Transcript Chapter 19
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Chapter
19
Burns
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Objectives
19.1
List four types of burns.
19.2
List the signs and symptoms for each type of burn.
19.3
Compare and contrast the methods for classifying burns.
19.4
Describe the clinical significance of a voice change in the setting of a thermal burn.
continued
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Objectives
19.5
Compare and contrast direct current and alternating current.
19.6
Describe how to assess burn severity using the “ Rule of Nines ” system.
19.7
Describe and demonstrate the management of a burn patient.
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Topics
Anatomy and Physiology Burn Sources Burn Classifications Assessment Management Chapter Summary National Ski Patrol,
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Case Presentation
A 4-year-old boy has pulled a boiling hot dish out of a microwave and onto himself. The mother is with him and is crying vigorously. He has no past medical history, is taking no medications, and has no allergies. National Ski Patrol,
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Anatomy and Physiology
Skin ◦ ◦ ◦ ◦ Largest organ of the body Two layer Multipurpose Vulnerable to damage when exposed to extreme temperature, caustic substances, and other hazardous sources National Ski Patrol,
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Anatomy and Physiology
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Burn Sources
Thermal ◦ Heat comes directly into contact with skin Chemical ◦ Exposure to a caustic substance Electrical ◦ Contact with an electrical current
continued
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Burn Sources
Radiation ◦ ◦ Exposure to a radiation emitting object UV Light exposure National Ski Patrol,
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Burn Classifications
Determined by depth of skin damage ◦ Thickness-based • • • Superficial Partial thickness Full thickness ◦ Degree-based • • • • First Second Third Fourth National Ski Patrol,
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Burn Classifications
Copyright Charles Stewart M.D. and Associates Copyright Edward Dickinson, M.D.
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Case Update
After confirming that the ABCDs are intact, you call for assistance and begin a secondary assessment. You note that the boy ’ s chin and the front of his neck for a distance of about twice as long as his palms are bright red and are surrounded by larger areas of redness in a splash-like pattern. Blisters are forming on his chest. He is breathing rapidly and his heart rate is 110 and regular at the brachial artery pulse point.
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Assessment
Scene safety is a first priority Use BSI and PPE Airway/breathing is a major concern Collect information on the burning agent Determine severity with degree or thickness based method
continued
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Assessment
Use the Rule of Nines to determine extent of partial/full thickness burns Check for critical issues ◦ Treatment should be at a burn center if possible National Ski Patrol,
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Assessment
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Assessment
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Management
Safety concerns take priority Stop the burning process Care for ABCDs CPR may be needed for electrical burn patients Control bleeding Remove clothing and jewelry
continued
Cool and irrigate with room temp water National Ski Patrol,
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Management
continued
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Management
Cover with clean linens/blanket After cooling use dry, sterile dressings Smaller burns may use clean, wet, cool dressings Do NOT apply creams, ointments, etc.
Treat for shock
continued
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Management
Extensive Burns ◦ Remember that with extensive burns, patients lose the ability to thermoregulate. Make sure they do not become hypothermic by wrapping them in warm, dry sheets.
continued
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Management
Elevate upper body if burned to minimize edema Transport all but most minor burns to a burn or trauma center if possible ◦ Use a clean, dry sheet to prevent the patient from sticking to the transport device.
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Thermal Burns
Put out the flames – Roll ” or smother ◦ “ Stop, Drop and Do not use chemical fire extinguishers Remove burned, singed, or smoldering clothing, or clothing soaked in hot liquid ◦ Do not pull if fabric has melted onto skin Do not break blisters Do not apply cold compresses National Ski Patrol,
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Chemical Burns
Use PPE to avoid contamination Remove all clothing and jewelry Consider Hazmat Brush off dry chemicals Irrigate with large amounts of tepid water (15 mins, or until burning ceases) Do not try to neutralize Chemtrec #: 800.262.8200
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Chemical Burns
BRADY Chemical Burn Alert ◦ Caution! When managing chemical burns, do not apply a neutralizing agent because this may cause a thermal reaction, worsening the injury. Dust off any dry chemicals and irrigate the area with room-temperature water. Note as well that the application of water to some chemicals also produces heat.
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Electrical Burns
Make sure the power is OFF Immobilize on a backboard Maintain airway, give oxygen Do CPR (use AED) if necessary Check for entrance/exit wounds National Ski Patrol,
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Electrical Burns
Entrance and Exit Wounds ◦ Remember that patients injured by electricity often appear to be much better off than they actually are because many of their burns are beneath the surface. Take vital signs frequently and be prepared for extensive resuscitation (CPR and AED).
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Radiation Burns
If the burn is not from ultraviolet light, the patient should be treated only by HAZMAT personnel.
UV burns (sunburn) are usually treated as first-degree burns.
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Case Disposition
What are the patroller ’ s findings?
What treatment and transportation choices were made?
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Chapter Summary
Rescuer and bystander safety is the top priority when treating a burn patient.
The four types of burns are thermal burns, chemical burns, electrical burns, and radiation burns.
The focus of treatment is stopping the burning process.
continued
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Chapter Summary
Brush off dry or powdered chemicals first.
Irrigate chemical burns with water for a minimum of 15 minutes.
Inhalation injuries are often associated with facial burns and vocal hoarseness.
continued
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Chapter Summary
Burns are classified by the depth of the injury.
Use the Rule of Nines to calculate the extent of burns.
Do not delay transport of patients with significant burns. Treat burn patients for shock and hypothermia.
continued
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Chapter Summary
Transport burn patients to a burn center or trauma center, whenever possible.
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