Ch. 24-Burn Emergencies

1. Ch. 24-Burn Emergencies 1

2. 24.1 Assessment of Burns • Depth of the burn • Percentage of the body burned • Severity of the burn • Location of the burn • Accompanying complications (such as preexisting physical or mental conditions) • Age of the victim 2

3. Vocabulary • Superficial (first-degree)- a burn that involves only the epidermis, or outer layer of skin, characterized by pain and redness • Partial-thickness (second-degree)- a burn that involves both the epidermal and dermal layers of the skin, characterized by blistering, swelling, and pain • Full-thickness (third-degree)- a burn involving all layers of the skin as well as fat, muscle, and bone; a third-degree burn is characterized by dry, leathery, charred skin • Rule of Nines- A method of estimating how much body surface was burned by mentally dividing the body into regions, each representing 9 percent (or a multiple of 9 percent) of the body surface • Palmar surface method- A method of using the size of the victim’s palm to estimate the percentage of body surface that has been burned 3

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5. PROGRESS CHECK 1. In a superficial burn, the skin is ____________ and extremely painful. (mottled/reddened/moist) 2. A partial-thickness burn affects both the epidermal and dermal layers of skin and is characterized by ____________. (blistering/dryness/charring) 3. A full-thickness burn can extend to the bone and may cause the victim little or no pain because ____________. (the victim is in shock/the nerve endings are destroyed/the victim is usually unconscious) 4. You can quickly assess the amount of body surface involved by using the Rule of Nines, which divides the body into ____________. (regions that each represent 9 percent of the body surface/nine regions/nine areas most critical if burned) 5. The most serious burn in an adult is ____________. (a full-thickness burn covering 10 percent of the body/a partial-thickness burn covering 30 percent of the body/an electrical burn) 6. Burns on the face are considered especially serious because of possible ____________. (disfigurement/injury to the mouth/airway closure) 5

6. 24.2 Burn Management • Airway or respiratory difficulties • Toxic inhalation • Related musculoskeletal injuries • Loss of body fluids, contributing to shock • Pain, contributing to shock • Anxiety, contributing to shock • Swelling • Infection due to destruction of skin tissue 6

7. First Aid Care 1. Remove the victim from the source of the burn. 2. Eliminate the cause of the burn—put out the fire, wash away the chemicals, and so on. 3. Assess ABCDs, and manage respiratory and cardiac complications. 4. Activate the EMS system as soon as possible. 5. Continue to assess the victim’s vital signs until medical help arrives. 6. Stop the burning process by applying cool water to the burn. 7

8. PROGRESS CHECK 1. One of the most common types of burn is __________. (chemical/thermal/electrical) 2. The first priority in burn care is __________. (preventing further injury/removing the source of the burn/moving the victim away from the source of the burn) 3. You should always check for __________ complications immediately. (burn/shock/airway and respiratory) 4. If less than 10 percent of the body surface is burned, cover the burned area with __________. (ice packs/adherent gauze/wet sterile dressings) 8

9. 24.3 Inhalation Injuries Signs and Symptoms: • Facial burns • Singed nasal hairs • Burned specks of carbon in the saliva • A sooty or smoky smell on the breath • Respiratory distress, accompanied by: • Restriction of chest-wall movement • Restlessness • Chest tightness • Difficulty in swallowing • Hoarseness • Coughing • Cyanosis • Noisy breathing • Actual burns of the mucous membranes in the mouth or nose 9

10. Carbon Monoxide • Headache • Weakness • Nausea and/or vomiting • Loss of manual dexterity • Confusion, lethargy, irrational or reckless behavior 10

11. First Aid Care • Activate the EMS system immediately. • Remove the victim as far as possible from the source of the toxic fumes, especially if it is a fire; try to situate the victim in fresh air. • Clear the airway and provide artificial ventilation if breathing is absent or ineffective. • Place the victim in an upright position to allow for easier breathing unless injuries contraindicate it. • Remove any clothing that may restrict chest movement, including neckties and necklaces if they are not sticking to the skin. • If respiratory distress occurs, maintain an adequate airway. 11

12. PROGRESS CHECK 1. Suspect inhalation injury in any victim of thermal burn, especially if the victim was ____________. (in contact with chemicals/in an enclosed space/lying down when burned) 2. The most common cause of an upper airway burn is ____________. (smoke/heat/carbon monoxide) 3. The signs and symptoms of inhalation injury may be delayed because the ____________associated with it is progressive. (shock/swelling/infection) 4. Always assume respiratory injury if the __________ is burned.(face/chest/upper extremities) 5. Always assume that any burn victim who is ____________ is suffering from carbon monoxide poisoning. (in a confined space/burned on the face/unconscious) 12

