1. BURN EMERGENCIES
2018

2. THE LARGEST ORGAN OF THE BODY IS
The Skin
THE LARGEST ORGAN OF THE BODY IS

3. The Function of the Skin
Unlike most organs, the skin has many functions.
The Three Major Functions:
1. Protect the body from the environment
Keeps out harmful bacteria
2. Regulate body temperature
Helps to cool down or heat up body
3. Transmit information from the environment to the brain
AAOS 11th Ed P. 213

4. Anatomy of the Skin Our skin is broken down into 2 Layers Epidermis
Subcutaneous
Tissue

5. Anatomy of the Skin Epidermis: Most superficial layer
Varies in thickness
Thick areas: scalp, back, soles of feet
Thin areas: forearm
Germinal Layer at the base of the Epidermis

6. Anatomy of the Skin Epidermis Continued: Germinal Layer
Blood supply found here
Skin cells produced here & then cells move to surface
Journey takes 4 weeks
Outermost cells are constantly rubbed away
Enroute to the surface the cells die
Stratum Corneum layer: dead layer of skin (see next slide)
No blood supply
Contains pigment granules (help produce skin color)
AAOS 11th Ed P. 212

7. Anatomy of the Skin

8. Anatomy of the Skin Dermis: Sweat glands Sebaceous (oil) glands
Cooling of the body
Sebaceous (oil) glands
Waterproofing and softening of skin
Hair follicles
Blood vessels
Provide nutrients and oxygen to skin
Specialized nerve endings
Sensitive to environmental stimuli
AAOS 11th Ed. P

9. Burns
Generally, Burns themselves don’t kill, however, complications resulting from burns do kill.
When large amounts of skin are damaged by a burn, body processes are upset.
The care you provide as a first responder can make a big difference in the patients recovery and in some cases life or death.

10. Three Burn Depth Classifications
Superficial (first-degree)
Partial-Thickness (second-degree)
Full-Thickness (third-degree)

11. Three Burn Depth Classifications
Superficial ( first-degree) Burns
These involves the top layer of skin.

12. Three Burn Depth Classifications
Partial-Thickness (second-degree) burns
Involve the epidermis and dermis

13. Three Burn Depth Classifications
Full-Thickness (third-degree) burn
Extends through all layers of the skin

14. Classifications of Minor Burns in Adults
First-degree involving less than 50%
Second-degree involving less than 15%
Third-degree involve less than 2%
AAOS page 925 Table 26-1

15. Classifications of Moderate Burns in Adults
First Degree that involves more than 50% of the body’s total surface area.
Second Degree that involve 15% - 30% of the body’s total surface area.
Third Degree involving 2%-10% of the body’s total surface area (excluding the hands, feet, groin or major joints)
AAOS page 925 Table 26-1

16. Classification of Severe Burns in Adults
Moderate Burns on patients younger than 5 and older than 55.
Burns associated with respiratory injury (smoke inhalation or inhalation injury)
Burns complicated by fractures
AAOS page 925 Table 26-1

17. Classification of Severe Burns in Adults
Second Degree involving more than 30% of body’s total surface area.
Third Degree involving more than 10% of body’s total surface area.
Third Degree burn involving the face, hands, feet, upper airway, groin, circumferential or major joint.
AAOS page 925 Table 26-1

18. Type of Burns Thermal Burns Inhalation Burns Inhalation of Toxic Gases
Chemical Burns
Electrical Burns
Taser Injures
Radiation Burns
AAOS page 931 and 937

19. Thermal Burns Scalds – hot liquids Steam burn Open Flame burn
Most common along with Open Flame
Mostly seen in children and handicapped
Steam burn
Type of Scald burn
Open Flame burn
Most common along with Scalds
AAOS page 932 and 933

20. Thermal Burns Contact burn Flash burn Touching a hot object
Rarely deep due to reflexes
Flash burn
Explosion: brief exposure to intense heat
Lightning
AAOS page 932 and 933

21. Inhalation Burns
Upper airway damage usually caused by superheated gases
Lower airway damage usually caused by chemicals or particulate matter
AAOS page 933 and 934

22. Inhalation of Toxic Gases
Incomplete combustion
Carbon Monoxide
Carbon Dioxide
Hydrogen Cyanide
Other Gases
AAOS page 933 and 934

23. Chemical Burns Toxic substance contacts the body
Usually a strong acid or strong alkalis (base)
Fumes from chemicals can cause burns, especially to the respiratory tract
Severity of burns are related to:
Type of chemical
Concentration of the chemical
Duration of exposure
Consider requesting Haz Mat
AAOS page 934

