1. BURNS BLS, ILS, ALS OTEP Russ Armstrong, EMT-I, Fire Prevention Officer, Stevens County Fire Protection District #1

2. While we do understand this presentation is an instructional tool for all levels of certification, taking this into consideration everyone taking this class must remember that they can only practice at their level of certification NOT by their level of instruction. YOU CAN ONLY PRACTICE AT THE LEVEL YOU HAVE BEEN CERTIFIED.

3. BURN INTRODUCTION A burn is an injury caused by extremes of temperature, electric current, or certain chemicals. In this session we will learn how to determine percentage and severity of burns, proper treatment, and delivery to the appropriate medical facility.

4. TYPES OF BURNS Focus on the treatment of life-threatening injuries even though burn may consume attention. Three types of Burns –Superficial (1 ST degree) –Partial thickness (2 nd degree) –Full thickness (3 rd degree)

5. SUPERFICIAL (1 ST DEGREE) Superficial (1 st degree) – involves only the upper layers of the epidermis and dermis. It is an irritation of the living cells in this region and results in some pain, minor edema, and erythema.

6. SUPERFICIAL AND PARTIAL THICKNESS (1 ST & 2 ND DEGREE)

7. PARTIAL THICKNESS BURN (2 ND DEGREE) Epidermis and Dermis No other underlying tissue Intense pain Skin may appear white or red, moist or mottled Blisters usually

8. PARTIAL THICKNESS BURN

9. FULL THICKNESS (3 RD DEGREE) Through all dermal layers SQ tissue, muscle, bone, and/or organs involved. Nerves have been burnt away. –Thus no pain –However, there may be extreme pain where full thickness and partial thickness interface.

11. Third Degree Burn Text

12. CLASSIFICATION OF BURNS Thermal Burns – caused by exposure to excessive heat. Electrical Burns – caused by direct contact with electricity. Chemical Burns – caused by contact with chemicals.

13. THERMAL BURN INJURY

14. ELECTRICAL BURN INJURY

15. CHEMICAL BURN INJURY

16. RULE OF NINES System used to estimate the percentage of body surface involved in a burn injury To estimate the severity of the burn To “paint” a picture in the mind of the M.D.

18. MINOR BURNS <15% of BSA No complications or involvement of hands, face, feet, or perineum. No evidence of inhalation burns, associated injury, or severe preexisting medical problem.

19. MODERATE BURNS 15-25% of BSA No complications or involvement of the face, hands, feet or perineum. No evidence of inhalation burns, associated injury, or severe preexisting medical problem.

20. MAJOR BURNS 25% or greater of BSA burns A functionally significant involvement of hands, face, feet, or perineum.

21. PATIENT ASSESSMENT Rule out possible c-spine involvement. Determine level of consciousness. ABC’s

22. AIRWAY ASSESSMENT Airway – look for signs of inhalation injury. Soot around mouth and nose. Black mucus from mouth. Visible burns around nose and mouth.

23. INHALATION INJURY

24. BREATHING ASSESSMENT Breathing – Make sure patient is breathing adequately and give supplemental oxygen via nonrebreather mask. Auscultate lung sounds

25. CIRCULATION ASSESSMENT Circulation – Check carotid pulse, and pulses below injury site. Perform head to toe assessment and treat all burns appropriately.

26. BURN TREATMENT Be concerned for the airway (tube early) High flow O2 Monitor IV’s (Burns need fluid replacement) Medicate for pain control (if available)

27. BURN TREATMENT (CONT.) Keep the patient warm. Treat any other injuries. Transport to appropriate facility while monitoring vital signs and airway.

28. PARKLAND BURN FORMULA Formula to calculate the volume of fluid necessary for fluid replacement Adult 4ml x (% of BSA 2 nd or 3 rd burns) x kg 2 = fluid replacement for first 8 hours after insult.

29. Test Answers 1.The three classifications of burn severity include all of the following, except: a.Minor b.Eschar c.Severe d.Moderate 2.During the __________phase of a burn injury there is a release of vasoactive substances from the burned tissues causing wound edema, fluid loss and hypovolemia. a.Fluid shift. b.Release of catecholamines. c.Compensation.

30. 3. Which of the following signs or symptoms may indicate that a patient has an inhalation injury: –Stridor. –Singed nasal hairs. –Inspiratory wheezing. –All of the above. 4. The cause of death from electricity can be attributed to all the following, except. –The electrical effect on the heart. –Scar tissue formation. –Massive muscle destruction from the current passing through the body. –Thermal burns from contact with the electrical source.

31. 5. The “rule of nines” is a method of determining a. Body surface burned. b. Severity of the burn. c. Classification of the burn. d. Type and degree of the burn. 6. Which of the following is not a classification of a burn injury? a. Superfical. b. Deep fascia d. Partial-thickness. e. Full-thickness.

32. 7. The Parkland formula is used by many burn centers to _____________ for the burn patient. a.Measure scar formation. b.Determine the time of healing. c.Determine fluid replacement. d.Measure circulatory compromise. 8. All of the following should be considered in the treatment of a burn patient, except. a.Cool the patient with cold water. b.High flow O2. c.Replace fluids with IV’s. d.Transport to appropriate facility.

33. 9. At what percent of BSA burned would be considered a Major or Severe burn. a.30% b.25% c.35% d.All of the above. 10. Burns are the leading cause of trauma in the ___________age group. a.Newborn. b.Toddler and preschool. c.Teenage. d.Elderly.

34. Contact Renee Anderson 1-509-232-8155 Phone 1-509-232-8344 Fax andersr@inhs.org Russ Armstrong: rarmstrong@scfd1.comrarmstrong@scfd1.com