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Chapter 23Chapter 23BurnsBurns
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
ObjectivesObjectivesDescribe incidence, patterns, sources of burn injuryDescribe incidence, patterns, sources of burn injury
Describe local and systemic responses to burn injuryDescribe local and systemic responses to burn injury
Classify burn depth, extent, severity Classify burn depth, extent, severity
Discuss pathophysiology of signs and symptoms of Discuss pathophysiology of signs and symptoms of burn shock burn shock
Outline physical exam of burn patientOutline physical exam of burn patient
Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
ObjectivesObjectivesDescribe field management of burn injuryDescribe field management of burn injury
Discuss signs and symptoms and management Discuss signs and symptoms and management of patients with:of patients with:
Inhalation injuryInhalation injuryChemical injuryChemical injuryElectrical injuryElectrical injuryRadiation injuryRadiation injury
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Sanders: Mosby's Paramedic Textbook, Revised 3rd Edition PowerPoint Lecture Notes
Chapter 23: Burns
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Scenario,Scenario,As you pull up to the scene of a house fire you see As you pull up to the scene of a house fire you see firefighters struggling to pull an elderly male out the firefighters struggling to pull an elderly male out the front door. They frantically shout for you. Your patient front door. They frantically shout for you. Your patient is unconscious. You immediately notice soot and is unconscious. You immediately notice soot and burns on his face. His clothing is smoldering, and you burns on his face. His clothing is smoldering, and you note white, leathery, waxy burns on his arms. You note white, leathery, waxy burns on his arms. You can hear the highcan hear the high--pitched stridor as he struggles to pitched stridor as he struggles to breathe, and the acrid smell of his burning flesh fills breathe, and the acrid smell of his burning flesh fills the air.the air.
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DiscussionDiscussionWhat is your first concern as you approach this What is your first concern as you approach this scene?scene?
What immediate life threats do you anticipate What immediate life threats do you anticipate with this patient?with this patient?
What are your priorities of care for this man?What are your priorities of care for this man?
Why will he need the resources of a burn Why will he need the resources of a burn center?center?
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Burn InjuryBurn Injury10,000 deaths/year10,000 deaths/year
More common in menMore common in men
Death rates high in kids and older adultsDeath rates high in kids and older adults
Most deaths happen in homeMost deaths happen in home
High incidence in lowHigh incidence in low--income householdsincome households
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Major Sources of BurnsMajor Sources of BurnsInteraction between energy (thermal, chemical, Interaction between energy (thermal, chemical, electrical, or radiation) and biological matterelectrical, or radiation) and biological matter
Thermal burnsThermal burnsMost common typeMost common typeFlames, scalds, or contact with hot substancesFlames, scalds, or contact with hot substancesFrostbite is a type of thermal injuryFrostbite is a type of thermal injury
Chemical burnsChemical burnsSubstances that produce chemical changes in skin with or Substances that produce chemical changes in skin with or without heat productionwithout heat production
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Major Sources of BurnsMajor Sources of BurnsElectrical injuries Electrical injuries
Lightning injuriesLightning injuriesDirect contact with electrical currentDirect contact with electrical currentArcing of electricity between two contact points Arcing of electricity between two contact points near skinnear skinFlash burns if fuel source is ignitedFlash burns if fuel source is ignited
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Radiation InjuryRadiation InjuryIonizing and nonionizing radiationIonizing and nonionizing radiation
Burns may result from high level of radiation Burns may result from high level of radiation exposure to a specific areaexposure to a specific area
RareRare
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Pathophysiology of Thermal Burn InjuryPathophysiology of Thermal Burn Injury
Tissue destruction depends on:Tissue destruction depends on:Temperature and duration of exposureTemperature and duration of exposure
