Transcript 011309 Burns - faculty at Chemeketa

Burns
Paramedic Class, W09
Created by P. Andrews
Incidence & Patterns of Burn
Injury
Devastating trauma
High mortality rate
Long rehabilitation
Permanent disability, disfigurement
common
> 2 million burns in USA q yr
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70,000 hospital admissions
10,000 die
Incidence & Pattern, cont.
M & M follow signification patterns
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Gender
2/3 all fatalities are men
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Age
Death rate highest among children and elders
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Socioeconomic status
¾ all fire related deaths occur in homes with
highest incidence in lower-income households
Prevention!
Key component of professional role is
community education
Major Sources of Burns
Thermal
Chemical
Inhalation
Electrical
A & P review
Epidermis
Sebum
Dermis
Subcutaneous Layer
Thermal Burns
1st degree
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Superficial
2nd degree
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Partial thickness
3rd degree
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Full thickness
Burn
Thickness
1st Degree Burns
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Epidermis,
Dermis
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Redness
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Pain
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Mild edema
2nd Degree
Burns
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Dermis
Redness
Pain
Blisters
Edema
Deep partial thickness
burns
May require skin
grafting
Third Degree Burns
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Entire Dermis
Painless
Various
discolorations
Grey
Black
Brown, leathery
Skin grafts often
required
Calculating Burn Surface Area
Rule of nine’s
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Modified for infant, child
Palmar surface
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Patient’s hand
1%
Management of Burns
Stop the Burning
process!!!
Safety for personnel
is priority!
Remove smoldering
clothing
Remove rings, etc.
Cut around plastic,
etc that is stuck to
skin.
Management of burns
Rule of 10
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If less than 10% BSA
Within 10 min. of burn
Cool for 10 min
Cover with sterile/clean non-linty
material
Bulky dressings with dressings
between digits
Management of burns
Airway management!
High flow Oxygen
Early intubation, prn
Management of Burns
At least one large bore IV
In non-burned area if possible
Parkland Formula
Your 180 pound patient is burned on
What
hisanterior
TBSA %?
both ofishis
legs and right
anterior arm.
22.5%
Parkland Formula
4 x TBSA % x kg
4 x 22.5 = 90 x kg
90 x 82 = 7380 ml
3690 ml first 8 hours
461.25 ml / hour
Transport considerations
Transport to burn center if:
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Burn with respiratory tract injury
Burn to face, eyes, ears, hands, feet, genitalia
Any 3rd degree burn 20% or more BSA
Burn with fractures
Circumferential burns
Peds < 5 y/o
Adults > 55 y/o
Electrical Burns
•Electrical Currents
•Lightning
•Path of least
resistance
•Cardiac
dysrhythmias
•Underlying injuries
not readily apparent
•ABC’s
Assess for
Entrance
and
Exit wounds
Chemical Burns
Acids
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Rust removers
Bathroom cleaners
Swimming pool acidifiers
Alkalis
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Oven cleaners
Drain cleaners
Fertilizers
Heavy industrial cleaners
Cement, concrete
Organic compounds
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Creosote
Gasoline
Assessment of Chemical burns
Type (take container to hospital with pt.)
Concentration
Volume
Mechanism (immersion, splash, etc.)
Time of exposure
First aid before EMS
Pain
Management of Chemical Burns
Safety for rescuers
Stop burning process
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Remove all clothing including shoes
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Brush off powdered chemical
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Irrigate with copious amounts water
Before transport if possible
Specific Chemicals
Petroleum
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Prolonged contact
Hydrofluoric acid
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Glass etching, manufacture of
silicone chips
Leaches calcium from bones
and deposits in tissue
Irrigate very well
Treat with calcium gluconate
injection into burn site
Specific Chemicals,
cont.
Ammonia
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Noxious gas; strong alkali – water soluble
Especially harmful to eyes
Common in processing plants, cooling areas
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Irrigate eyes with water for up to 24 hours
Respiratory injury
Short-term; upper airway edema
Long-term; lower airway injury
High-concent. Oxygen, ventilate prn
Burns to Airway
Evaluate for:
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Burns around nose
or mouth
Soot in mouth/nose
Singed nasal hairs
Intraoral burns
Hoarseness
Visible pharyngeal
edema
Inspiratory stridor
Airway Burns, cont.
Evaluate for:
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Rate, depth of
respirations
Wheezes, crackles, or
rhonchi?
Mentation changes
History:
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Closed space burn?
Explosives?
Chemicals?
PMH?
Medications?
Management:
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Careful vitals
High flow oxygen
ECG monitoring
Manage airway aggressively
and early!
Chemical burns to
eyes
Sx:
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Local pain
Visual disturbances
Lacrimation
Edema
Redness
Tx:
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Flush continuously with water
Remove contact lenses if
present
Chemical Burn by using NAIR Hair Remover
Systemic Complications
Hypothermia
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Loss of skin integrity
Hypovolemia
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Plasma loss
3rd spacing
Eschar
Electrolyte loss
Acidosis
Inhalation injury
Infection
Hypoxia
Dysrhythmias
Renal failure
Liver failure
Heart failure
Escharotomy
Special Notes
Child abuse?
That’s all, folks