BURNS
War Wounds – Blast, Burn, Fragmentation
OVERVIEW
• Structure & function of the skin
• Types of burns
• Management of burns
• Inhalation injury
• Toxic gas exposure
• Burn centers
ANATOMY & PHYSIOLOGY
• Largest organ• Functions
– Barrier• Keeps fluids in
• Keeps bacteria out
– Sensory organ
– Temperature organ
TYPES OF BURNS
• Flame (Thermal)• Electrical
– AC & DC– Lightning
• Chemical• Steam• Radiation• Scald
COURTESY DAVID EFFRON, M.D.
THIRD DEGREE BURNS WITH ESCHAROTOMIES
SEVERITY OF BURN
• Burn injury result of– Direct injury – Inflammatory response
• Severity depends upon– Extent – Depth
• Extent estimated by– Rule of nines– Palmar surface is about 1% of BSA
DEPTHS OF BURNS
First DegreeSecond Degree
Third Degree
FIRST AND SECOND DEGREE BURNS
FIRST DEGREE BURN SECOND DEGREE BURN
THIRD DEGREE BURNS
COURTESY DAVID EFFRON,M.D.COURTESY BONNIE
MENEELY, R.N.
ELECTRICAL BURNS
COURTESY DAVID EFFRON, M.D.
COURTESY BONNIE
MENEELY, R.N.
CHEMICAL BURN
COURTESY ROY ALSON, M.D.
SCALD BURN
COURTESY DAVID EFFRON, M.D.
INITIAL FIELD CARE
• Safety is #1 priority• Protect yourself and
your patient• Rescue of victims
from burning structure takes priority over all other treatment!
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
THIS IS WHAT HAPPENS WHEN
YOU GRAB HIGH VOLTAGE!
COURTESY DAVID EFFRON, M.D.
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
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
Hand Burn Dressing
ESTIMATION OF BURN SIZE
CRITERIA FOR BURN CENTER TRANSFER
• Specialized burn types– Electrical &
lightning– Chemical– Inhalation injury– Circumferential
chest or extremity burns
• Significant medical illness
• Significant other injuries
INHALATION INJURIES
• Carbon monoxide poisoning
• Toxic gas inhalation
• Smoke inhalation
• Heat inhalation
• Steam inhalation
• Asphyxiation
Toxins in the Battlefield Environment
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
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
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
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
FACTORS CAUSING TISSUE DAMAGE IN CHEMICAL BURNS
• Type of chemical
• Concentration of chemical
• Amount of chemical
• Duration of contact
• Manner of contact
• Mechanism of action
ACID BURN
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”
Chemical Eye Treatment
Chemical Burn
ELECTRICAL BURNS
• Extent of injury depends upon– Type of current
– Amount of current
– Path of current
– Duration of current
ADDITIONAL INJURIES
• Skin burns• Entrance and exit
wounds• Fractures• cannot determine
the extent of the injury from the surface burn
DAY
ONE
DAY
3
LIGHTNING STRIKE
• Usually superficial injury
• Victims die from cardiac arrest
• Resuscitate the “dead”» Patients who are
breathing will usually survive
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
QUESTIONS?