Ability to resist burn injury depends on:Ability to resist burn injury depends on:Water content of skin tissueWater content of skin tissueThickness and pigmentation of skinThickness and pigmentation of skinInsulating substances (e.g., skin oils, hair)Insulating substances (e.g., skin oils, hair)Peripheral circulation of skinPeripheral circulation of skin
•• Affects dissipation of heatAffects dissipation of heat
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Local Response to Burn InjuryLocal Response to Burn InjuryBurn injury destroys cells or completely Burn injury destroys cells or completely disrupts their metabolic functionsdisrupts their metabolic functions
Cellular death ensuesCellular death ensuesCellular damage is distributed over a spectrum of Cellular damage is distributed over a spectrum of injuryinjury
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Local Response to Burn InjuryLocal Response to Burn Injury
Major burns have three Major burns have three zones of injury zones of injury
Appear in bullsAppear in bulls--eye eye pattern:pattern:
Zone of hyperemia (A)Zone of hyperemia (A)Zone of stasis (B)Zone of stasis (B)Zone of coagulation (C)Zone of coagulation (C)
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Systemic Response to Burn InjurySystemic Response to Burn Injury
Hypovolemic shock associated with: Hypovolemic shock associated with: Decrease in venous returnDecrease in venous return
•• Decreased cardiac outputDecreased cardiac output•• Increased vascular resistance (except in zone of Increased vascular resistance (except in zone of
hyperemia)hyperemia)
Renal failure may occur due to:Renal failure may occur due to:•• Hemolysis (destruction of RBCs)Hemolysis (destruction of RBCs)•• Rhabdomyolysis (muscle necrosis)Rhabdomyolysis (muscle necrosis)
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Systemic Response to Burn InjurySystemic Response to Burn Injury
Pulmonary Pulmonary
Gastrointestinal Gastrointestinal
Musculoskeletal Musculoskeletal
NeuroendocrineNeuroendocrine
Metabolic Metabolic
Immune Immune
EmotionalEmotional
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Classifications of Burn Injury Classifications of Burn Injury Assess and classify as accurately as Assess and classify as accurately as possible in the prehospital settingpossible in the prehospital setting
Difficult because of progressive nature of injuryDifficult because of progressive nature of injuryAmount of tissue damage may not be evident Amount of tissue damage may not be evident for hours/days after injuryfor hours/days after injury
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Depth of Burn InjuryDepth of Burn InjuryFirst, second, and third degree (some include First, second, and third degree (some include fourth degree)fourth degree)
FirstFirst-- and secondand second--degree burns are partialdegree burns are partial--thickness burnsthickness burns
•• Usually heal without surgeryUsually heal without surgery
ThirdThird--degree burns are fulldegree burns are full--thickness burnsthickness burns•• Usually require skin graftsUsually require skin grafts
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FirstFirst--Degree BurnDegree BurnPainful, red, dry, blanch Painful, red, dry, blanch with pressurewith pressure
Superficial layer of Superficial layer of epidermal cells is epidermal cells is destroyeddestroyed
Heals in 2Heals in 2--3 days3 days
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SecondSecond--Degree BurnDegree BurnSuperficial partialSuperficial partial--thicknessthickness
BlistersBlisters
Injury extends through Injury extends through epidermis to dermisepidermis to dermis
If no infection, generally If no infection, generally heals without scarringheals without scarring
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SecondSecond--Degree BurnDegree BurnDeep partialDeep partial--thicknessthickness
Involves basal layer of dermisInvolves basal layer of dermisSensation in and around wound may be Sensation in and around wound may be diminisheddiminishedMay appear red and wet or white and dry, May appear red and wet or white and dry, depending on the degree of vascular injurydepending on the degree of vascular injuryMajor complication is wound infectionMajor complication is wound infection
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Deep PartialDeep Partial--Thickness BurnThickness Burn
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ThirdThird--Degree BurnDegree Burn
FullFull--thickness burnthickness burn
Epidermis and dermis Epidermis and dermis destroyed destroyed
