Docstoc

Prehospital Burn Care - EMS House of DeFrance

Document Sample
Prehospital Burn Care - EMS House of DeFrance Powered By Docstoc
					Soft Tissue Trauma and Burns

    Tulsa Technology Center
     Ken Corn, NREMT-P
           Instructor
Integumentary System

    EPIDERMIS
   Outermost layer of
    dying skin
   Protective barrier
   Moistened by
    Sebum to make it
    waterproof and
    pliable
Integumentary System

                   DERMIS
                  Contains blood
                   vessels, glands and
                   nerve endings
                  Temperature
                   regulation
                  Sweat mechanism
                  SubQ adipose cells
Functions of Skin

   Largest organ            Provides barrier
   Keeps the inside in       against infection
    and the outside out       from the
   Sensory organ             environment
   Contains vital body      Provides insulation
    fluids                    from trauma
   Main organ of            Road rash not
    temperature               withstanding!!
    regulation
Wounds
   Contusions
   Blunt injuries
   Erythemia, redness
    caused by contusion
   Ecchymosis, bluish
    color, late sign
   Hematoma, literally
    “Blood Tumor”
Wounds
            Abrasions-scraping
             away layers usually
             little bleeding
            Lacerations-jagged
             open wounds of any
             depth
            Incisions-clean neat
             lacerations, lots of
             blood
Wounds
   Punctures-small
    rounded entrance
    wound that normally
    heals itself, lots of
    infection
   Avulsions-laceration
    with a flap hanging off
   Degloving-avulsion
    stripping all skin off
   Amputation-pretty self
    explanatory
Hemorrhage

 Can be arterial, venous, capillary
 Important to determine volume
 Clotting mechanism takes about 10
  minutes
 Clean lacs and amputations have little
  blood
 Crushing injuries involve many tissues
  and hemorrhage control can be very
  difficult, may have to use pressure
Thermal Burns
 Causes increased rate of molecular
  motion causing cells to break down
 Tissue injury and death progress
  rapidly
 Injury is directly related to heat
  transference
 Energy transferred depends on
  temperature heat source and contact
  time
Types of Thermal Burns

                  Hot liquids-Boiling
                   water, grease filled
                   liquids are worst
                  Hot Solids-Stove,
                   iron, fireplace tools
                  Hot Gases-from
                   house fires
                  Flame
                  Superheated steam
Electrical Burns
   Energy enters and          Low voltage (<7000
    exits body                  volts) takes the path
   This causes an              of least resistance
    extensive damage            usually blood
    track                       vessels & nerves
   Soft tissue, bone and      High voltage (>7000
    nerves are damaged          volts) takes the
   Cardiac                     shortest route to
    arrhythmia's                ground regardless
Electrical Burns
   Burns can be FLASH
    or CONTACT
   Will usually have a
    small entrance
    wound (Target ring)
   Will usually have a
    large exit wound
    (Blowout)
Chemical Burns
   Destroys cells by
    biochemical change
    Liquids like drain
    cleaners
   Dry chemicals like
    lime or sodium
    metal
   Acids react with
    H2 O
   Alkalis react with fat
Radiation Injury
                Ionizing radiation
                 enters a cell and
                 changes it’s make
                 up
                Unshielded
                 radiation from a
                 radioactive source
                Dust debris
                 containing small
                 active particles
Radiation Types

 Alpha radiation-Weak source blocked
  by paper, skin clothes etc.
 Beta radiation-Greater strength than
  alpha can penetrate skin and clothes
 Gamma radiation-Very powerful
  penetrates the entire body blocked by
  lead shielding
 Neutron radiation-VERY-VERY
  dangerous not easily blocked by
  anything
Radiation Exposure Mechanism

 Radiation exposure has 3 IMPORTANT
  considerations
 1-Duration of exposure
 2-Distance of exposure
 3-Shielding between you and the
  radioactive source
 Radiation is invisible and cannot be
  seen or felt (If it is your will should be
  up to date!)
Inhalation Injury
   Breathing in hot
    gases, heated air,
    flame or
    superheated steam
   Inhalation injury is
    the most common
    cause of burn
    related death
    within the first 24
    hours
Toxic Inhalation
   One important consideration is what was on
    fire, the Cleveland Clinic fire of 1929 had 123
    deaths caused by breathing the oxides of
    nitrogen released by burning x-ray film
   Toxins are given off by resins and plastics as
    they burn. Chemicals such as potassium
    cyanide and hydrogen sulfide
   40% of the population can smell cyanide and
    whether you can or not is hereditary
Airway Thermal Burns
 Airway mucosa is damaged from heat
 1200o F in anethesized dogs
 Superheated steam is needed to burn
  lower airways (Industrial high pressure
  steam)
 Airway obstruction and respiratory
  arrest are common with thermal burns
 Hoarseness is an important early sign
Carbon Monoxide (CO) Poisoning

