Acute injuries found in the primary and secondary survey should be addressed in accordance with standard trauma protocols. In evaluating a patient for non-burn trauma, avoid becoming distracted by the burns.
Perform a rapid airway assessment and obtain a definitive airway if needed. Immediate intubation may not be necessary in less severely burned casualties, thereby allowing time to complete the primary survey and prepare for controlled intubation.
Indications for endotracheal intubation include coma or depressed mental status with Glasgow Coma Scale (GCS) <8, symptomatic inhalation injury, deep facial or neck burns, and burns of ≥ 40% TBSA.
NOTE: Edema after burns or inhalation injury causes supraglottic airway devices such as laryngeal mask airways to be ineffective.
Keep the patient warm. Burns increase insensible heat loss. Burn casualties with injuries >20% TBSA are at high risk of hypothermia.
NOTE: Do not debride blisters until the patient has reached a facility with emergency medical or surgical capability. Cover burns with loose, dry gauze or a clean sheet.