Eschar present Eschar present Sensation and capillary Sensation and capillary refill absent refill absent Skin grafts needed for Skin grafts needed for timely and proper healingtimely and proper healing
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FourthFourth--Degree BurnDegree BurnIncluded in some burn classificationsIncluded in some burn classifications
FullFull--thickness injury that penetratesthickness injury that penetratesSubcutaneous tissueSubcutaneous tissueMuscleMuscleFasciaFasciaPeriosteumPeriosteumBoneBone
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Extent and Severity of Burn InjuryExtent and Severity of Burn Injury
Common methodsCommon methodsRule of ninesRule of ninesLund and Browder chartLund and Browder chart
American Burn Association (ABA) has devised American Burn Association (ABA) has devised a categorization of burns to determine severitya categorization of burns to determine severity
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Rule of NinesRule of NinesDivides total body surface Divides total body surface area (TBSA) into area (TBSA) into segments that are segments that are multiples of 9%multiples of 9%
Rough estimate of burn Rough estimate of burn sizesize
Most accurate for adults Most accurate for adults and children >10 y/oand children >10 y/o
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Lund and Browder ChartLund and Browder ChartAccurate method to determine area of burn Accurate method to determine area of burn injuryinjury
Assigns numbers to each body partAssigns numbers to each body part
Used to measure burns in infants and young Used to measure burns in infants and young childrenchildren
Allows for developmental changes in percentages Allows for developmental changes in percentages of body surfaceof body surface
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Lund and Browder ChartLund and Browder Chart
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American Burn Association CategorizationAmerican Burn Association Categorization
Classifies burns as major, moderate, and Classifies burns as major, moderate, and minorminor
Considers: Considers: Patient's agePatient's ageMedical or surgical problemsMedical or surgical problemsBurns of:Burns of:
•• Face and neckFace and neck•• Hands and feetHands and feet•• GenitaliaGenitalia
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Burn Center Referral CriteriaBurn Center Referral CriteriaBurn categorizations used to determine Burn categorizations used to determine which patients need transport to specialized which patients need transport to specialized burn centersburn centers
American College of Surgeons and American American College of Surgeons and American Burn Association have 10 guidelines for burns Burn Association have 10 guidelines for burns that usually require burn center referralthat usually require burn center referral
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Burn ShockBurn ShockShock results from:Shock results from:
Edema and accumulation of Edema and accumulation of vascular fluid in the tissues in vascular fluid in the tissues in the area of injurythe area of injurySystemic fluid leakSystemic fluid leak
Burn shockBurn shockEmergent phaseEmergent phaseFluid shift phaseFluid shift phaseHypermetabolic phaseHypermetabolic phaseResolution phaseResolution phase
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Burn ShockBurn ShockTherapy aimed at supporting patient through Therapy aimed at supporting patient through hypovolemic shockhypovolemic shock
Crystalloid solution (e.g., lactated RingerCrystalloid solution (e.g., lactated Ringer’’s solution) s solution) fluid of choice in initial resuscitation fluid of choice in initial resuscitation Three formulas for calculating fluid replacement Three formulas for calculating fluid replacement volume:volume:
•• Parkland formulaParkland formula•• Modified Brooke formulaModified Brooke formula•• Consensus formulaConsensus formula
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Assessment of the Burn PatientAssessment of the Burn Patient
Initial assessmentInitial assessmentAirwayAirway
•• Especially patients with inhalation injuryEspecially patients with inhalation injury
BreathingBreathingCirculationCirculationNeurological statusNeurological status
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Probability of Upper Airway ObstructionProbability of Upper Airway Obstruction
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HistoryHistoryChief complaint (pain, dyspnea)Chief complaint (pain, dyspnea)
Circumstances of injuryCircumstances of injuryEnclosed space?Enclosed space?Explosive forces involved?Explosive forces involved?Hazardous chemicals involved?Hazardous chemicals involved?Related trauma?Related trauma?
