Chapter 29. Objectives. Objectives 01/09/2013. Burns

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1 Chapter 29 Burns Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1. Define key terms introduced in this chapter. 2. Explain the concept that burns are not just skin deep. 3. Describe the effects of burns on the following body systems (slides 13-25): a. Circulatory b. Respiratory c. Renal d. Nervous and musculoskeletal e. Gastrointestinal 4. Explain the classification of burns by depth and by body surface area involved, for both adult and pediatric patients (slides 27-30). Objectives 5. Discuss considerations of burn depth, location, body surface area involved, the patient s age, and any preexisting medical conditions in determining the severity of burn injuries (slides 29-36). 6. Discuss each of the following types of burns (slides 37-38). a. Thermal b. Inhalation c. Chemical d. Electrical e. Radiation 1

2 Objectives 7. Discuss each of the following mechanisms of burn injuries (slides 39-40): a. Flame b. Contact c. Scald d. Steam e. Gas f. Electrical g. Flash 8. Describe the assessment-based approach to burns (slides 41-48). 9. Describe special considerations in the scene sizeup when responding to calls involving burned patients (slides 41-42). Objectives 10. Explain the concept of stopping the burning process (slide 44). 11. Identify indications of inhalation injury (slide 48). 12. Discuss special considerations for dressing burns, including burns to specific anatomical areas (slides 49-50). 13. Describe special considerations in responding to, assessing, and managing chemical and electrical burns (slides 51-54). Topics The Skin: Structure and Function Review Airway, Breathing, and Circulation Effects of Burns on Body Systems Assessment and Care of Burns 2

3 CASE STUDY Dispatch EMS Unit 101 Respond to 38 Blackstrap Road for a structure fire. Time out 0235 Upon Arrival En route the fire department learns a man is trapped on second floor; building fully involved You request two more ambulances Upon arrival, you find a firefighter carrying an unresponsive patient down a ladder 3

4 How would you proceed to assess and care for this patient? The Skin: Structure and Function Review Back to Topics Structure Functions 4

5 Airway, Breathing, and Circulation Back to Topics Most frequent cause of death ABCs management key Back to Objectives Effects of Burns on Body Systems Back to Topics 5

6 Circulatory System Increase capillary permeability Burn shock If in shock, consider hypovolemia first Respiratory System 6

7 Swelling Fluid in the lungs Circumferential burns may limit expansion Renal System (Kidneys) Decreased urinary output Cell destruction may obstruct kidneys May cause kidney failure 7

8 Nervous and Musculoskeletal Systems Loss of function Muscle wasting Joint dysfunction Gastrointestinal System 8

9 Blood flow decreased Nausea and vomiting common Ulcers may form Assessment and Care of Burns Back to Topics Classifying Burns by Depth Back to Objectives 9

10 Determining the Severity of Burn Injuries Back to Objectives Percentage of body surface area Location of the burn Patient s age Preexisting medical conditions 10

11 Determining the Severity of Burn Injuries Burn Injury Location Burn Injury Location Considered critical due to potential loss of life or function Circumferential burns Determining the Severity of Burn Injuries Age and Preexisting Medical Conditions 11

12 Age and Preexisting Medical Conditions Children under five years and adults over 55 years Reasons for delayed healing Special considerations Determining the Severity of Burn Injuries Body Area Percentage 12

13 Types of Burns Back to Objectives Thermal Inhalation Chemical Electrical Radiation ( Charles Stewart, M.D. and Associates) Causes of Burns Back to Objectives 13

14 Flame burn Contact burn Scald Steam burn Gas burn Electrical burn Flash burn ( Charles Stewart, M.D. and Associates) Assessment-Based Approach: Burns Scene Size-Up Back to Objectives Scene Size-Up Scene safety Standard Precautions Mechanism of injury Number of patients ( Charles Stewart, M.D. and Associates) 14

15 Assessment-Based Approach: Burns Primary Assessment Primary Assessment Stop the burning process Remove loose clothing ABCs Administer O 2 Transport priority Determine BSA burned Back to Objectives ( Charles Stewart, M.D. and Associates) Assessment-Based Approach: Burns Secondary Assessment 15

16 Secondary Assessment Physical exam Look for other injuries Determine BSA Remove clothing and jewelry Vital signs History Signs and symptoms ( Charles Stewart, M.D. and Associates) Assessment-Based Approach: Burns Emergency Medical Care Emergency Medical Care Remove patient from the source of the burn and stop the burning process ABCs Classify the severity of the burn; transport if critical Cover burn area Keep patient warm Transport the patient to the appropriate facility Back to Objectives 16

17 Assessment-Based Approach: Burns Special Considerations for Dressing Burns Back to Objectives Special Considerations for Dressing Burns Avoid material that leaves particles Never apply ointments, lotions, or antiseptics Never break blisters Chemical Burns Back to Objectives 17

18 Protect yourself first Brush off dry chemicals before flushing with water Flush chemicals with copious amounts of water Electrical Burns Scene safety Care for electrical burns 18

19 CASE STUDY Follow-Up CASE STUDY Primary Assessment Patient is a male with charring and other burns on right half of body Unresponsive Airway open; breathing shallow and rapid Face is blackened CASE STUDY Primary Assessment Pulse weak and rapid Insert OPA and set up BVM Full thickness burn over 50 percent BSA 19

20 CASE STUDY Secondary Assessment Cool patient and cover him with a sterile burn sheet Cover patient in blankets for warmth Find no other injuries BP: 98/68 mmhg; P: 124 and weak; RR: 12; SpO 2 : 87 percent Hear wheezing in all lung fields CASE STUDY Treatment and Reassessment Short transport; only do one reassessment No change in patient s status; PPV helping Upon arrival, transfer care to trauma room staff CASE STUDY Treatment and Reassessment Physicians intubate patient and start fluids Complete report and return to service 20

21 Critical Thinking Scenario Unknown age female student reported to be burned in a lab at the local university Patient was working under the protective hood in chemistry lab when a beaker of solution got bumped, causing chemicals to splash on her face and chest The chemical is identified as ammonium hydroxide, an alkali Critical Thinking Scenario Patient was wearing protective gear but the solution managed to splash behind her glasses and soaked through her lab jacket The lab assistant immediately got her to the safety shower and began the flushing process before calling 911 Critical Thinking Scenario Upon your arrival, the patient is sitting with a wet towel wrapped around her bare chest, holding her hand over her eyes in an attempt to shield from the bright light She complains only of a severe burning to her eyes and has no observable burns to her face or oral cavity The chemical that splashed onto her chest did not seem to penetrate to her skin 21

22 Critical Thinking Questions 1. Would these burns be considered mild, moderate, or severe? 2. What is your rationalization for the above answer? 3. How are the eye injuries best managed while en route to the hospital? 4. What is the process recommended for flushing chemical eye injuries? Critical Thinking Questions 5. If there were a community hospital within two minutes of the university, and a regional burn/trauma center within 15 minutes of the university, to which facility should the EMT elect to transport? Reinforce and Review Please visit and follow the mybradykit links to access content for the text. 22