1. BURN S

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

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

4. 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.

5. 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

6. DEPTHS OF BURNS
Second Degree
First Degree
Third Degree

7. FIRST AND SECOND DEGREE BURNS
FIRST DEGREE BURN

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

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

10. CHEMICAL BURN
COURTESY ROY ALSON, M.D.

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

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

13. 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!

14. 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

15. 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

16. ESTIMATION OF BURN SIZE

17. 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

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

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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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”

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

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

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

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

30. 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

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

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

33. 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

34. QUESTIONS?