Burn Emergencies

8/12/2019 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 othertrauma, 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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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

Assessment Cont..


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Obtain SAMPLE history

Patient

Family

Bystanders

See questions on page 555

Assessment Cont..


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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 partialthickness 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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Gastrointestinal System

Nausea and vomiting due to shunting

Documents

Burn Emergencies