Prolonged Field Care Podcast PFC Podcast: Burns In The Austere Environment
Feb 5, 2026
Dr. DeMello, a British military medical officer and burns specialist with over 40 years in burn care. He talks about practical pre-hospital burn management and keeping trauma priorities clear. Discussion covers realistic TBSA estimation, pragmatic fluid strategies, airway timing and nebulized epinephrine, analgesia choices like ketamine, escharotomy planning, rapid cooling while avoiding hypothermia, and common mistakes to avoid.
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Give Oral Fluids And Sit Patients Up
- If no inhalation injury and patient can swallow, offer small sips of clear fluids to hydrate and feed the gut.
- Sit major upper‑torso burn patients upright to reduce facial/airway swelling and lower intubation need.
Anticipate Airway Swelling And Prepare Early
- Anticipate airway swelling that peaks 18–36 hours post‑burn; intervene early if mechanism suggests inhalation injury or transfer logistics risk airway loss.
- If you place a surgical airway, cover with a sterile dry dressing and do not suture the stoma closed.
Nebulized Epinephrine To Buy Airway Time
- For borderline inhalation cases with mild stridor and okay work of breathing, nebulize 1 mg epinephrine in 10 mL to shrink mucosa and buy time.
- Use this adjunct while positioning and monitoring rather than immediate intubation every time.