Burn assessment

• First degree: epidermis (sunburn-like, no blistering)
• Second degree: epidermis and partial dermis (blistering)
• Third degree: penetrating the dermis and underlying tissues (full-thickness, eschar, and/or whitish-gray appearance)
• Percentage of total body surface area (TBSA) involved (count only second- and third-degree burns); For small, irregularly shaped burns, palm of hand is equal to 1%
• Age of Pt (age + TBSA = % probability of mortality)
• Pulmonary injury (smoke inhalation, toxic fumes)
• Associated injuries (airway burns and other trauma)
• Chemical/electrical burns, carbon monoxide poisoning
• Pre-existing diseases (potential for exacerbation)

EMT—basic/intermediate

• Establish and manage ABCs per protocol
• Use c-spine precautions for obvious or suspected trauma
• Administer high-flow O₂, or manually ventilate as indicated
• Rapid transport to burn center if Pt meets inclusion criteria

Paramedic

• Assess need for advanced airway, and intubate as indicated
• Anticipate laryngospasm/airway complications
• Start two large-bore IVs (LR), and titrate to SBP >90 mm Hg
• Attach ECG monitor, and manage dysrhythmias per ACLS