18 Caring for Soft-Tissue Injuries and Bleeding

BURNS

State Standards 24) Research and evaluate National Trauma Triage Protocol. Identify and perform skills to manage life threatening injuries based on assessment findings of a patient with trauma emergencies, utilizing rubrics from textbooks, National HOSA guidelines, or clinical standards of practice in the following areas: a. Internal and external bleeding b. Chest trauma such as sucking chest wound and impaled objects in chest c. Abdominal trauma such eviscerations and impaled objects d. Orthopedic trauma such as fractures, dislocations, amputations e. Soft tissue trauma, burns, dressings, and bandages f. Head, facial, neck and spine trauma such as head injuries, scalp injuries, and injuries to spine g. Environmental emergencies such as submersion and exposure to heat and cold h. Multi-system trauma

Objectives Students will be able to… Classify types of burns Determine percent body burned Apply treatments and dressings for burns

Burns Classification of Burns Heat (thermal) burns Chemical burns Fire Steam Hot objects Chemical burns Caused by caustics such as acids and alkalis Teaching Tip: Contact a burn center or national burn association for teaching resources. continued on next slide

Burns Classification of Burns Electrical burns Lightning burns Originate from outlets, frayed wires, or faulty circuits Lightning burns Occur during electrical storms

Burns Classification of Burns Light burns Radiation burns Intense light such as an arc welder, industrial laser, ultraviolet Radiation burns Result from nuclear sources Teaching Tip: Use multimedia graphics to illustrate different types of burns. Ask students to classify the depth of each burn presented.

Figure 18.25 Burns are classified by depth of injury.

Burns Classification of Burns Superficial burns Involves top layer of skin (epidermis) Often a result of sunburn Partial-thickness burns Involves both epidermis and dermis Intense pain, white to red skin that is moist and mottled and blisters Critical Thinking: Why might a hand burn be more serious than the same-sized and type burn on the abdomen?

Figure 18.26 Partial-thickness burns are characterized by the presence of redness and blisters. (© Edward T. Dickinson, MD)

Burns Classifications of Burns Full-thickness burns Extend through all dermal layers May involve subcutaneous layers, muscle, bone, or organs

Figure 18. 27 Full-thickness burns involve all layers of the skin Figure 18.27 Full-thickness burns involve all layers of the skin. (© Edward T. Dickinson, MD)

Burns Rule of Nines for Adults 9 percent to of total body surface area Head and neck Abdomen Back of each leg Lower back Chest continued on next slide

Burns Rule of Nines for Adults 9 percent to of total body surface area Each arm Upper back Buttocks Remaining 1 percent assigned to genital area continued on next slide

Burns Rule of Nines for Infants and Children 18 percent to head and neck 9 percent to each upper limb 18 percent to chest and abdomen 18 percent to entire back 14 percent to each lower limb 1 percent to genital area

Figure 18.28 The rule of nines for estimating body surface area affected.

Burns Thermal Burns Support ABCs as needed. Stop burning process by cooling. Cover with dry sterile dressing. Moisten only if burn is less than 9 percent of skin surface. Critical Thinking: Consider the role of pain control in a burn patient. How might this factor impact your need for advanced life support? continued on next slide

Burns Thermal Burns Separate digits with clean gauze pads. Apply moist, clean gauze to both eyes without opening eyelids. Be sure it is not a chemical burn. Critical Thinking: Consider the role of pain control in a burn patient. How might this factor impact your need for advanced life support?

Scan 18.5 Assessment and Care of Thermal Burns SERIOUS BURNS: Partial-Thickness and Full-Thickness burns continued on next slide

Burns Chemical Burns Stop burning process by removing irritant and all contaminated clothing and jewelry. Primary care for chemical burns is to flush with water for 20 minutes. Discussion Question: What is an important consideration when treating someone with a chemical burn to the eye? Answer: Being careful not to contaminate the other eye. Class Activity: Direct students to work in pairs to practice flushing a simulated chemical burn to the eye; using caution not to contaminate the unaffected eye. Have them complete the treatment with the application of moist pads to both eyes. (This also a good exercise for promoting empathy and the importance of keeping patients informed of what is happening during care). continued on next slide

Burns Chemical Burns If dry chemical (e.g., dry lime), use dry dressing to brush chemical away first before flushing with water. Apply a dry, clean dressing. Discussion Question: What is an important consideration when treating someone with a chemical burn to the eye? Answer: Being careful not to contaminate the other eye. Class Activity: Direct students to work in pairs to practice flushing a simulated chemical burn to the eye; using caution not to contaminate the unaffected eye. Have them complete the treatment with the application of moist pads to both eyes. (This also a good exercise for promoting empathy and the importance of keeping patients informed of what is happening during care).

Figure 18.29a Chemical burns: Brush away dried powders. continued on next slide

Burns Electrical Burns Scene of electrical injury often very hazardous Be sure source of electricity has been turned off before attempting care of patient. Cardiac arrest, nervous system damage, fractures, injury to internal organs may occur. Critical Thinking: Why should you always insist that a patient accept transfer to a hospital by EMS after an electrical injury? continued on next slide

Burns Electrical Burns Perform primary assessment. Look for entrance and exit burn sites. Apply dry, clean dressings to burn sites. Critical Thinking: How might the entrance burn site appear? How might an exit burn site appear? Why are they different? continued on next slide

Burns Electrical Burns Apply moistened dressings if: Transport is delayed. Burn involves less than 9 percent of body. Not in a cold environment Provide oxygen/care for shock. Critical Thinking: How might the entrance burn site appear? How might an exit burn site appear? Why are they different?

Burns Infants and Children Children frequently victims of accidental burns Consider possibility of child abuse. Burns used as form of discipline or punishment by adults Report your suspicion to appropriate authorities. Remain objective and focus on caring for child. Teaching Tip: Review state regulations regarding reporting child abuse.

Think About It You respond to a home where you find a 52-year-old male who has sustained multiple burns after pouring water onto a grease fire on his gas grill. His face, chest, arms, and hands are all affected. What are your concerns? How will you proceed?

Activity ***We have no covered all of our objectives Complete the burns worksheet case study on the class website. Answer all of the questions as a review. Exit ticket: Calculate the % burn for someone with 2 burnt arms, facial burns, anterior chest burns Abdominal burns, pubic burns, thigh burns