BURN EMERGENCIES

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BURN EMERGENCIES
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Layers of Skin

• Epidermis - outermost layer of skin
• Dermis - second layer
• Subcutaneous layer - innermost layer

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Skin/Function

• Protective barrier against infection and bacteria
• Insulates and protects body organs from injury
• Aides in body temperature regulation
• Provides sensation transmission (cold, hot, pain,
  and touch)
• Waste elimination

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Airway, Breathing and Circulation

• Most burn patients who die in the prehospital
  setting will die from an occluded airway, toxic
  inhalation, or other trauma, and not from the
  burn itself.

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Classifying Burns by Depth

• Superficial
• Partial thickness
• Full thickness

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Superficial Burns

• 1st-degree burn
• Involves only epidermis
• Sun burn, flash burn
• Skin appearance
• Pink to red, dry
• Slight swelling, no blisters
• Can be very painful, several days to heal
• Not much emergency care required for small areas

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Partial Thickness Burn

• 2nd-degree burn
• Involves epidermis and dermis
• Caused by direct contact
• Skin appearance
• White to cherry red, moist, mottled
• Damage to underlying vessels cause plasma and
  tissue fluid to leak which form blisters
• Intense pain resulting from nerve-ending damage

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Full Thickness Burns

• 3rd-degree burn
• Involves all layers of skin
• Can extend to muscle, bone or organs below
• Contact with extreme heat
• Skin appearance
• White and waxy, dark brown or black and charred
• Dry, hard, tough, and leathery (eschar)
• 3rd-degree burns may not be painful at all due to
  destruction of nerve endings.
• Be aware of partial thickness burns around the
  site that will be painful

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Determining Severity of Burns

• Classified as
• Critical
• Moderate
• Minor
• See chart on page 583

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Body Surface Area Percentage

• Used to quickly determine the amount skin surface
  or body surface area percentage of a burn
• Rule of nines-larger areas
• Rule of palm-smaller areas
• See page page 553
• Remember these methods are estimates only

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Burn Injury Location

• Face - airway compromise
• Hands and feet - loss of function
• Genitalia, groin - loss of genitourinary function
  increase for infection
• Circumferential burns
• Encircle a body area
• Circulatory compromise, nerve damage results from
  constriction and swelling tissues

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Age Preexisting Medical Conditions

• Children under 5
• Larger skin surface in relation to body mass
• Potential for greater fluid and heat loss
• Growth impairment
• Adults over 55
• Prolonged healing process
• Underlying medical conditions may affect response
  to burn injuries

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Assessment

• Scene size-up
• Stop the burning process (within first 10 minutes
  of injury)
• Initial assessment
• Attempt to remove any smoldering clothing or
  jewelry
• Do not remove article that are adhered to the skin

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Assessment Cont..

• Do not keep burn immersed more than 2 minutes
  (hypothermia)
• Frightened burn victims first reaction is to
  inhale deeply
• Provide Big Os NRB mask (breathing adequate)
• BVM if inadequate
• Assess circulation, determine BSA and make a
  transport decision

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Assessment Cont..

• Treat for shock (Hypovolemic)
• Reassess MOI
• Begin focused history and physical exam
• Alert - focused trauma assessment
• Altered mental status, evidence of additional
  injuries, rapid trauma assessment
• Assess for any DCAP/BTLS
• Remember to remove clothing as you go

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Assessment Cont..

• Obtain SAMPLE history
• Patient
• Family
• Bystanders
• See questions on page 555

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Signs Symptoms of Superficial Burns

• Pink or red, dry skin
• Slight swelling

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Signs Symptoms Partial Thickness Burns

• White to cherry red skin
• Moist and mottled skin
• Blistering and intense pain

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Signs Symptoms Full Thickness Burns

• Dry, hard, tough, leathery skin that might appear
  white-waxy to dark brown or black and charred
  (eschar)
• Inability to feel pain

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Inhalation Injuries

• Singed nose hair
• Facial burns
• Burned specks of carbon in the sputum
• Sooty or smoky smell on the breath
• Respiratory distress accompanied by restriction
  of chest wall movement, restlessness, chest
  tightness, stridor, wheezing, difficulty in
  swallowing, hoarseness, coughing, and cyanosis
• Presence of actual burns of the oral mucosa

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Emergency Medical Care

• Remove patient from source of burn and stop the
  burning process
• Assess mental status and apply Big Os
• Classify severity of burn and make transport
  decision
• Cover area with dry sterile dressing
• Other EMS Services 10 or less moist dressing
• Keep patient warm and treat for shock or other
  injuries
• Transport to appropriate facility

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Special Considerations for Dressing a Burn

• Use sterile burn sheet or white clean sheet
• Never apply ointments, lotions, or antiseptic to
  burns
• Never attempt to break or drain blisters
• Contamination
• Fluid loss

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Burns of Hands and Toes

• Remove all jewelry
• Separate all digits with dry sterile dressings
• Try to place hands in a position of function

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Burns to the Eyes

• Thermal burn do not force open the eyes
• Apply dry sterile dressing to both eyes and
  bandage in place
• Chemical burns
• Flush with copious amounts of water for at least
  20 minutes
• Flush from medial to lateral
• Perform detailed physical exam
• Perform ongoing assessment

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Chemical Burns

• Protect yourself first
• Dry chemicals such as lime should be brushed off
  first before applying water
• Flush chemical burns with copious amounts of
  water ( be sure to consult Haz-mat guide book)
• Make sure fluid runs away from injury
• Continue to flush while en route to hospital

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Electrical Burns

• Can cause severe damage
• Will always flow to ground seeking the path of
  least resistance to exit the body
• Can cause irregular heartbeats or cardiac arrest
• Always assume the electrical source is still
  charged
• Never attempt to remove patient from electrical
  source
• Never touch patient still in contact with
  electrical source

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Emergency Care

• Big Os
• Monitor for cardiac arrest (AED)
• Assess for twitching or seizure activity
• Look for entrance and exit wound
• Transport as soon as possible
• Always assume critical injuries

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Circulatory System

• Stress to heart
• Increased capillary permeability
• Decrease in fluid volume
• Edema
• Hypovolemic shock (hypoperfusion)
• 15 liters of fluid needed for a full or partial
  thickness burn victim with a BSA of 50 in the
  first 24 hours
• NPO

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Respiratory System

• Swelling
• Fluid accumulation in lungs
• Smoke inhalation
• Circumferential burns to chest, restricts
  expansion

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Renal System

• Decreased blood flow to kidneys
• Decreased urinary output
• Waste formation in blood due to cell destruction
• Blockage in kidney may result
• All or part of kidney forced to stop functioning
  or die

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Nervous Musculoskeletal System

• Destruction of nerve endings causing loss of
  function
• Joint dysfunction due to scarring

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Gastrointestinal System

• Nausea and vomiting due to shunting