When we think of resuscitation, patients with an underlying cardiac issue often come to mind first. But a cardiac cause isn’t always the starting point. Burn victims, for example, need immediate interventions to prevent adverse outcomes like shock and eventual cardiac arrest. That’s because severe burns not only cause injury to the local site itself, but also lead to a systemic response in the body.1 If not managed properly, that response can lead to shock, decreased cardiac output, arrest, and more.
To prevent this from happening, early management is key. Supporting burn victims early on in their treatment and allowing for supportive fluid resuscitation sets patients up for recovery and reduces the risk of poor outcomes.
But how is this done? Keep reading to learn 3 key early intervention strategies to support victims of severe burns.
With any burn victim, a preliminary assessment will help determine the most appropriate site of care for the patient and the severity of the injury.
Is transfer to a burn center indicated?
Of course, not all burns are life-threatening. Small burns that are localized can be treated at an urgent care, a physician’s office, or even at home. But larger, more severe burns require immediate transfer to a burn center to reduce the risk of mortality. The American Burn Association offers criteria for when transfer to a burn center is appropriate. For example, factors like advanced age, smoke inhalation, and electrical burns all increase the risk for poor outcomes. Any patients meeting these criteria should be transferred to a burn center immediately.2
Performing ABCDE assessment
Like trauma victims, initial assessment of a burn patient will include the “ABCDE” evaluation: airway, breathing, circulation, disability, and exposure. This assessment helps emergency medical technicians start initial treatment and begin to evaluate the need for fluid resuscitation.
With this foundation in place, we can turn our attention to ways to support these patients via early intervention. Keep reading to learn 3 key strategies that help support burn victims and prevent adverse outcomes like shock and cardiac arrest.
1. Secure the airway
The goal of early intervention is not only to support the burn patient’s injuries in the moment — although that’s obviously important as well. It is also about setting the patient up for successful resuscitation long-term in the hospital.
To that end, securing and protecting the airway immediately is a must. In cases where there is a risk of smoke inhalation, the airway will start to swell and blister internally within 1-2 hours. It becomes very difficult for clinicians to secure the airway after that point, making early airway protection a priority. Any signs of singed hair on the nose or face indicate a need for early intubation. Ideally, these patients should have an oxygen saturation greater than 90%.2
Key takeaway: In most cardiac resuscitation models, airway securement in the form of intubation isn’t required. But for burn victims, it’s one of the top measures to support them.
2. Establish intravenous access & begin fluid resuscitation
The next step is to secure an intravenous line to allow access for fluid resuscitation.
Initial fluid resuscitation can be a crucial, lifesaving intervention for burn victims, helping to avoid burn shock, maintain perfusion to the organs, and prevent organ failure. Still, it’s important for clinicians to remember that initial fluid resuscitation is a balancing act: it’s possible to be either too conservative or too aggressive in your approach. An overly conservative approach can lead to burn shock, organ failure, and other adverse outcomes. But treating aggressively comes with its own risks too, such as compartment syndrome, third spacing, and other problems.3
Key takeaway: When it comes to fluid resuscitation for burn victims, be sure to follow the practices and protocols at your hospital to avoid treating too conservatively or aggressively.4 This can help prevent complications at either end of the spectrum.
3. Monitor fluid intake and outtake
Following your hospital’s protocols regarding fluid resuscitation is important, but it’s only the first step. Subsequent monitoring of urine output is essential to ensure the protocol is appropriate for the patient and to monitor kidney function.2 Once fluids have been started, insert a Foley catheter to accurately assess fluids in and out.
Key takeaway: Protocols at your hospital should be followed to determine initial fluid resuscitation for burn victims, but it’s important to keep in mind that these are just guidelines. Every patient will respond differently and should be monitored to determine if fluids need to be adjusted.
Next, learn how resuscitation in trauma cases is both similar and different to standard resuscitation cases — and how responders can customize their response to better support trauma victims.
Simko LC & Culleiton A. (2017). Burn injuries in the ICU: A case scenario approach. Nursing Critical Care, 12(2):12-22. https://doi.org/10.1097/01.CCN.0000511826.04099.6e
Oliver RI Jr. & de la Torre J. (2021, March 29). Burn resuscitation and early management: Background, pathophysiology, initial evaluation and treatment. Medscape. Available at: https://emedicine.medscape.com/article/1277360-overview?reg=1%26icd=login_success_email_match_norm
Boehm D, Schröder C, Arras D, et. al. (2019). Fluid management as a risk factor for intra-abdominal compartment syndrome in burn patients: A total body surface area—independent multicenter trial part I. Journal of Burn Care & Research, 40(4), 500–506. https://doi.org/10.1093/jbcr/irz053
Harshman J, Roy M, & Cartotto R. (2018). Emergency care of the burn patient before the burn center: A systematic review and meta-analysis. Journal of Burn Care & Research, 40(2), 166–188. https://doi.org/10.1093/jbcr/iry060