24. Electrical Burns Possible Sources AC: Alternating Current
DC: Direct Current
Lightning

25. Electrical Burns Damage will consist of:
An entrance wound
An exit wound
Unseen damage along the internal path
The burn might be larger under the skin
Electrical burns are ALWAYS more severe than they appear
Electricity causes thermal burns and chemical changes.
AAOS page 936

26. Electrical Burns Chemical Changes occur to the following systems:
Nervous
Cardiovascular
Muscular
Chemical changes cause:
Disruption of normal body functions
May cause system failure
AAOS page 936

27. Electrical Burns Your safety is paramount
Always assume that power lines are energized
Never touch electrical lines
Do not step over electrical lines
Never touch a patient who is in contact with an electrical source
AAOS page 937

28. Taser Injuries Two prongs 13 mm long
Generally treated as impaled objects
Deaths associated with tasers have been associated with ‘excited delirium.’
Excited delirium is commonly associated with illegal drugs like cocaine & meth
Can cause dysrhythmias and sudden cardiac arrest
AAOS page 937

29. Taser Injuries Excited Delirium is characterized by:
Extreme aggression
Shouting
Delusions
Paranoia
Strength
Hyperthermia
Excited Delirium is a true emergency requiring ALS
AAOS page 937 and Mecklenburg County Protocols Page 97

30. Radiation Burns Possible Sources Nuclear sources
Ultraviolet light is also considered a source of radiation burns, as in sunburn.

31. Three Types of Ionizing Radiation
Alpha :
Low energy. Stopped by clothing.
Beta :
Not stop by clothing.
Dust particles can be inhaled.
Can cause cell damage.
Gamma : X Rays
Can cause death
Can be protected by lead.
AAOS page 937 and 938

32. Determining the Severity of a Burn
The severity of a burn is gauged by both the:
DEPTH and the
AMOUNT (TBSA)
Use the Rule of Nines to estimate the % of Total Body Surface Area (TBSA) burned
TBSA only used for thermal burns
TBSA only used for 2nd and 3rd Degree burns
TBSA does NOT apply to electrical burns
Mecklenburg County Protocol Page 118

33. Rule of 9s for Adults Estimation of % total body surface area – Adult
Head = 9% (face 4.5%, scalp 4.5%)
Anterior torso = 18%
Posterior torso = 18%
R Arm = 9% (anterior 4.5%, posterior 4.5%)
L Arm = 9% (anterior 4.5%, posterior 4.5%)
R Leg = 18% (anterior 9%, posterior 9%)
L Leg = 18% (anterior 9%, posterior 9%)
Genitalia = 1%
Mecklenburg County Burn Protocol Page 118

34. Rule of 9s for Adults

35. Rule of 9s for Pediatrics
Estimation of % total body surface area – Pediatric
Head = 18% (face 9%, scalp 9%)
Chest = 13%
Back = 13%
R Arm = 9%
L Arm = 9%
R Leg = 18%
L Leg = 18%
Genitalia = 1%
Mecklenburg County Burn Protocol Page 118

36. Rule of 9s for Pediatrics

37. Care and Treatment of Burns
Scene Safety
Move the patient away from the burning area.
STOP THE BURNING PROCESS
Follow proper BSI techniques
Medical Gloves at a Minimum
Face Protection
Gown

38. Care and Treatment of Burns
Maintain ABCs
Airway - Open
Breathing – Ensure Adequate, Provide Oxygen
Circulation – Check for a Pulse
Remove clothing check for additional burning
Cool burn with saline ONLY if within the first 1 to 2 minutes of exposure
Dress burns with clean, DRY dressing
Mecklenburg County Protocols Page 119

39. Care and Treatment of Burns
Do NOT apply ice
Consider:
Carbon Monoxide Poisoning
Cyanide Poisoning
Toxic Gases
Consider abuse, particularly in pediatrics
Mecklenburg County Protocols Page 119

40. Examine the Airway Carefully
Look for burns around face & in the mouth
Stridor, dyspnea
Soot around nose and mouth.
Carbonaceous (Sooty) sputum
Singed nasal hair
Mecklenburg County Protocols Page 119

41. Gasses CO Carbon Monoxide colorless tasteless`
Causing saturation the red blood cells
Hydrogen Chloride Found in upholstery & PVS
Causing pulmonary edema
Hydrogen Cyanide Found in nylons, wool's and plastics.
Interferes with cellular respiration.

42. Gasses Formaldehyde Found in Lacquered woods
Depression of the central nervous system
Formic Acid