Advanced Burn Life Support Course - American Burn Association

CARE RESEARCH PREVENTION REHABILITATION TEACHING

Advanced Burn Life Support Course

PROVIDER MANUAL 2018 UPDATE

American Burn Association 311 South Wacker Drive, Suite 4150 Chicago, IL 60606 (312) 642-9260

2017? 2018

ABLS Advisory Committee

Tam N. Pham, MD, FACS Contributing Editor UW Medicine Regional Burn Center at Harborview Seattle, WA

Amanda P. Bettencourt RN, MSN University of Pennsylvania School of Nursing Philadelphia, PA

Gerarda M. Bozinko, RN, MSN, CCRN Crozer-Chester Medical Center Upland, PA

Philip H. Chang, MD Shriners Hospitals for Children - Cincinnati Cincinnati, OH

Kevin K. Chung, MD, FCCM U.S. Army Institute of Surgical Research Fort Sam Houston, TX

Christopher K. Craig, MMS, PA-C Wake Forest Baptist Health Winston-Salem, NC

Alice M. Fagin, MD, FACS Arkansas Children's Hospital Little Rock, AR

Kathleen A. Hollowed, RN, MSN Contributing Editor MedStar Washington Hospital Center Washington, DC

Laura S. Johnson, MD, FACS MedStar Washington Hospital Center Washington, DC

Peter Kwan, BScE, MD, PhD, FRCSC University of Alberta Edmonton, AB

Elizabeth A. Mann-Salinas, RN, PhD Army Burn Center San Antonio, TX

Joseph A. Molnar, MD, FACS Wake Forest University, School of Medicine Winston-Salem, NC

Lisa Rae, MD, MS Vanderbilt University Medical Center Nashville, TN

David H. Ahrenholz, MD, FACS Contributing Editor Regions Hospital Burn Center St. Paul, MN

Kathe M. Conlon, BSN, RN, MSHS Contributing Editor The Burn Center at Saint Barnabas West Orange, NJ

Gretchen J. Carrougher, MN, RN Contributing Editor UW Medicine Regional Burn Center at Harborview Seattle, WA

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Acknowledgements

The American Burn Association (ABA) gratefully acknowledges the leadership, time and dedication of the current and past members of the ABLS Advisory Committee. Also, the continued assistance of the ABA Central Office Staff is deeply appreciated.

Copyright ? American Burn Association 2018. All Rights Reserved. No part of this publication may be reproduced in any way, or by any means without permission in writing from the publisher.

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Table of Contents

Chapter 1

Introduction

4

Chapter 2

Initial Assessment and Management

7

Chapter 3

Airway Management and Smoke Inhalation Injury

23

Chapter 4

Shock and Fluid Resuscitation

31

Chapter 5

Burn Wound Management

39

Chapter 6

Electrical Injury

46

Chapter 7

Chemical Burns

52

Chapter 8

Pediatric Burn Injuries

59

Chapter 9

Stabilization, Transfer and Transport

68

Chapter 10 Burn Disaster Management

73

Appendix 1 Glasgow Coma Scale

81

Appendix 2 Tetanus Prophylaxis

82

Appendix 3 Radiation Injury

83

Appendix 4 Cold Injuries

86

Appendix 5 Blast Injuries

90

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CHAPTER 1

Introduction

Objectives

Upon completion of this chapter the participant will be able to:

? Understand the epidemiology of burn injuries in the United States

? D escribe learning goals for this course

I. BURN BASICS

A burn is defined as damage to the skin and underlying tissues caused by heat, chemicals, or electricity. Each year in the United States about 450,000 people receive medical attention for burn injuries. An estimated 4,000 people die annually due to fire and burns, primarily from residential fires (3,500). Other causes include motor vehicle and aircraft crashes, contact with electricity, chemicals or hot liquids and substances, and other sources of burn injury. About 75% of these deaths occur at the scene of the incident or during initial transport. The leading cause of fire death in the United States is from fires due to smoking materials, especially cigarettes. The ABA has been a lead organization in the attempt to require all cigarettes sold in every state to be fire-safe cigarettes.

Approximately 45,000 people are hospitalized for burn injuries each year and will benefit most from the knowledge gained in the Advanced Burn Life Support (ABLS) Provider Course.

Below are a few interesting facts regarding burn injuries in the United States. These statistics are for patients admitted to burn centers and based on the ABA's National Burn Repository Report for Data from 1999-2008. ? Nearly 71% of patients with burns were men. ? Children under the age of 5 accounted for 17% of cases. ? Sixty-seven percent of the reported cases sustained burns of less than 10% TBSA. ? Sixty-five percent of the reported patients were burned in the home. ? During this 10-year period, the average length of burn center stay declined from roughly 11 days to 9 days. ? Four percent of patients died from their injuries. ? Ninety-six percent of patients treated in burn centers survived

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Chapter 1 Introduction 4

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