national ski patrol, outdoor emergency care, 5/e ©2012 by pearson education, inc., upper saddle...
TRANSCRIPT
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Burns
Chapter 19
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Objectives
19.1 List four types of burns.
19.2 List the signs and symptoms for each type of burn.
19.3 Compare and contrast the methods for classifying burns.
19.4 Describe the clinical significance of a voice change in the setting of a thermal burn.
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Objectives
19.5 Compare and contrast direct current and alternating current.
19.6 Describe how to assess burn severity using the “Rule of Nines” system.
19.7 Describe and demonstrate the management of a burn patient.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Topics
Anatomy and Physiology Burn Sources Burn Classifications Assessment Management Chapter Summary
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Case Presentation
A 4-year-old boy has pulled a boiling hot dish out of a microwave and onto himself. The mother is with him and is crying vigorously. He has no past medical history, is taking no medications, and has no allergies.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Anatomy and Physiology
Skin◦ Largest organ of the body◦ Two layer◦Multipurpose◦ Vulnerable to damage when exposed to
extreme temperature, caustic substances, and other hazardous sources
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Anatomy and Physiology
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Burn Sources
Thermal◦Heat comes directly into contact with
skin Chemical
◦ Exposure to a caustic substance Electrical
◦Contact with an electrical current
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Burn Sources
Radiation◦ Exposure to a radiation emitting object◦UV Light exposure
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Burn Classifications
Determined by depth of skin damage◦ Thickness-based
• Superficial• Partial thickness• Full thickness
◦Degree-based• First • Second• Third• Fourth
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Burn Classifications
Copyright Edward Dickinson, M.D.Copyright Charles Stewart M.D. and Associates
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Case Update
After confirming that the ABCDs are intact, you call for assistance and begin a secondary assessment. You note that the boy’s chin and the front of his neck for a distance of about twice as long as his palms are bright red and are surrounded by larger areas of redness in a splash-like pattern. Blisters are forming on his chest. He is breathing rapidly and his heart rate is 110 and regular at the brachial artery pulse point.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Assessment
Scene safety is a first priority Use BSI and PPE Airway/breathing is a major concern Collect information on the burning
agent Determine severity with degree or
thickness based methodcontinued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Assessment
Use the Rule of Nines to determine extent of partial/full thickness burns
Check for critical issues ◦ Treatment should be at a burn center if
possible
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Assessment
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Assessment
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Management
Safety concerns take priority Stop the burning process Care for ABCDs CPR may be needed for electrical burn
patients Control bleeding Remove clothing and jewelry Cool and irrigate with room temp watercontinued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Management
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Management
Cover with clean linens/blanket After cooling use dry, sterile dressings Smaller burns may use clean, wet,
cool dressings Do NOT apply creams, ointments,
etc. Treat for shock
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Management
Extensive Burns◦Remember that with extensive burns,
patients lose the ability to thermoregulate. Make sure they do not become hypothermic by wrapping them in warm, dry sheets.
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Management
Elevate upper body if burned to minimize edema
Transport all but most minor burns to a burn or trauma center if possible◦Use a clean, dry sheet to prevent the
patient from sticking to the transport device.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Thermal Burns
Put out the flames – “Stop, Drop and Roll” or smother◦Do not use chemical fire extinguishers
Remove burned, singed, or smoldering clothing, or clothing soaked in hot liquid◦Do not pull if fabric has melted onto skin
Do not break blisters Do not apply cold compresses
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Chemical Burns
Use PPE to avoid contamination Remove all clothing and jewelry Consider Hazmat Brush off dry chemicals Irrigate with large amounts of tepid
water (15 mins, or until burning ceases) Do not try to neutralize Chemtrec #: 800.262.8200
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Chemical Burns
Chemical Burn Alert◦ Caution! When managing chemical burns, do not apply a
neutralizing agent because this may cause a thermal reaction, worsening the injury. Dust off any dry chemicals and irrigate the area with room-temperature water. Note as well that the application of water to some chemicals also produces heat.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Electrical Burns
Make sure the power is OFF Immobilize on a backboard Maintain airway, give oxygen Do CPR (use AED) if necessary Check for entrance/exit wounds
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Electrical Burns Entrance and Exit Wounds
◦ Remember that patients injured by electricity often appear to be much better off than they actually are because many of their burns are beneath the surface. Take vital signs frequently and be prepared for extensive resuscitation (CPR and AED).
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Radiation Burns
If the burn is not from ultraviolet light, the patient should be treated only by HAZMAT personnel.
UV burns (sunburn) are usually treated as first-degree burns.
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Case Disposition
What are the patroller’s findings? What treatment and transportation
choices were made?
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Chapter Summary
Rescuer and bystander safety is the top priority when treating a burn patient.
The four types of burns are thermal burns, chemical burns, electrical burns, and radiation burns.
The focus of treatment is stopping the burning process. continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Chapter Summary
Brush off dry or powdered chemicals first.
Irrigate chemical burns with water for a minimum of 15 minutes.
Inhalation injuries are often associated with facial burns and vocal hoarseness.
continued
National Ski Patrol, Outdoor Emergency Care, 5/e ©2012 by Pearson Education, Inc., Upper Saddle River, NJ
BRADY
Chapter Summary
Burns are classified by the depth of the injury.
Use the Rule of Nines to calculate the extent of burns.
Do not delay transport of patients with significant burns.
Treat burn patients for shock and hypothermia. continued