Transcript BURNS - SilverCross EMS

BURNS
SILVER CROSS EMS SYSTEM
EMD CE
NOVEMBER 2012
Burns
 Account for over 10,000 deaths a year
 Among the most serious and painful of all injuries
 A burn occurs when the body receives more
radiant energy than it can absorb.
 Sources of this energy include heat, toxic chemicals,
and electricity.
Burns
 The skin serves as a barrier that prevents foreign substances from
entering the body.
 The skin helps regulate body temperature and acts as a sense
organ.
 It also prevents loss of body fluids.
 When the skin is damaged, it can no longer perform these essential
functions.
 Any break in the skin allows bacteria to enter and raises the
possibilities of:
 Infection
 Fluid loss
 Loss of temperature control
The Anatomy and Physiology of the
Skin
 Skin varies in thickness.
 Thinner in the very young and very old
 Thinner on the eyelids, lips, and ears than on the scalp, back, soles
of feet
 Thin skin is more easily damaged than thick skin. Skin has two
principal layers: the epidermis and the dermis.
 Epidermis is the tough, external layer
 Dead skin and pigment
 Watertight, protects
 Dermis is the inner layer.
 Blood vessels, nerves, hair follicles, sweat glands, sebaceous glands
The Anatomy and Physiology of the
Skin
The Anatomy and Physiology of the
Skin
 Skin covers all the external surfaces of the body.
 Bodily openings are lined with mucous membranes.
 Mucous membranes secrete a watery substance that lubricates
the openings.
 These are wet, whereas skin is dry.
Burn Depth
 Superficial burns (first-
degree burns)
 Reddened and painful skin
 The injury is confined to the
outermost layers of the skin.
 The patient experiences
minor to moderate pain.
© Amy Walters/ShutterStock, Inc.
Burn Depth
 Partial-thickness burns
(second-degree burns)
 Do not damage the deepest
layers of the skin
 Blistering
 Fluid loss and moderate to
severe pain
 Usually heal within 2 to 3
weeks
© E. M. Singletary, M.D. Used with permission.
Burn Depth
 Full-thickness burns (third-
degree burns)
 Damage all layers of the skin
 Pain is absent because the
nerve endings have been
destroyed.
 Patients lose large quantities of
body fluids and are susceptible
to shock and infection.
Extent of Burns (BSA)
 Rule of nines
 Method for determining what percentage of the body has been
burned
 In an adult, the head and arms each equal 9% of the total body
surface.
 The front and back of the trunk and each leg are equal to 18%
of the total body surface.
 This formulation is slightly modified for children.
 For smaller burns the Palmar Method is used. The patient’s
palm is 1%.
Extent of Burns - Rule of 9’s
Cause or Type of Burns
 Thermal burns
 Caused by heat
 Place the burned area in clean, cold water.
 Cover it with a dry, sterile dressing or a burn sheet.
 Do not break blisters.
 Patients with large burns must be treated for shock and
transported to a hospital.
Cause or Type of Burns
 Respiratory burns
 A burn to any part of the airway
 Look for signs and symptoms:
 Burns around the face
 Singed nose hairs
 Soot, redness or swelling in the mouth or nose
 Difficulty breathing or swallowing
 Hoarse voice
 Excessive coughing
 Loss of consciousness as a result of fire
 Breathing problems can be progressive
 Swelling and Edema can develop
Cause or Type of Burns
 Chemical burns
 Many strong substances can cause chemical burns.
 The longer the chemical remains in contact with the skin, the
more damage it does.
 Initial treatment
 Remove as much of the chemical as possible.
 Brush away any dry chemical.
 Flush with water for at least 10 minutes.
 Cover the area with a dry, sterile dressing.
 Arrange for prompt transport.
Cause or Type of Burns
 Chemical burns (cont’d)
 Chemical burns to the eyes cause extreme pain and severe
injury.
 Flush the eye(s) with water for at least
20 minutes.
 Hold the eye open to allow water to flow over its entire
surface.
 Loosely cover the injured eye(s) with gauze bandages.
 Arrange for prompt transport.
Cause or Type of Burns
 Electrical burns
 Occur when an electrical current enters the body at one point,
travels through the body tissues and organs, and exits at the
point of ground contact
 Electricity causes major internal damage.
 Patients may experience irregularities of cardiac rhythm or full
cardiac arrest and death.
Cause or Type of Burns
 Electrical burns (cont’d)
 Be certain that a patient is not still in contact with the
electrical power source before you touch or treat him or her.
 Call for assistance from the power company or from a qualified
rescue squad.
 Monitor the ABCs of electrical burn patients and arrange for
prompt transport.
Burn Severity
 Burn severity depends on:
 Depth of burn
 Extent of burn
 Critical areas involved
 Face, upper airway, hands, feet, genitalia
 Preexisting medical conditions
 Patient younger than 5 or older than 55
 Children have a greater BSA (body surface area) in proportion
Complications of Burns
 Burns to the airway are of significant importance.
 Cough, carbonaceous sputum, hoarse voice
 Circumferential burns of the chest can compromise
breathing.
 Circumferential burns of the extremity can lead to
neurovascular compromise and irreversible damage.
Critical Burns
 Full thickness burns of critical areas or circumferential burns
 Full thickness > 10% BSA
 Partial thickness > 30%
 Airway or respiratory burns
 Burns complicated by fractures
 >55y/o or < 5y/o burns that would be classified as
moderate
 Example: partial thickness burn 20% BSA
Moderate Burns
 Full thickness 2-10% (excluding critical areas)
 Partial thickness covering 15-30% BSA
 Superficial burns covering > 50% BSA
Minor Burns
 Full thickness <2% BSA
 Partial thickness covering <15% BSA
 Superficial burns covering < 50% BSA
EMD Care for Burns
 Stop the burning process
 If victim still on fire or smoldering, advise them to STOP, DROP and
ROLL. If it is safe to do so, roll patient in a blanket or coat or douse
them with water. Move them to a safe area.
 Do Not remove and clothing that is stuck to the patient’s skin.
 Monitor patient’s ABCs and Level of Consciousness.
 For red or blistered skin:
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Flush area with cool, clean water
Do Not apply ice
Do Not apply ointments, grease or butter
Do Not break blisters
 Cover burned area with clean cloth or sheet (lint free)
 Elevate burned extremities
EMD Care for Burns
 Chemical Burns:
Determine what type of chemical and follow instructions, if
available.
Flush with water unless contraindicated
Avoid contact with chemical
If dry particles are present, completely brush off without
touching and then flush
Carefully remove contaminated clothing and jewelry
If chemical is in the eyes and patient is wearing contacts,
they must be removed prior to flushing
Resources
 AAOS Emergency Medical Responder, 5th edition
 AAOS Emergency Care and Transport of the Sick and
Injured, 10th edition
 Will County 9-1-1 EMDPRS, June 2012
Next EMD CE packet available January
2013
 Please contact Rhonda with topic ideas for next year:
[email protected] or 815-258-9637.
Enjoy the Holiday Season!