You are evaluating a 47-year-old man who suffered more than 75% total body surface area burns in an explosion at a local glass-etching factory. You must evacuate him by helicopter to the burn center, which is located more than 150 miles away. You know that:
Nasogastric suction is not necessary in burn patients when transferring by helicopter or ambulance if they have not eaten within the last 6 hours or if they are otherwise alert and the gag reflex is intact.
+Sheets soaked in sterile ice water or iced saline should be used to cover all large burn areas to prevent further tissue injury and reduce pain.
+If the burns are from hydrofluoric acid, subcutaneous calcium chloride injected until the pain stops is the treatment of choice.
+Escharotomies of the chest and limbs are performed by infiltrating the site to be cut with 1% lidocaine and making an incision roughly one-fourth of an inch deep extending to uninvolved tissue.
+Burn patients should not receive morphine sulfate intramuscularly or subcutaneously for pain.
Only intravenous pain medication should be given in burn patients because of erratic absorption of medication from the subcutaneous and intramuscular routes. Ice should not be directly applied to wounds, and while cold compresses are helpful in small burns, hypothermia can result if they are applied to larger burns. Clean sheets are sufficient covering. Oxygen should be provided, blood gases and COHb levels checked, and in patients with evidence of severe heat injury to the face, stridor, or evidence of significant upper airway burns, early intubation should be considered before swelling makes this impossible. Patients with burns of greater than 20% of the body surface should all probably get an NG tube since ileus and gastric distension are common. Gastric rupture is a possibility in patients with distension and who are to be transported by helicopter. Third-degree burns are painless by definition and no local anesthesia is needed for escharotomy. The cut is made deep enough so the subcutaneous fat bulges through the incision and through the entire length of the eschar. Burns from hydrofluoric acid are extremely painful and destructive. Treatment includes subcutaneous or intra-arterial injection of calcium gluconate (not calcium chloride) solution until the pain stops.