made through the burned tissue to allow a release of pressure. After cleansing with soap and water, antibiotic bandages are applied.
University of Iowa Hospitals and Clinics
Department of Nursing
Critical Care Nursing Division
Peer Review Status: Internally Peer Reviewed