BURN S

OVERVIEW Structure & function of the skin Types of burns Management of burns Inhalation injury Toxic gas exposure Burn centers

ANATOMY & PHYSIOLOGY Largest organ Functions Barrier Sensory organ Keeps fluids in Keeps bacteria out Sensory organ Temperature organ

COURTESY DAVID EFFRON, M.D. TYPES OF BURNS THIRD DEGREE BURNS WITH ESCHAROTOMIES Flame (Thermal) Electrical AC & DC Lightning Chemical Steam Radiation Scald COURTESY DAVID EFFRON, M.D.

SEVERITY OF BURN Burn injury result of Severity depends upon Direct injury Inflammatory response Severity depends upon Extent Depth Extent estimated by Rule of nines Palmar surface is about 1% of BSA

DEPTHS OF BURNS Second Degree First Degree Third Degree

FIRST AND SECOND DEGREE BURNS FIRST DEGREE BURN

COURTESY DAVID EFFRON,M.D. THIRD DEGREE BURNS COURTESY BONNIE MENEELY, R.N. COURTESY DAVID EFFRON,M.D.

COURTESY DAVID EFFRON, M.D. ELECTRICAL BURNS COURTESY DAVID EFFRON, M.D. COURTESY BONNIE MENEELY, R.N.

CHEMICAL BURN COURTESY ROY ALSON, M.D.

COURTESY DAVID EFFRON, M.D. SCALD BURN COURTESY DAVID EFFRON, M.D.

INITIAL FIELD CARE Safety is #1 priority Protect yourself and your patient Rescue of victims from burning structure takes priority over all other treatment!

THIS IS WHAT HAPPENS WHEN INITIAL FIELD CARE Be aware of hazards Electrical lines Hazardous materials or chemicals Do not handle electrical lines or chemicals unless properly trained and equipped COURTESY DAVID EFFRON, M.D. THIS IS WHAT HAPPENS WHEN YOU GRAB HIGH VOLTAGE!

INITIAL FIELD CARE Priorities are the same as for other trauma patients BTLS Primary Survey first Cool burn area with water Do not induce hypothermia Cover burn with clean dry dressing Maintain body temperature

INITIAL FIELD CARE Remove constricting clothing and jewelry Cut around adherent clothing Do not apply anything but water to a burn What goes on must come off Do not delay transport to start IVs Burn shock does not develop early

ESTIMATION OF BURN SIZE

CRITERIA FOR BURN CENTER TRANSFER Both 2nd & 3rd degree burns >20% BSA any age >10% BSA <10 or >50 years of age 3rd degree only >5% BSA Burns of face, hands, feet, genitals, or joints

CRITERIA FOR BURN CENTER TRANSFER Specialized burn types Electrical & lightning Chemical Inhalation injury Circumferential chest or extremity burns Significant medical illness Significant other injuries

INHALATION INJURIES Carbon monoxide poisoning Toxic gas inhalation Smoke inhalation Heat inhalation Steam inhalation Asphyxiation

SIGNS OF SMOKE INHALATION Exposed to smoke in enclosed space Unconscious while exposed to smoke After exposure to smoke Develops cough Develops dyspnea Develops chest pain

SIGNS OF UPPER AIRWAY BURNS Burns of the face Singed eyebrows or nasal hairs Burns in the mouth Sooty sputum History of being burned while confined to an enclosed space COURTESY ROY ALSON, M.D. LIP BURNS & SOOT IN MOUTH

MANAGEMENT OF INHALATION AND/OR UPPER AIRWAY BURNS Wear protective gear 100% oxygen via mask Secure airway with ET tube if needed Assist ventilation as needed Prompt transport

CHEMICAL BURNS Injure the skin May be absorbed into the body and damage internal organs May be inhaled into the lungs and cause lung tissue damage May have minimal skin injury and yet cause severe systemic injury

FACTORS CAUSING TISSUE DAMAGE IN CHEMICAL BURNS ACID BURN Type of chemical Concentration of chemical Amount of chemical Duration of contact Manner of contact Mechanism of action

TREATMENT OF CHEMICAL EXPOSURE BSI precautions Remove and bag all contaminated clothing Brush off dry chemical Flush with copious amounts of water or any drinkable liquid Wipe or scrape any retained chemical and irrigate again “THE SOLUTION TO POLLUTION IS DILUTION”

ELECTRICAL BURNS Extent of injury depends upon Type of current Amount of current Path of current Duration of current

DO NOT ATTEMPT TO HANDLE ELECTRICAL HAZARDS UNLESS PROPERLY TRAINED AND EQUIPPED

ELECTRICAL INJURY CARDIAC ARRHYTHMIAS ARE THE MOST SERIOUS IMMEDIATE INJURY THAT OCCURS WITH ELECTRICAL CONTACT V-Fib V-Tach PVCs

ELECTRICAL INJURY Monitor heart in all patients with electrical contact Establish IV access for treatment of arrhythmias Treat per ACLS protocols

ELECTRICAL INJURY Most patients have healthy hearts Resuscitation often possible even after prolonged CPR All victims of electrical shock should be evaluated by a physician

ADDITIONAL INJURIES Skin burns Entrance and exit wounds Fractures Cannot determine the extent of the injury from the surface burn DAY ONE DAY 3

LIGHTNING STRIKE Usually superficial injury Victims die from cardiac arrest Resuscitate the “dead” Patients who are breathing will usually survive

SUMMARY Protect yourself and your patient Maintain c-spine immobilization Treat burn patients as trauma patients Properly cool the burn Be alert for inhalation injuries Flush chemical burns adequately Monitor heart in electrical burn patients

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