Approach to the critical patient
›First 5 minutes
›Cardiac monitor
›Defibrillator pads if unstable
›IV access
›Two large bore if high risk
›IO if no IV and unstable
›Oxygen if hypoxia
›Immediate ECG if high risk features
›Point of care glucose if altered
Burn and wound management
›Burn care
›Remove smoldering clothing and jewelry
›Cool thermal burns with tepid water
›Avoid prolonged cooling with hypothermia risk
›Cover burns with clean dry dressing
›Tetanus prophylaxis per immunization status
›Cardiac monitoring and treatment
›Telemetry duration local protocol dependent
›ACLS for dysrhythmias
›Treat hyperkalemia if present
›Calcium gluconate IV 1 g
›Insulin regular IV 10 units with dextrose
›Nebulized albuterol
Rhabdomyolysis and renal protection
›Fluid strategy
›Isotonic crystalloid IV bolus if hypovolemia
›Ongoing IV fluids titrated to urine output target local protocol dependent
›Avoid potassium containing fluids if hyperkalemia
›Electrolyte management
›Potassium correction
›Calcium correction only if symptomatic
›Phosphate correction if severe
›Analgesia
›Acetaminophen PO or IV
›Opioid IV for severe pain
›Avoid NSAIDs if acute kidney injury concern
Consultation and transfer
›Consultation plan
›Burn center criteria consideration
›Surgery or orthopedics if compartment concern
›Cardiology if persistent ECG changes
›Trauma team if multisystem trauma
›Reassessment cycle
›Repeat vitals every 15 to 30 minutes if high risk
›Repeat neurovascular checks every 30 to 60 minutes if limb injury
›Repeat pain and swelling assessment after analgesia
›Repeat ECG if symptoms change