Regulation of burn patients’ body temperature is essential
"Burn patients have lost their ability to maintain their body temperature when they received their burn," says Teresa Merk, RN, BSN, transport coordinator at Shriners Burns Hospital for Children in Cincinnati, OH.
When body temperature drops, patients will begin to shunt the blood to the vital organs in an attempt to preserve them, says Merk. "The blood is shunted from the skin (which may cause further damage) and the GI system," she explains. "Patients may develop necrotic bowel from getting too cold during the initial hours following their thermal injury."
Here are some ways to maintain body temperature of burn patients:
Cover the patient’s head. "Remember that a child’s head can be up to 19% of [his or her] total body surface area, and [he or she] can lose lots of heat from being uncovered," says Merk.
Limit drafts. "Keep the temperature in the room elevated, or have the air conditioner turned off," Merk advises.
Don’t use ice. The burn patient is at risk of developing hypothermia easily. "Ice or iced fluids should never be used, as they can cause further tissue damage by inducing systemic hypothermia and cutaneous vasoconstriction which can extend the thermal damage," says Merk. Ice should never be applied because of its vasoconstrictive action, resulting in a decreased blood flow to the already compromised wound, she stresses.
"Application of saline soaks or ice to these injuries will rapidly render these patients hypothermic," warns David Dries, MSE, MD, professor of surgery for the division of trauma, burns, and emergency surgery at the University of Michigan Health System. "Patient body temperature should be protected and wounds wrapped in clean, dry sheets, until the patient is transferred to a center capable of providing definitive care."
Don’t use wet dressings. "If you place a patient with a large burn in a wet dressing in an ED with the air conditioning on, your patient’s temperature will drop very fast," Merk stresses.
Instead, liberally apply silvadene and use bulky dry dressings for comfort and cushioning, says Tom Trimble, RN, an ED nurse and webmaster of Emergency Nursing World, a practice-based Internet resource for emergency nurses. "Bandaging should respect natural position of functioning," he explains.
Use lukewarm water. Ordinary tapwater at luke-warm or mildly cool temperature is sufficient; ice is not needed. "Water conducts heat 30 times better than air, and any temperature difference (or gradient) means that heat will be lost from the body to warm the water," says Trimble. "Little time is actually needed to cool the burn,’ per se, and, if a great deal of time has passed since the injury, one may assume that natural cooling has occurred."
Know which burns to flush with water. Chemical injuries should be flushed with copious amounts of water, but scalds, electrical, or flame burns should not be, says Merk. "The best treatment for 1st and 2nd degree burns is a product like Bacitracin or Polysporin. We have done much research on these types of burns and have found they heal fastest with this type of product," she reports.
Cover burns with a clean, dry sheet. During transport, the burn patient should be cocooned in a clean, dry sheet and blankets to maintain warmth, says Cheryl Wraa, RN, BSN, immediate past president of the National Flight Nurses Association, based in Park Ridge, IL. "This also protects the damaged nerve endings from exposure to air currents."
Initially, the patient may have water or cool saline applied, but once the burning is stopped, the patient should be kept warm and dry, says Merk. "Only isolated burns which are less than 10% of total body surface should have cool, moist dressings applied."
Consider amount of heat retention. The amount of heat retention depends on the type of burn, says Trimble. "Superficial burns from splash-scalds and brief contact with hot surfaces or flame will cause less heat retention," he explains. "Viscous clingy substances, such as puddings, tar, and napalm, or embedded burning metals or chemicals, continue transferring heat energy."
Don’t cool large burns rapidly. "Avoid rapid cooling unless the injury is small, typically less than 10% of the total body surface area, says Dries. "Simply removing the patient from the source of burning (or clothing if involved) will rapidly expose the patient to a room air environment which will cause cooling," he says.
A greater concern is the inappropriate hypothermia which follows rapid cooling of burn-injured patients, says Dries. "This can complicate resuscitation, compromising cardiovascular performance and lead to hemodynamic instability," he explains.