Source of burning agent (e.g., flame, metal, Source of burning agent (e.g., flame, metal, liquid, chemical)liquid, chemical)
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HistoryHistorySignificant medical historySignificant medical history
Patient medications (and drugs/alcohol) Patient medications (and drugs/alcohol)
Loss of consciousness at any timeLoss of consciousness at any timeSuspect inhalation injurySuspect inhalation injury
Last tetanus immunizationLast tetanus immunization
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Physical ExaminationPhysical ExaminationVital signsVital signs
If severe burns or preexisting cardiac or medical If severe burns or preexisting cardiac or medical illness, monitor ECGillness, monitor ECG
Field care and hospital destination determined Field care and hospital destination determined by:by:
Burn depthBurn depthBurn sizeBurn sizeExtent of burned tissueExtent of burned tissueAssociated illness or injuryAssociated illness or injury
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Goals of Prehospital Burn ManagementGoals of Prehospital Burn Management
Preventing further tissue injuryPreventing further tissue injuryMaintaining patent airwayMaintaining patent airwayAdministering oxygen and ventilatory supportAdministering oxygen and ventilatory supportFluid resuscitation (per protocol)Fluid resuscitation (per protocol)Rapid transport to appropriate medical facilityRapid transport to appropriate medical facilityClean technique to minimize patient's exposure to Clean technique to minimize patient's exposure to infectious agentsinfectious agentsPsychological and emotional supportPsychological and emotional support
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Stopping the Burning ProcessStopping the Burning ProcessProvide scene safety for rescue crewProvide scene safety for rescue crew
Minor firstMinor first--degree burnsdegree burnsCool the local area with cool waterCool the local area with cool water
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Stopping the Burning ProcessStopping the Burning ProcessSevere burnsSevere burns
Move patient to area of safety Move patient to area of safety If clothing is in flames or smoldering:If clothing is in flames or smoldering:
•• Place patient on floor or groundPlace patient on floor or ground•• Roll in blanket to smother flames and/or douse with large Roll in blanket to smother flames and/or douse with large
quantities of cleanest available waterquantities of cleanest available waterRemove clothing while cooling burn so heat is not Remove clothing while cooling burn so heat is not trapped under smoldering clothtrapped under smoldering clothAfter burn is cooled, cover patient with clean sheet After burn is cooled, cover patient with clean sheet
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Airway, Oxygen, and VentilationAirway, Oxygen, and Ventilation
Administer highAdminister high--concentration humidified (if concentration humidified (if available) oxygen available) oxygen
Assist ventilation as neededAssist ventilation as needed
If inhalation injury is suspected, closely observe If inhalation injury is suspected, closely observe for signs of impending airway obstruction:for signs of impending airway obstruction:
Laryngeal edema may be progressive and may make Laryngeal edema may be progressive and may make tracheal intubation difficult or impossibletracheal intubation difficult or impossibleDo not delay intubation in these patientsDo not delay intubation in these patients
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CirculationCirculationFluid resuscitation is based on:Fluid resuscitation is based on:
Severity of injurySeverity of injuryVital signsVital signsTransport time to hospitalTransport time to hospital
IV therapyIV therapy
If transport is to be delayed or interfacility transport is If transport is to be delayed or interfacility transport is possible, consider:possible, consider:
AnalgesicsAnalgesics——aggressive pain control aggressive pain control NG tube placementNG tube placementBladder catheterizationBladder catheterization
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Special ConsiderationsSpecial ConsiderationsFacial burns swell rapidly Facial burns swell rapidly
Associated with airway compromiseAssociated with airway compromiseElevate stretcher at least 30 degrees (if not Elevate stretcher at least 30 degrees (if not contraindicated by spinal trauma) to minimize contraindicated by spinal trauma) to minimize edemaedema
Avoid pillow if ears are burned Avoid pillow if ears are burned
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Special ConsiderationsSpecial ConsiderationsExtremity burnsExtremity burns
Remove jewelry to prevent vascular compromise Remove jewelry to prevent vascular compromise from edemafrom edemaAssess peripheral pulses frequentlyAssess peripheral pulses frequentlyElevate burned limb above patient's heartElevate burned limb above patient's heart
Circumferential burnsCircumferential burnsThreat to patient's life or limbThreat to patient's life or limbTourniquetTourniquet--like effect on extremity or chestlike effect on extremity or chest
