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Burns

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 70,000 hospital admissions 10,000 die. Incidence & Pattern, cont.

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Burns

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  1. Burns Paramedic Class, W09 Created by P. Andrews

  2. Incidence & Patterns of Burn Injury • Devastating trauma • High mortality rate • Long rehabilitation • Permanent disability, disfigurement common • > 2 million burns in USA q yr • 70,000 hospital admissions • 10,000 die

  3. Incidence & Pattern, cont. • M & M follow signification patterns • Gender • 2/3 all fatalities are men • Age • Death rate highest among children and elders • Socioeconomic status • ¾ all fire related deaths occur in homes with highest incidence in lower-income households

  4. Prevention! • Key component of professional role is community education

  5. Major Sources of Burns • Thermal • Chemical • Inhalation • Electrical

  6. A & P review Epidermis Sebum Dermis Subcutaneous Layer

  7. Thermal Burns • 1st degree • Superficial • 2nd degree • Partial thickness • 3rd degree • Full thickness

  8. Burn Thickness

  9. 1st Degree Burns • Epidermis, Dermis • Redness • Pain • Mild edema

  10. 2nd Degree Burns • Dermis • Redness • Pain • Blisters • Edema

  11. Deep partial thickness burns • May require skin grafting

  12. Entire Dermis Painless Various discolorations Grey Black Brown, leathery Skin grafts often required Third Degree Burns

  13. Calculating Burn Surface Area • Rule of nine’s • Modified for infant, child • Palmar surface • Patient’s hand • 1%

  14. 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

  15. Rule of 10 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

  16. Management of burns • Airway management! • High flow Oxygen • Early intubation, prn

  17. At least one large bore IV In non-burned area if possible Management of Burns

  18. What is his TBSA %? Parkland Formula 22.5% Your 180 pound patient is burned on both of his anterior legs and right anterior arm.

  19. 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

  20. Transport considerations • Transport to burn center if: • 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

  21. Electrical Burns • Electrical Currents • Lightning • Path of least resistance • Cardiac dysrhythmias • Underlying injuries not readily apparent • ABC’s

  22. Assess for Entrance and Exit wounds

  23. Chemical Burns • Acids • Rust removers • Bathroom cleaners • Swimming pool acidifiers • Alkalis • Oven cleaners • Drain cleaners • Fertilizers • Heavy industrial cleaners • Cement, concrete • Organic compounds • Creosote • Gasoline

  24. 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

  25. Management of Chemical Burns • Safety for rescuers • Stop burning process • Remove all clothing including shoes • Brush off powdered chemical • Irrigate with copious amounts water • Before transport if possible

  26. Specific Chemicals • Petroleum • Prolonged contact • Hydrofluoric acid • 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

  27. Specific Chemicals, cont. • Ammonia • Noxious gas; strong alkali – water soluble • Especially harmful to eyes • Common in processing plants, cooling areas • 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

  28. Burns to Airway • Evaluate for: • Burns around nose or mouth • Soot in mouth/nose • Singed nasal hairs • Intraoral burns • Hoarseness • Visible pharyngeal edema • Inspiratory stridor

  29. Evaluate for: Rate, depth of respirations Wheezes, crackles, or rhonchi? Mentation changes History: Closed space burn? Explosives? Chemicals? PMH? Medications? Management: Careful vitals High flow oxygen ECG monitoring Airway Burns, cont.

  30. Manage airway aggressively and early!

  31. Chemical burns to eyes • Sx: • Local pain • Visual disturbances • Lacrimation • Edema • Redness • Tx: • Flush continuously with water • Remove contact lenses if present

  32. Chemical Burn by using NAIR Hair Remover

  33. Hypothermia Loss of skin integrity Hypovolemia Plasma loss 3rd spacing Eschar Electrolyte loss Acidosis Inhalation injury Infection Hypoxia Dysrhythmias Renal failure Liver failure Heart failure Systemic Complications

  34. Escharotomy

  35. Special Notes Child abuse?

  36. That’s all, folks

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