National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Burns Chapter 19

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 19.1 List four types of burns List the signs and symptoms for each type of burn Compare and contrast the methods for classifying burns Describe the clinical significance of a voice change in the setting of a thermal burn. continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 19.5 Compare and contrast direct current and alternating current Describe how to assess burn severity using the “Rule of Nines” system Describe and demonstrate the management of a burn patient.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology Burn Sources Burn Classifications Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A 4-year-old boy has pulled a boiling hot dish out of a microwave and onto himself. The mother is with him and is crying vigorously. He has no past medical history, is taking no medications, and has no allergies.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Skin ◦ Largest organ of the body ◦ Two layer ◦ Multipurpose ◦ Vulnerable to damage when exposed to extreme temperature, caustic substances, and other hazardous sources

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Burn Sources Thermal ◦ Heat comes directly into contact with skin Chemical ◦ Exposure to a caustic substance Electrical ◦ Contact with an electrical current continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Burn Sources Radiation ◦ Exposure to a radiation emitting object ◦ UV Light exposure

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Burn Classifications Determined by depth of skin damage ◦ Thickness-based Superficial Partial thickness Full thickness ◦ Degree-based First Second Third Fourth

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Burn Classifications Copyright Edward Dickinson, M.D. Copyright Charles Stewart M.D. and Associates

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update After confirming that the ABCDs are intact, you call for assistance and begin a secondary assessment. You note that the boy’s chin and the front of his neck for a distance of about twice as long as his palms are bright red and are surrounded by larger areas of redness in a splash-like pattern. Blisters are forming on his chest. He is breathing rapidly and his heart rate is 110 and regular at the brachial artery pulse point.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Scene safety is a first priority Use BSI and PPE Airway/breathing is a major concern Collect information on the burning agent Determine severity with degree or thickness based method continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Use the Rule of Nines to determine extent of partial/full thickness burns Check for critical issues ◦ Treatment should be at a burn center if possible

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Safety concerns take priority Stop the burning process Care for ABCDs CPR may be needed for electrical burn patients Control bleeding Remove clothing and jewelry Cool and irrigate with room temp water continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Cover with clean linens/blanket After cooling use dry, sterile dressings Smaller burns may use clean, wet, cool dressings Do NOT apply creams, ointments, etc. Treat for shock continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Extensive Burns ◦ Remember that with extensive burns, patients lose the ability to thermoregulate. Make sure they do not become hypothermic by wrapping them in warm, dry sheets. continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Elevate upper body if burned to minimize edema Transport all but most minor burns to a burn or trauma center if possible ◦ Use a clean, dry sheet to prevent the patient from sticking to the transport device.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Thermal Burns Put out the flames – “Stop, Drop and Roll” or smother ◦ Do not use chemical fire extinguishers Remove burned, singed, or smoldering clothing, or clothing soaked in hot liquid ◦ Do not pull if fabric has melted onto skin Do not break blisters Do not apply cold compresses

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chemical Burns Use PPE to avoid contamination Remove all clothing and jewelry Consider Hazmat Brush off dry chemicals Irrigate with large amounts of tepid water (15 mins, or until burning ceases) Do not try to neutralize Chemtrec #:

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chemical Burns Chemical Burn Alert ◦ Caution! When managing chemical burns, do not apply a neutralizing agent because this may cause a thermal reaction, worsening the injury. Dust off any dry chemicals and irrigate the area with room-temperature water. Note as well that the application of water to some chemicals also produces heat.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Electrical Burns Make sure the power is OFF Immobilize on a backboard Maintain airway, give oxygen Do CPR (use AED) if necessary Check for entrance/exit wounds

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Electrical Burns Entrance and Exit Wounds ◦ Remember that patients injured by electricity often appear to be much better off than they actually are because many of their burns are beneath the surface. Take vital signs frequently and be prepared for extensive resuscitation (CPR and AED).

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Radiation Burns If the burn is not from ultraviolet light, the patient should be treated only by HAZMAT personnel. UV burns (sunburn) are usually treated as first-degree burns.

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition What are the patroller’s findings? What treatment and transportation choices were made?

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Rescuer and bystander safety is the top priority when treating a burn patient. The four types of burns are thermal burns, chemical burns, electrical burns, and radiation burns. The focus of treatment is stopping the burning process. continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Brush off dry or powdered chemicals first. Irrigate chemical burns with water for a minimum of 15 minutes. Inhalation injuries are often associated with facial burns and vocal hoarseness. continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Burns are classified by the depth of the injury. Use the Rule of Nines to calculate the extent of burns. Do not delay transport of patients with significant burns. Treat burn patients for shock and hypothermia. continued

National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Transport burn patients to a burn center or trauma center, whenever possible.