   Suspect in all burn cases especially
    enclosed spaces or if the victim was
    unconscious
   Hemoglobin as an affinity for CO that is
    200 times greater than the affinity for O2
   CO shoves the Oxygen off of the
    hemoglobin and does not allow oxygen to
    bind resulting in hypoxemia
   Pulse oxemitry is not only of no value for
    these patient but may be DANGEROUS
Degree of Burn

FIRST DEGREE
 Involves the upper
  layer of skin
 Pain minor swelling
  and redness
 Normally, no
  complications
 AKA Superficial
  Burn
Degree of Burn

                 SECOND DEGREE
                  Penetrates deeper
                   and produces
                   blisters
                  Redness &
                   edematous
                    Most PAINFUL
                     Burn
                    AKA Partial
                     Thickness Burn
Degree of Burn

THIRD DEGREE AKA Full Thickness
 Penetrates through the entire epidermis
  may involve muscle or bone
 Destroys nerve endings
 Dry, leathery, gray or white appearance
 Usually painless for lack of nerve
  endings
 Healing is very difficult and takes
  FOREVER (especially if it is you)
Adult Rule of Nines

   Head and neck 9%
   Front torso 18%
   Back torso 18%
   Upper extremities
    9%
   Lower extremities
    18% each
   Genitalia 1%
   Total 100% cool huh?
Pediatric Rule of Nines

                    Head and Neck 18%
                    Front torso 18%
                    Back torso 18%
                    Upper Extremities
                     9%
                    Lower Extremities
                     13.5% each
                    Genitalia 1%
                    Total 100%
Body Surface Measurement

Lund and Browder          Area equivalent
   Chest & abdomen        measurement
    13%
                          Palmar hand
   Buttocks 2.5% each
                           surface = 1% of
   Thigh 9.5% each
                           BSA
   Lower leg 7% each
   Foot 3.5% each
   Upper arm 4% each
   Forearm 3% each
   Hand 3% each
Special Considerations & Complications

   Hypothermia-Excess heat loss from burn
   Hypovolemia-From plasma loss through
    burn
   Eschar-Formation of dead, necrotic tissue
   Infection, Patient’s age & overall health
   Total Fluid loss
   Associated injuries and illnesses
BREAK TIME 15 minutes!
Assessment of Soft Tissue Injury

Primary assessment
   Control serious bleeding and determine
    blood loss
Secondary assessment
   Palpate the injury and determine underlying
    damage
   Note the mechanism of injury
   Prioritize wound injuries and treat
    appropriately
Assessment of Thermal Burns

 Note mechanism of injury
 Stop the burning process (DUH!)
 Remove clothing and jewelry
 Assess surface area and severity of burn
 Assess for respiratory involvement
 Assess for associated trauma
 Determine SWAMPLE History
Assessment of Chemical Burns

 Assess ongoing danger, LOOKOUT!!!!!
 Remove contaminated clothing
 Assess chemical name, exposure time
  and area affected
 Determine if anything was done for the
  patient prior to your arrival
 Determine if there is a specific antidote
Assessment of Electrical Burns

                    TURN OFF THE
                     POWER
                    Stop the burning
                     process (DUH
                     again!)
                    Remove all
                     smoldering clothing
                     and jewelry
                    Search for entrance
                     and exit wounds &
                     determine voltage
                    Monitor for cardiac
Assessment of Radiation Burns

   Approach carefully
    and find the expert
   Protect everyone
    from exposure
   Remove
    contaminated
    clothing
   Strip, wash and
    rinse the patient
    prior to assessment
Determining Criticality of Burns

   Minor - Superficial burns and small partial
    thickness burns
   Moderate - Partial thickness of >15% BSA
    small full thickness burns
   Severe Partial thickness of >30% BSA
   Burns to hands, feet, face, genital or with
    circumfrential patterns are critical
   Toxic inhalation burns are always critical
Management of Wounds

 Direct pressure
  and elevation
 Pressure point
 Both of the above
 Pneumatic
  pressure
 Tourniquet as a
  last resort
Management of Wounds

 Get the big chunks off or out grass,
  glass etc
 Clean is nice but not necessary
 If it is gross looking wash it with a little
  saline to get the big dirty chunks off
 Apply neat sterile dressing (blue side
  out)
 Immobilization helps clotting
   QUIT LOOKING UNDER THE DRESSING!!
Management of Wounds (PLO)