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Inhalation Burn InjuryInhalation Burn InjuryEpidemiologyEpidemiology
IncidenceIncidence
Morbidity/mortalityMorbidity/mortality
Risk factorsRisk factors
Prevention strategiesPrevention strategies
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Carbon Monoxide PoisoningCarbon Monoxide PoisoningColorless, odorless, tasteless gas Colorless, odorless, tasteless gas
Produced by incomplete combustion of carbon fuelsProduced by incomplete combustion of carbon fuelsDoes not physically harm lung tissueDoes not physically harm lung tissue
Affinity for hemoglobin 250x oxygenAffinity for hemoglobin 250x oxygenSmall concentrations of CO can cause severe physiological Small concentrations of CO can cause severe physiological impairmentsimpairmentsEffects of carbon monoxide poisoning related to blood CO Hgb Effects of carbon monoxide poisoning related to blood CO Hgb levellevel
TreatmentTreatment
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Inhalation Injury above the GlottisInhalation Injury above the Glottis
Upper airway structures Upper airway structures susceptible to injury if susceptible to injury if exposed to high exposed to high temperaturestemperatures
Signs and symptomsSigns and symptoms
Prehospital carePrehospital care
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Inhalation Injury below the GlottisInhalation Injury below the Glottis
Mechanisms of direct injury to lung Mechanisms of direct injury to lung parenchyma areparenchyma are
HeatHeatToxic material inhalationToxic material inhalation
Signs and symptoms often delayed Signs and symptoms often delayed
Prehospital care Prehospital care
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Chemical Burn InjuryChemical Burn InjuryThree common types of caustic agentsThree common types of caustic agents
Alkalis (strong bases with a high pH)Alkalis (strong bases with a high pH)•• Hydroxides and carbonates of:Hydroxides and carbonates of:
Sodium, potassium, ammonium, lithium, barium, calciumSodium, potassium, ammonium, lithium, barium, calciumOven cleaners, drain cleaners, fertilizers, heavy industrial Oven cleaners, drain cleaners, fertilizers, heavy industrial cleaners, cement and concretecleaners, cement and concrete
Strong acidsStrong acids•• Rust removersRust removers•• Bathroom cleanersBathroom cleaners•• Swimming pool acidifiersSwimming pool acidifiers
Organic compounds (chemicals that contain carbon)Organic compounds (chemicals that contain carbon)•• WoodWood•• CoalCoal
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Chemical Burn InjuryChemical Burn InjuryIntraoral chemical burns Intraoral chemical burns sustained by a boy who sustained by a boy who ingested bleachingested bleach
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Chemical Burn InjuryChemical Burn InjurySeverity of chemical injury related to:Severity of chemical injury related to:
Chemical agentChemical agentConcentration and volume of chemicalConcentration and volume of chemicalDuration of contactDuration of contact
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AssessmentAssessment——Chemical InjuryChemical InjuryDetermine:Determine:
Type of chemicalType of chemicalConcentration of chemical Concentration of chemical Volume of chemical Volume of chemical Mechanism of injuryMechanism of injury
•• Local immersion of body part, injection, splashLocal immersion of body part, injection, splash
Time of contaminationTime of contaminationFirst aid before EMS arrivalFirst aid before EMS arrivalAppearance (chemical burns vary in color)Appearance (chemical burns vary in color)PainPain
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ManagementManagementScene safetyScene safety
Consider protective gearConsider protective gear
Remove all clothing, including shoesRemove all clothing, including shoes
Brush off powdered chemicalsBrush off powdered chemicals
Irrigate affected area with copious amounts of waterIrrigate affected area with copious amounts of water
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Chemical Burn Injury to the EyesChemical Burn Injury to the Eyes
CausesCauses
Signs and symptomsSigns and symptoms
Management Management Antidotes or neutralizing Antidotes or neutralizing agentsagentsNo agent superior to water No agent superior to water for treating most chemical for treating most chemical injuriesinjuries Use of nasal cannula for eye irrigation
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Specific Chemical InjuriesSpecific Chemical InjuriesPetroleumPetroleum
Hydrofluoric acidHydrofluoric acid
Phenol (carbolic acid)Phenol (carbolic acid)
AmmoniaAmmonia
Alkali metalsAlkali metals
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Electrical Burn InjuriesElectrical Burn InjuriesEpidemiologyEpidemiology
IncidenceIncidence
Morbidity/mortalityMorbidity/mortality
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Types of Electrical InjuryTypes of Electrical InjuryTissue damage produced by electrical current Tissue damage produced by electrical current depends ondepends on
Amperage (current flow)Amperage (current flow)Voltage (force)Voltage (force)ResistanceResistanceType of currentType of current