13. Vocabulary • Inhalation injury- An injury caused by breathing in heat, toxic chemicals, smoke, or carbon monoxide • Carbon monoxide- An odorless, colorless, tasteless, poisonous gas resulting from incomplete combustion of anything containing carbon • Toxic- Poisonous • Thermal burn- A burn caused by flames • Contact burn- A burn caused by touching either a hot surface or a live electrical circuit • Arcing injury (flash burn)- An injury caused when an electrical current jumps from one surface to another; nearby skin is burned, but electricity does not actually pass through the skin 13

14. 24.4 Chemical Burns 1. Brush any dry powder off the skin, then flush the burned area vigorously in a steady stream of water; a shower or garden hose is ideal. 2. While flushing the burn area, remove the victim’s clothing, shoes, stockings, and jewelry. 3. If the victim is able, have him or her wash with soap and water, then rinse thoroughly, after you have finished irrigating the burn. 4. If any chemicals splash into the victim’s eyes, use a faucet or hose on low pressure to irrigate the eyes for at least 20 minutes; make sure contact lenses are removed. You can also use a pan, bucket, cup, or bottle; make sure to irrigate well underneath the lids. 5. When you have finished flushing, cover the burned area with a dry sterile dressing. 6. Activate the EMS system as soon as possible 14

15. 24.5 Electrical Burns Protecting Yourself and the Victim • Look for downed wires whenever a vehicle has struck a power pole. If it is dark, use a flashlight to inspect the poles and the surrounding area. • Never attempt to move downed wires! Notify the power company and request an emergency crew. • If a downed power line is lying across a wrecked vehicle, do not touch the vehicle, even if the victims inside are seriously injured. If you touch the vehicle, you will likely be electrocuted. If the victims in the car are conscious, warn them not to leave the vehicle. • If a victim is holding a power tool, look for cords; the tool does not have to be on to present an electrical hazard. • If a victim is in a pool, turn off all power at the main switch before entering the water. • If a victim is found in a bathtub with an electrical appliance that has energized the water, pull the plug of the appliance before you touch the victim. 15

16. Severity of Electrical Shock • Voltage and amperage of the current • Amount of time the victim was exposed to the shock • Amount of moisture on the victim • Amount of the victim’s body surface that is in contact with water • Amount of insulation worn by the victim • Area of the body through which the current passes • Type of current (AC or DC) 16

17. Signs and Symptoms of Electrocution • Dazed and confused condition • Obvious and severe burns on the skin surface • Unconsciousness • Weak, irregular, or absent pulse • Shallow, irregular, or absent breathing • Possibility of multiple severe fractures due to intense muscular contractions 17

18. First Aid Care for Electrical Shock 1. Activate the EMS system immediately. 2. Your first priority is to protect yourself. Do not approach the victim unless you can do so safely. 3. Check the victim’s breathing and pulse; immediately start CPR and apply the AED if available, even if you are unsure about the extent of injury. 4. If the victim fell or was thrown, treat for spinal injuries. 5. If the victim is conscious and his or her condition is not urgent, provide basic burn care for source and ground wounds and splint fractures. 6. Treat the victim for shock. 18

19. Lightning Injuries Lightning strike victims usually sustain injury to the following body systems: • The nervous system • The skin • The heart and the vascular system 19

20. First Aid Care of Lightning Injuries 1. Activate the EMS system immediately. 2. Survey the scene, assess what happened, and make sure the victim is safe from further injury. Remove debris that has fallen on the victim, and move the victim away from any source of electricity. 3. Assess breathing and pulse; if appropriate, begin artificial ventilation or CPR. Apply an AED if the victim is pulseless. The key to survival is early, vigorous, prolonged resuscitation efforts. Hold the head in a neutral position and bring the jaw forward gently in case of spinal injury. 4. Stabilize the victim’s neck to prevent aggravating a possible cervical spine injury. If possible, move the victim to dry ground after stabilizing the neck. 5. If the victim is conscious, check movement in all extremities; determine the victim’s reaction to pain. 6. While waiting for medical help to arrive, assess the victim for open wounds or fractures, and provide appropriate care. 20

21. PROGRESS CHECK 1. If a downed power line is lying across a vehicle, ____________. (have occupants of the car get out/use a wooden pole to move the line/do not touch the vehicle) 2. If a victim is found in the bathtub with an appliance that has energized the water, ____________. (unplug the appliance/drain the bathtub) 3. An arcing injury occurs when ____________. (an extremity is struck by lightning/a current enters the body/a current jumps from one surface to another) 4. Your first priority in treating an electrical shock victim is to__________. (remove the source of electricity/ protect yourself/get the victim away from the electrical source) 5. Always assume a victim of lightning strike has sustained ____________. (multiple injuries/cardiac arrest/internal burns) 6. Victims of lightning strike have a greater chance of resuscitation than victims of arrest from other causes because ____________. (the heart may restart on its own/body temperature is slightly elevated) 7. The goal of first aid for lightning victims is to ____________. (prevent further injury/oxygenate the heart and brain/ restore circulation) 21