                 Find the part
                 Pick up the part
                 Gently rinse off the
                  part
                 Place the part in a
                  DAMP sterile
                  dressing
                 Place in plastic bag
                 Place in 2nd bag and
                  then ON ice not IN ice
                 Transport with the pt.
Management of Thermal Burns

                  PROTECT
                   YOURSELF! # 1
                  Put out the fire, ie
                   stop the burning
                   process
                  Use whatever’s
                   there
                  The burn is a lesser
                   priority than the
                   ABCs
                  Assess the
Management of Thermal Burns

GET THE HX OF THE PRESENT
  ILLNESS
 How long ago?
 Enclosed space? with loss of
  consciousness?
 What was done? (Pleeeezzee tell me you
  didn’t put butter on this burn!!)
 SWAMPLE History
 Consider ET SOONER rather than
Management of Thermal Burns

 For small burns <15% BSA use moist
  sterile dressings
 For serious burns use DRY
  DRESSINGS!
 Commercial burn dressing are great but
  a standard hospital sheet works as good
 DO NOT make your patient
  hypothermic
 DO NOT forget the ABCs
Management of Electrical Burns

   PROTECT YOURSELF! # 1 DO NOT
    TOUCH A POSSIBLY CHARGED PATIENT
   Determine the amount of current (high or low
    voltage or even lightning)
   Determine the duration of exposure
   Deep burn or superficial burn? (Arc flash)
   Treat skin burns like any thermal burn
   Monitor EKG, consider Lidocaine (Electricity
    is NOT good for your heart but falling is!!!)
Management of Chemical Burns

   PROTECT YOURSELF! # 1
   Put out the fire, ie stop the burning
    process
   Remove patient’s clothes including
    underwear and jewelry
   Flush with large volumes of water, the wetter
    the better (Urine is a sterile fluid)
   Scrub wounds if appropriate (dry lime)
   If the patient’s eyes are involved remove
    contacts & irrigate copiously with saline
Management of Chemical Burns

   Check to see if special fluids need to be
    used (Oil for Na+ & K+ metal, alcohol for
    phenol)
   Check for antidote (calcium gluconate for
    hydrofluoric acid)
   Be aware of fire potential for certain
    chemicals (gasoline)
   NO IV UNTIL DECONTAMINATION
   Avoid water with sulfuric acid, use soap
Management of Radiation Burns

   PROTECT YOURSELF! # 1
 Remove and shield patients
 Wash and rinse the patients BEFORE
  you contaminate your unit
 Care for injuries as appropriate
 If the patient was exposed to ionizing
  radiation but not contaminated you are
  not in danger, otherwise they are
  contaminated
IV Therapy for Burn Care

OBJECTIVES
 Maintain pulse rate
  below 110/min
 Maintain normal
  mentation
 Maintain urine
  output between 30-50
  ml/hour
 < 20 ml/hour is
  bladder sweat
IV Therapy for Burn Care

PARKLAND BURN FORMULA
 4.0 ml lactated Ringer’s/kg of body
  weight times BSA burned over the first
  24 hours
 Give 50% in the first 8 hours post burn
 Give 50% during the next 16 hours
 Second 24 hour give 2000 ml D5W to
  avoid hypernatremia & blood or
  plasma if needed
IV Therapy for Burn Care

BROOKE BURN FORMULA
 2.0 ml lactated Ringer’s/kg of body
  weight times BSA burned over the first
  24 hours
 Give 50% in the first 8 hours post burn
 Give 50% during the next 16 hours
 Second 24 hour give 2000 ml D5W to
  avoid hypernatremia & blood or
  plasma if needed
Special Considerations for Burn Care

 At the scene, the burn injury is the
  LEAST priority (You remember, A-B-C)
 You may have the best chance to
  intubate the patient, may not be
  possible later
 Be aware of eschar formation on the
  chest and extremities (You may have to
  perform an escharotomy)
Special Considerations for Burn Care

   Consider breathing treatments for toxic
    inhalation along with high flow O2
 Development of rales and pulmonary
  edema are a VERY GRAVE sign
 If the patient’s skin is burned and you
  can see a vein go ahead and use it, it’s
  sterile
 No IVs on chemical burn patients
  unless they have been COMPLETELY
  deconed
Don’t forget rule #1

PROTECT     YOURSELF
      and watch your
      partner’s back!!
Have a good winter break!!

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:9
posted:1/26/2013
language:Unknown
pages:51