•• AlternatingAlternating•• DirectDirect
Current pathwayCurrent pathwayDuration of current flowDuration of current flow
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Types of Electrical InjuryTypes of Electrical InjuryDirect contact burnsDirect contact burns
Arc injuriesArc injuries
Flame and flash burnsFlame and flash burns
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Direct Contact BurnDirect Contact BurnDirect contact burnDirect contact burn——entry wound (hand)entry wound (hand)
Exit woundExit wound
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Effects of Electrical InjuryEffects of Electrical InjuryMusculoskeletal Musculoskeletal
Similar to crush injurySimilar to crush injuryMyoglobin released from muscle damageMyoglobin released from muscle damage
Cardiovascular Cardiovascular Significant dysrhythmiasSignificant dysrhythmiasTachycardiaTachycardiaHypertensionHypertensionHemolysis releases hemoglobinHemolysis releases hemoglobinBlood vessel necrosisBlood vessel necrosis
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Effects of Electrical InjuryEffects of Electrical InjuryExternal burnsExternal burns
Respiratory injuryRespiratory injuryVentilation impaired Ventilation impaired
Neurological injuriesNeurological injuriesRespiratory center depressionRespiratory center depressionBrain tissue injuryBrain tissue injury
Myoglobin release and renal involvementMyoglobin release and renal involvement
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Assessment and ManagementAssessment and ManagementScene safety for rescuers or bystandersScene safety for rescuers or bystanders
If patient is in contact with electrical source, If patient is in contact with electrical source, consult appropriate personnel before consult appropriate personnel before touching patienttouching patient
Once scene is safe, patient care can beginOnce scene is safe, patient care can begin
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Initial AssessmentInitial AssessmentProceed as for all other trauma patientsProceed as for all other trauma patients
Immobilize cervical spineImmobilize cervical spine
If apnea, provide assisted ventilation:If apnea, provide assisted ventilation:Intubation because apnea may persist for lengthy periodsIntubation because apnea may persist for lengthy periods
For breathing patient, maintain a patent airway and For breathing patient, maintain a patent airway and support with supplemental highsupport with supplemental high--concentration oxygenconcentration oxygen
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Initial AssessmentInitial AssessmentIf patient is in cardiac arrest, resuscitation If patient is in cardiac arrest, resuscitation efforts should be implemented according to efforts should be implemented according to protocolprotocol
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HistoryHistoryHistory History
Chief complaint (e.g., injury, disorientation)Chief complaint (e.g., injury, disorientation)Source, voltage, and amperage of electrical injurySource, voltage, and amperage of electrical injuryDuration of contactDuration of contactLevel of consciousness before and after injuryLevel of consciousness before and after injuryPast significant medical historyPast significant medical history
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Physical ExaminationPhysical ExaminationSearch for:Search for:
Entrance and exit woundsEntrance and exit woundsTrauma caused by tetany or a fallTrauma caused by tetany or a fall
Remove all clothing and jewelryRemove all clothing and jewelryAssess and document distal pulses, motor Assess and document distal pulses, motor function, and sensation in all extremities function, and sensation in all extremities Cover wounds with sterile dressingsCover wounds with sterile dressingsManage associated trauma appropriatelyManage associated trauma appropriatelyMonitor ECGMonitor ECG
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ManagementManagementEarly fluid resuscitation is critical Early fluid resuscitation is critical
Establish two largeEstablish two large--bore IV lines in extremity bore IV lines in extremity without entry or exit woundswithout entry or exit wounds
•• Fluid of choice is LR or NSFluid of choice is LR or NS•• Flow rate determined by patientFlow rate determined by patient’’s clinical statuss clinical status
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Lightning InjuryLightning Injury70 deaths/year70 deaths/year
DC of 200,000 ampsDC of 200,000 amps
Potential of 100 million voltsPotential of 100 million volts
Injury by direct strike or side flashInjury by direct strike or side flash
Cardiac arrest possibleCardiac arrest possible
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Lightning InjuryLightning Injury
Pathway of damage Pathway of damage often often overover rather than rather than throughthrough skin skin
Lightning burns are Lightning burns are linear, feathery, and linear, feathery, and punctate (pinpoint) punctate (pinpoint) Classified as minor, Classified as minor, moderate, or severemoderate, or severe
