BURNS

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INTRODUCTION
Optimal patient care requires that the EMT-I and EMT-P understand the signs/symptoms and field treatment of burns. The following topics will be discussed during this lesson:

· Functions of the skin
· Types of burns
· Categories of burns
· Severity of burns
· Field treatment of burns


LESSON OBJECTIVES
At the end of this lesson the participants will be able to:

1. State 6 functions of the skin.

2. List the 4 types of burns.

3. Discuss the characteristics of the 3 degrees of burns.

4. Identify critical body areas in relation to burns.

5. Understand the “Rule of Nines” used to estimate the percentage of burns.

6. Verbalize the criteria to determine the severity of burns.

7. Identify the most frequent causes of death from burns.

8. Identify the importance of determining whether a burn injury was received in a closed
area.

9. Identify signs and symptoms of a respiratory burn.

10. Discuss appropriate field treatment and transportation for burn victims.


SKILLS
None


KEY VOCABULARY
The following terms will be used during this class:

· eschar - charred, leathery skin

KEY CONCEPTS
The following section provides information and space for taking notes on the key concepts discussed by the instructor.

INTEGUMENTARY SYSTEM (REVIEW)
Functions of the skin
· Protects internal organs
· Maintains integrity of internal environment
· Provides barrier to bacteria
· Assists in temperature regulation
· Provides sense of temperature, touch, and texture

CLASSIFICATION AND ESTIMATION OF BURNS

Types of burn
· Thermal
· Chemical
· Electrical
· Radiation


Degrees and characteristics of burns
First degree/partial thickness:
· reddened skin, painful (sunburn)Second degree/partial thickness:
· reddened skin, painful, blisters Third degree/full thickness:
· charred, leathery skin, white, waxy, painless, no capillary refill


Critical body areas for burns
· Respiratory tract (always suspect respiratory involvement in closed area burns)
· Face
· Hands and/or feet/Joint surfaces
· Perineum


Burn estimation (Rule of Nines)
Adult:
Head 9%
Arms 9%(each)
Torso (front/back)18%
Legs 18%
Perineum 1%

Child:
Head18%
Arms 8.5% (each)
Torso (front/back) 18% (each)
Legs 14% (each)
Perineum 1%


Severity of burns
Minor burn:
· No critical area or respiratory involvement
· Second degree less than 15% of body surface
· Third degree less than 2% of body surface


Moderate:
· First degree burn to 50% - 75% of body surface
· Second degree to 15% - 30% of body surface
· Third degree burn of 2% - 10% of body surface


Critical:
· Respiratory involvement
· Associated injuries or fractures
· Critical area involvement
· Second degree burn greater than 30% of body surface
· Third degree burn of greater than 10% of body surface
· All electrical burns


Signs and symptoms of a respiratory burn
Burns sustained in a closed area often have associated respiratoryinvolvement.
· Productive cough
· Dyspnea
· Singed nasal hair
· Sooty sputum


BURN MORTALITY

Death from burns
Initial 24 hours:
· respiratory burn
· hypovolemic shockAfter 24 hours:
· infection
· kidney failure

FIELD MANAGEMENT OF BURN VICTIMS

Thermal burns
BLS procedures:
· Ensure scene safety
· Remove the patient from the source of the burn
· ABC’s
· High flow oxygen
· Assess for associated injuries
· Remove clothing and jewelry from burn sites
· Cool with sterile water
· Cover with dry sterile dressings or a clean sheet
· Prevent hypothermia· TransportALS procedures:
· Venous access (large bore)


Chemical burns
BLS procedures:
· Brush off dry chemical
· Flush with copious and continuous irrigation
· TransportALS procedures:
· Venous access (prn)

Electrical burns
BLS procedures:
· Ensure scene safety
· Remove the patient from the electrical source
· ABC’s· High flow oxygen· Assess and treat for associated injuries
· Moist sterile dressing to burn
· ALS to transportALS procedures:
· Venous access (prn)
· Cardiac monitor


Radiation burns
BLS procedures:
· Summon expert assistance
· Contain source of radiation if possible
· Have patient remove clothing
· Follow decontamination procedureALS Procedures:
· Venous access (prn)

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