Changing perspectives in the prehospital management of patients with severe burns
Sunday, February 2, 2020
Treatment for burn injuries has typically involved the immediate cooling of the affected area with water to reduce pain and halt the progression of heat-induced tissue necrosis. For patients suspected to be at risk of airway compromise following inhalation burn injury, historical research has long advocated early prophylactic endotracheal intubation. In contrast, current literature is showing a change in the evidence base. To investigate this, a literature review was carried out and the evidence scrutinised in conjunction with local and national guidance. Controversy has more recently emerged over whether prophylactic endotracheal intubation is appropriate in the initial emergency management of suspected inhalation burn injury. Compounding this, it appears that no appropriate evidence-based guidelines have yet been made available. Traditional indications for prophylactic endotracheal intubation are sensitive but not specific. Research has subsequently demonstrated that large numbers of patients are being unnecessarily intubated and thus placed at risk of avoidable iatrogenic harm. A higher threshold for airway intervention is warranted. Additionally, a consensus remains over the use of prehospital cooling for burn injuries. This practice is, however, informed primarily by anecdotal and animal evidence. Patients with severe burns are at significant risk of hypothermia, which is associated with mortality. There is significantly more literature demonstrating the detrimental effects of hypothermia over the benefits of burn injury cooling in patients with severe burns. Treatment should therefore focus on the maintenance of normothermia as a priority. If cooling burned areas risks inducing hypothermia, it should be postponed.
Subscribe to get full access to the Journal of Paramedic Practice
Thank you for vising the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.
Reading the Journal of Paramedic Practice counts towards your professional development
Develop your career
We provide professional information dedicated to paramedics covering training, education and jobs
Get the latest clinical information to ensure you are aware of the latest think and best practice in paramedicne
Already registered? - Sign in here