Transcript Trauma- Focused Individual Training

BURNS
War Wounds – Blast, Burn, Fragmentati
OVERVIEW
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Structure & function of the skin
Types of burns
Management of burns
Inhalation injury
Toxic gas exposure
Burn centers
ANATOMY & PHYSIOLOGY
• Largest organ
• Functions
– Barrier
• Keeps fluids in
• Keeps bacteria
out
– Sensory organ
– Temperature
organ
TYPES OF BURNS
• Flame (Thermal)
• Electrical
THIRD DEGREE BURNS
WITH ESCHAROTOMIES
– AC & DC
– Lightning
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Chemical
Steam
Radiation
Scald
COURTESY DAVID
EFFRON, M.D.
SEVERITY OF BURN
• Burn injury result of
– Direct injury
– Inflammatory response
• Severity depends upon
– Extent
– Depth
• Extent estimated by
– Rule of nines
– Palmar surface is about 1% of BSA
DEPTHS OF BURNS
First Degree
Second Degree
Third Degree
FIRST AND SECOND DEGREE
BURNS
FIRST DEGREE BURN
SECOND DEGREE BURN
THIRD DEGREE BURNS
COURTESY BONNIE
MENEELY, R.N.
COURTESY DAVID EFFRON,M.D.
ELECTRICAL BURNS
COURTESY DAVID EFFRON,
M.D.
COURTESY BONNIE
MENEELY, R.N.
CHEMICAL BURN
COURTESY ROY ALSON,
M.D.
SCALD BURN
COURTESY DAVID
EFFRON, M.D.
INITIAL FIELD CARE
• Safety is #1 priority
• Protect yourself and
your patient
• Rescue of victims
from burning structure
takes priority over all
other treatment!
INITIAL FIELD CARE
• Be aware of hazards
– Electrical lines
– Hazardous materials
or chemicals
• Do not handle
electrical lines or
chemicals unless
properly trained and
equipped
COURTESY DAVID EFFRON, M.D.
THIS IS WHAT HAPPENS WHEN
YOU GRAB HIGH VOLTAGE!
INITIAL FIELD CARE
• Priorities are the same as for other trauma
patients
• BTLS Primary Survey first
• Cool burn area with water
– Do not induce hypothermia
• Cover burn with clean dry dressing
• Maintain body temperature
INITIAL FIELD CARE
• Remove constricting clothing and jewelry
– Cut around adherent clothing
• Do not apply anything but water to a burn
– What goes on must come off
• Do not delay transport to start IVs
– Burn shock does not develop early
Hand Burn Dressing
ESTIMATION OF BURN SIZE
CRITERIA FOR BURN CENTER
TRANSFER
• Specialized burn
types
– Electrical &
lightning
– Chemical
– Inhalation injury
– Circumferential
chest or extremity
burns
• Significant medical
illness
• Significant other
injuries
INHALATION INJURIES
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Carbon monoxide poisoning
Toxic gas inhalation
Smoke inhalation
Heat inhalation
Steam inhalation
Asphyxiation
Toxins in the Battlefield Environment
SIGNS OF SMOKE
INHALATION
• Exposed to smoke in enclosed
space
• Unconscious while exposed to
smoke
• After exposure to smoke
– Develops cough
– Develops dyspnea
– Develops chest pain
SIGNS OF UPPER AIRWAY
BURNS
• Burns of the face
• Singed eyebrows or
nasal hairs
• Burns in the mouth
• Sooty sputum
• History of being burned
while confined to an
enclosed space
COURTESY ROY ALSON, M.D.
LIP BURNS & SOOT IN
MOUTH
MANAGEMENT OF
INHALATION AND/OR
UPPER AIRWAY BURNS
• Wear protective gear
• 100% oxygen via mask
– Secure airway with ET tube if needed
• Assist ventilation as needed
• Prompt transport
CHEMICAL BURNS
• Injure the skin
• May be absorbed into the body and damage
internal organs
• May be inhaled into the lungs and cause
lung tissue damage
• May have minimal skin injury and yet cause
severe systemic injury
FACTORS CAUSING
TISSUE DAMAGE IN
CHEMICAL BURNS
• Type of chemical
• Concentration of
chemical
• Amount of chemical
• Duration of contact
• Manner of contact
• Mechanism of action
ACID BURN
TREATMENT OF CHEMICAL
EXPOSURE
• BSI precautions
• Remove and bag all contaminated
clothing
• Brush off dry chemical
• Flush with copious amounts of water or
any drinkable liquid
• Wipe or scrape any retained chemical
and irrigate again
“THE SOLUTION TO POLLUTION IS
DILUTION”
Chemical Eye Treatment
Chemical Burn
ELECTRICAL BURNS
• Extent of injury
depends upon
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Type of current
Amount of current
Path of current
Duration of current
ADDITIONAL INJURIES
• Skin burns
• Entrance and exit
wounds
• Fractures
• cannot determine
the extent of the
injury from the
surface burn
DA
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3
LIGHTNING STRIKE
• Usually superficial
injury
• Victims die from
cardiac arrest
• Resuscitate the “dead”
» Patients who are
breathing will
usually survive
SUMMARY
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Protect yourself and your patient
Maintain c-spine immobilization
Treat burn patients as trauma patients
Properly cool the burn
Be alert for inhalation injuries
Flush chemical burns adequately
Monitor heart in electrical burn patients
QUESTIONS?