chapterww4.mgh.org/emt/emtlib/mistovich_ch29_lecture.pdf · discuss each of the following...

01/09/2013

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Chapter 29

Burns

Copyright ©2010 by Pearson Education, Inc.

All rights reserved.

Prehospital Emergency Care, Ninth Edition

Joseph J. Mistovich • Keith J. Karren

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

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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

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CASE STUDY

Dispatch

Respond to 38 Blackstrap Road for a structure fire.

EMS Unit 101

Time out 0235

• 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

Upon Arrival

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How would you proceed to assess and care for this patient?

Back to Topics

The Skin: Structure

and Function Review

• Structure

• Functions

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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

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Circulatory System

• Increase

capillary

permeability

• Burn shock

• If in shock,

consider

hypovolemia

first

Respiratory System

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• 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

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Nervous and

Musculoskeletal Systems

• Loss of function

• Muscle wasting

• Joint dysfunction

Gastrointestinal System

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• 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

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Determining the Severity of

Burn Injuries

Back to Objectives

• Percentage of body

surface area

• Location of the burn

• Patient’s age

• Preexisting medical

conditions

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Determining the Severity

of Burn Injuries

Burn Injury Location

Burn Injury Location

• Considered critical due to

potential loss of life or function

• Circumferential burns


of Burn Injuries

Age and Preexisting

Medical Conditions

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Age and Preexisting

Medical Conditions

• Children under five years and adults

over 55 years

• Reasons for delayed healing

• Special considerations


of Burn Injuries

Body Area Percentage

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Types of Burns

Back to Objectives

(© Charles Stewart, M.D. and Associates)

• Thermal

• Inhalation

• Chemical

• Electrical

• Radiation

Causes of Burns

Back to Objectives

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• Flame burn

• Contact burn

• Scald

• Steam burn

• Gas burn

• Electrical burn

• Flash burn


Assessment-Based Approach: Burns

Scene Size-Up

Back to Objectives

Scene

Size-Up

• Scene safety

• Standard Precautions

• Mechanism of injury

• Number of patients


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Primary Assessment


Primary

Assessment

• Stop the burning process

• Remove loose clothing

• ABCs

• Administer O2

• Transport priority

• Determine BSA burned

Back to Objectives


Secondary Assessment

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Secondary

Assessment

• Physical exam

• Look for other injuries

• Determine BSA

• Remove clothing and

jewelry

• Vital signs

• History

• Signs and symptoms


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

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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

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• 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

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CASE STUDY

Follow-Up

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

CASE STUDY

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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; SpO2: 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

CASE STUDY

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• 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


• 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


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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?

Critical Thinking Questions

Reinforce and Review

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