burns. war wounds – blast, burn, fragmentation

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?