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BURNS

Temple College

EMS Professions

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Anatomy of Skin

Largest body organ

More than just a passivecovering

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Skin Functions

Sensation

Protection Temperature regulation

Fluid retention

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Anatomy

Two layers

Epidermis

Dermis

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Epidermis

Outer layer

Top (stratum corneum) consistsof dead, hardened cells

Lower epidermal layers form

stratum corneum and contain

protective pigments

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Dermis

Elastic connective tissue

Contains specialized structures Nerve endings

Blood vessels

Sweat glands

Sebaceous (oil) glands

Hair follicles

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Burn Epidemiology

2,500,000/year

100,000 hospitalized 12,000 deaths

Third leading cause of trauma deaths

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Pathophysiology

Loss of fluids

Inability to maintain bodytemperature

Infection

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Critical Factors

Depth

Extent

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Burn Depth

First Degree (Superficial)

Involves only epidermis

Red Painful

Tender

Blanches under pressure

Possible swelling, no

blisters

Heal in ~7 days

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Burn Depth

Second Degree

(Partial Thickness)

Extends throughepidermis into dermis

Salmon pink

Moist, shiny

Painful

Blisters may be present

Heal in ~7 to 21 days

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Burn Depth

Burns that

blister are

second degree. But all second

degree burns

dont blister.

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Burn Depth

Third Degree (Full

Thickness)

Through epidermis, dermisinto underlying structures

Thick, dry

Pearly gray or charred

black

May bleed from vesseldamage

Painless

Require grafting

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Burn Depth

Often cannot be accurately

determined in acute stage

Infection may convert to higher

degree

When in doubt, over-estimate

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Burn Extent

Rule of Nines

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Burn Extent

Adult Rule of Nines9

99

1818

1

18, Front

18, Back

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Burn Extent

Pediatric Rule of Nines18

99

13.513.5

1

18, Front

18, Back

For each year over 1year of age, subtract

1% from head,

add equally to legs.

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Burn Extent

Rule of Palm

Patients palm

equals 1% of

his body

surface area

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Burn Severity

Based on

Depth

Extent

Location

Cause

Patient Age

Associated Factors

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Critical Burns

3rd Degree >10% BSA

2nd Degree > 25% BSA (20% pediatric)

Face, Feet, Hands, Perineum

Airway/Respiratory Involvement

Associated Trauma

Associated Medical Disease

Electrical Burns

Deep Chemical Burns

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Moderate Burns

3rd Degree 2 to 10%

2nd Degree 15 to 25% (10 to

20% pediatric)

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Minor Burns

3rd Degree

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Associated Factors

Patient Age

< 5 years old

> 55 years old

Burn Location

Circumferential burns of chest,

extremities

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MANAGEMENT

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Stop Burning Process

Remove patient from source of

injury

Remove clothing unless stuck

to burn

Cut around clothing stuck toburn, leave in place

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Assess

Airway/Breathing

Start oxygen if:

Moderate or critical burn

Decreased level of consciousness

Signs of respiratory involvement

Burn occurred in closed space

History of CO or smoke exposure

Assist ventilations as needed

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Assess Circulation

Check for shock signs /symptoms

Early shock seldom results from effects of

burn itself.

Early shock = Another injury until provenotherwise

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Obtain History

How long ago?

What has been done?

What caused burn?

Burned in closed space?

Loss of consciousness? Allergies/medications?

Past medical history?

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Rapid Physical Exam

Check for other injuries

Rapidly estimate burned,

unburned areas

Remove constricting bands

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Treat Burn Wound

Cover with DRY, CLEAN SHEETS

Do NOT rupture blisters

Do NOT put goo on burn

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Special Considerations

Pediatrics

Geriatrics

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Pediatrics

Thin skin, increased severity

Large surface to volume ratio

Poor immune response

Small airways, limited

respiratory reserve capacity Consider possibility of abuse

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Geriatrics

Thin skin, poorly circulation

Underlying disease processes

Pulmonary

Peripheral vascular

Decreased cardiac reserve

Decreased immune response

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Geriatrics

Percent mortality =

Age + % BSA Burned

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Inhalation Injury

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Problems

Hypoxia

Carbon monoxide toxicity

Upper airway burn

Lower airway burn

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Carbon Monoxide

Product of incomplete combustion

Colorless, odorless, tasteless

Binds to hemoglobin 200x stronger

than oxygen

Headache, nausea, vomiting,roaring in ears

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Carbon Monoxide

Exposure makes pulseoximeter data meaningless!

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Upper Airway Burn

True Thermal Burn

Danger Signs

Neck, face burns

Singing of nasal hairs, eyebrows

Tachypnea, hoarseness, drooling

Red, dry oral/nasal mucosa

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Lower Airway Burn

Chemical Injury

Danger Signs

Loss of consciousness

Burned in a closed space

Tachypnea (+/-)

Cough

Rales, wheezes, rhonchi

Carbonaceous sputim

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Chemical Burns

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Concerns

Damage to skin

Absorption of chemical; systemictoxic effects

Avoiding EMS personnel exposure

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Management

Remove chemical from skin

Liquids

Flush with water

Dry chemicals

Brush away

Flush what remains with water

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Special Concerns

Phenol

Not water soluble

Flush with alcohol

Sodium/Potassium

Explode on water contact

Cover with oil

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Special Concerns

Tar

Use cold packs to solidify tar

Do NOT try to remove

Tar can be dissolved with organic

solvents later

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Chemical in Eyes

Flush with NS or Ringers

No other chemicals in eye

Flush out contacts

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Electrical Burns

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Considerations

Intensity of current

Duration of contact

Kind of current (AC or DC)

Width of current path

Types of tissues exposed(resistance)

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Voltage

Voltage Does Not Kill

Current Kills

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Electrical Burns

Conductive injuries

Tip of Iceberg

Entrance/exit wounds may be small

Massive tissue damage between

entrance/exit

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Electrical Burns

Nonconductive injuries

Arc burns

Ignition of clothing

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Other Complications

Cardiac arrest/arrhythmias

Respiratory arrest

Spinal fractures

Long bone fractures

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Management

Make sure current is off!

Check ABCs

Assess carefully for other injuries

Patient needs hospital evaluation,

observation