1. Burns Paramedic Class, W09 Created by P. Andrews

2. Incidence & Patterns of Burn Injury Devastating trauma High mortality rate Long rehabilitation Permanent disability, disfigurement common > 2 million burns in USA q yr 70,000 hospital admissions 70,000 hospital admissions 10,000 die 10,000 die

3. Incidence & Pattern, cont. M & M follow signification patterns Gender Gender 2/3 all fatalities are men Age Age Death rate highest among children and elders Socioeconomic status Socioeconomic status ¾ all fire related deaths occur in homes with highest incidence in lower-income households

4. Prevention! Key component of professional role is community education

5. Major Sources of Burns Major Sources of Burns ThermalChemicalInhalationElectrical

6. A & P review EpidermisSebumDermis Subcutaneous Layer

8. Thermal Burns 1 st degree Superficial Superficial 2 nd degree Partial thickness Partial thickness 3 rd degree Full thickness Full thickness

9. Burn Thickness

10. 1 st Degree Burns Epidermis, Dermis Epidermis, Dermis Redness Redness Pain Pain Mild edema Mild edema

12. 2 nd Degree Burns Dermis Dermis Redness Redness Pain Pain Blisters Blisters Edema Edema

14. Deep partial thickness burns May require skin grafting

15. Entire Dermis Entire Dermis Painless Painless Various discolorations Various discolorationsGreyBlack Brown, leathery Skin grafts often required Third Degree Burns

18. Calculating Burn Surface Area Rule of nine’s Modified for infant, child Modified for infant, child Palmar surface Patient’s hand Patient’s hand 1% 1%

21. Management of Burns Stop the Burning process!!! Safety for personnel is priority! Remove smoldering clothing Remove rings, etc. Cut around plastic, etc that is stuck to skin.

22. Management of burns Rule of 10 If less than 10% BSA If less than 10% BSA Within 10 min. of burn Within 10 min. of burn Cool for 10 min Cool for 10 min Cover with sterile/clean non-linty material Bulky dressings with dressings between digits

23. Management of burns Airway management! High flow Oxygen Early intubation, prn

24. Management of Burns At least one large bore IV In non-burned area if possible

26. Parkland Formula Your 180 pound patient is burned on both of his anterior legs and right anterior arm. What is his TBSA %? 22.5%

27. 4 x TBSA % x kg 4 x 22.5 = 90 x kg 90 x 82 = 7380 ml 3690 ml first 8 hours 461.25 ml / hour Parkland Formula

28. Transport considerations Transport to burn center if: Burn with respiratory tract injury Burn with respiratory tract injury Burn to face, eyes, ears, hands, feet, genitalia Burn to face, eyes, ears, hands, feet, genitalia Any 3 rd degree burn 20% or more BSA Any 3 rd degree burn 20% or more BSA Burn with fractures Burn with fractures Circumferential burns Circumferential burns Peds < 5 y/o Peds < 5 y/o Adults > 55 y/o Adults > 55 y/o

29. Electrical Burns Electrical Currents Lightning Path of least resistance Cardiac dysrhythmias Underlying injuries not readily apparent ABC’s

30. Assess for Entrance and Exit wounds

31. Chemical Burns Acids Rust removers Rust removers Bathroom cleaners Bathroom cleaners Swimming pool acidifiers Swimming pool acidifiersAlkalis Oven cleaners Oven cleaners Drain cleaners Drain cleaners Fertilizers Fertilizers Heavy industrial cleaners Heavy industrial cleaners Cement, concrete Cement, concrete Organic compounds Creosote Creosote Gasoline Gasoline

32. Assessment of Chemical burns Type (take container to hospital with pt.) ConcentrationVolume Mechanism (immersion, splash, etc.) Time of exposure First aid before EMS Pain

33. Management of Chemical Burns Safety for rescuers Stop burning process Remove all clothing including shoes Remove all clothing including shoes Brush off powdered chemical Brush off powdered chemical Irrigate with copious amounts water Irrigate with copious amounts water Before transport if possible

34. Specific Chemicals Petroleum Prolonged contact Prolonged contact Hydrofluoric acid Glass etching, manufacture of silicone chips Glass etching, manufacture of silicone chips Leaches calcium from bones and deposits in tissue Leaches calcium from bones and deposits in tissue Irrigate very well Irrigate very well Treat with calcium gluconate injection into burn site Treat with calcium gluconate injection into burn site

35. Specific Chemicals, cont. Ammonia Noxious gas; strong alkali – water soluble Noxious gas; strong alkali – water soluble Especially harmful to eyes Common in processing plants, cooling areas Irrigate eyes with water for up to 24 hours Irrigate eyes with water for up to 24 hours Respiratory injury Respiratory injury Short-term; upper airway edema Long-term; lower airway injury High-concent. Oxygen, ventilate prn

36. Burns to Airway Evaluate for: Burns around nose or mouth Burns around nose or mouth Soot in mouth/nose Soot in mouth/nose Singed nasal hairs Singed nasal hairs Intraoral burns Intraoral burns Hoarseness Hoarseness Visible pharyngeal edema Visible pharyngeal edema Inspiratory stridor Inspiratory stridor

37. Airway Burns, cont. Evaluate for: Rate, depth of respirations Rate, depth of respirations Wheezes, crackles, or rhonchi? Wheezes, crackles, or rhonchi? Mentation changes Mentation changesHistory: Closed space burn? Closed space burn? Explosives? Explosives? Chemicals? Chemicals? PMH? PMH? Medications? Medications?Management: Careful vitals High flow oxygen ECG monitoring

38. Manage airway aggressively and early!

39. Chemical burns to eyes Sx: Local pain Local pain Visual disturbances Visual disturbances Lacrimation Lacrimation Edema Edema Redness RednessTx: Flush continuously with water Flush continuously with water Remove contact lenses if present Remove contact lenses if present

40. Chemical Burn by using NAIR Hair Remover

42. Systemic Complications Hypothermia Loss of skin integrity Loss of skin integrityHypovolemia Plasma loss Plasma loss 3 rd spacing 3 rd spacingEschar Electrolyte loss Acidosis Inhalation injury InfectionHypoxiaDysrhythmias Renal failure Liver failure Heart failure

43. Escharotomy

44. Special Notes Child abuse?

46. That’s all, folks