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Assessment and ManagementAssessment and ManagementScene safety Scene safety Prevent injury from subsequent lightning strikesPrevent injury from subsequent lightning strikesAirway and ventilatory supportAirway and ventilatory supportBasic and advanced life supportBasic and advanced life supportPatient immobilizationPatient immobilizationFluid resuscitation to prevent hypovolemia and renal failureFluid resuscitation to prevent hypovolemia and renal failurePharmacological therapy (per protocol) Pharmacological therapy (per protocol) Wound careWound careRapid transport to appropriate hospitalRapid transport to appropriate hospital
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Radiation ExposureRadiation ExposureIndustrial radiography is sourceIndustrial radiography is source
Rarely requires emergency careRarely requires emergency care
Scene safety is a priorityScene safety is a priority
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Radioactive ParticlesRadioactive ParticlesAlpha particlesAlpha particles
Skin will stopSkin will stopDangerous if ingested or inhaledDangerous if ingested or inhaled
Beta particlesBeta particlesPenetrate subcutaneous tissuePenetrate subcutaneous tissueFull PPE, including SCBA, neededFull PPE, including SCBA, needed
Gamma rays and xGamma rays and x--raysraysMost dangerousMost dangerousLead shields neededLead shields needed
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Radiation ExposureRadiation ExposureNonionizing radiationNonionizing radiation
Not usually considered dangerousNot usually considered dangerousRadio waves and microwavesRadio waves and microwaves
Ionizing radiationIonizing radiationNuclear weaponsNuclear weaponsReactorsReactorsRadioactive materialRadioactive materialXX--ray machinesray machinesThreat to rescue personnelThreat to rescue personnel
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Measurements of RadiationMeasurements of RadiationRoentgensRoentgens
RAD (radiation absorbed dose)RAD (radiation absorbed dose)
REM (roentgen equivalent man)REM (roentgen equivalent man)
Radiation dosesRadiation doses
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Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents
Approach with cautionApproach with caution
Do not enter scene until it is secured Do not enter scene until it is secured Rescue personnel, emergency vehicles, and Rescue personnel, emergency vehicles, and command post positioned 200command post positioned 200--300 ft upwind of site300 ft upwind of siteShould not eat, drink, or smoke at accident site or in Should not eat, drink, or smoke at accident site or in any rescue vehicleany rescue vehicle
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Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents
Contact appropriate local authorities Contact appropriate local authorities
Wear suitable protective clothing Wear suitable protective clothing
Dose meters should be available for all rescue Dose meters should be available for all rescue personnelpersonnel
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Personal Protection from RadiationPersonal Protection from Radiation
FactorsFactorsTimeTimeDistanceDistanceShieldingShieldingQuantityQuantity
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Emergency Care for Victims of Emergency Care for Victims of Radiation AccidentsRadiation Accidents
Patients who have been irradiated are not radioactivePatients who have been irradiated are not radioactiveFollow protocol for removing radioactive material from a Follow protocol for removing radioactive material from a patient's clothing, skin, or open woundspatient's clothing, skin, or open woundsTreat patients in normal fashionTreat patients in normal fashionMove patient away from radiation sourceMove patient away from radiation sourceDo not delay lifesaving care for patient transfer or Do not delay lifesaving care for patient transfer or decontaminationdecontaminationIV fluid replacement should be initiated if indicated using striIV fluid replacement should be initiated if indicated using strict ct aseptic techniqueaseptic technique
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Radiation DecontaminationRadiation DecontaminationRadiation emergencies may be defined as:Radiation emergencies may be defined as:
CleanClean•• Patient exposed but not contaminatedPatient exposed but not contaminated
DirtyDirty•• Patient contaminatedPatient contaminated•• Only properly trained personnel should attempt to Only properly trained personnel should attempt to
decontaminate radiation victimsdecontaminate radiation victims
Patients who are transported should be isolated from Patients who are transported should be isolated from the environmentthe environmentTransport all patientTransport all patient’’s effects with patients effects with patient
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ConclusionConclusionUnderstanding the consequences of burn Understanding the consequences of burn
injuries and appropriate prehospital injuries and appropriate prehospital management can reduce morbidity and management can reduce morbidity and mortality in this complex patient group.mortality in this complex patient group.
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