Monitor closely and frequently and note when a pulse in an extremity changes. Elevate all burned extremities after pulse checks, to reduce swelling and increase blood flow back to the heart. Tight eschar or swelling with eschar can impede circulation, causing the patient to lose a pulse and posing the danger of neurovascular injury. Losing the pulse in an injured extremity is an emergency requiring an escharotomy to prevent extensive damage. A lert and oriented, responds to V erbal stimulus, responds only to P ainful stimulus, U nresponsive.
Most burn patients are alert and oriented regardless of the extent of burn injury.
If they aren't alert, suspect other injuries. In the secondary survey, expose and examine your patient from head to toe, looking for any minor associated injuries. If the patient has suffered a flash facial burn, check his corneas for injury. Assessing burn size Next, calculate the patient's burn size, degree of injury, and fluid requirements. The rule of nines can't be used for children because a child's body has different proportions.