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Ch. 24-Burn EmergenciesCh. 24-Burn Emergencies

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24.1 Assessment of Burns24.1 Assessment of Burns

Depth of the burnDepth of the burn Percentage of the body burnedPercentage of the body burned Severity of the burnSeverity of the burn Location of the burnLocation of the burn Accompanying complications (such as Accompanying complications (such as

preexisting physical or mental preexisting physical or mental conditions)conditions)

Age of the victimAge of the victim

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VocabularyVocabulary

Superficial (first-degree)-Superficial (first-degree)- a burn that involves only the a burn that involves only the epidermis, or outer layer of skin, characterized by pain and epidermis, or outer layer of skin, characterized by pain and redness redness

Partial-thickness (second-degree)-Partial-thickness (second-degree)- a burn that involves a burn that involves both the epidermal and dermal layers of the skin, both the epidermal and dermal layers of the skin, characterized by blistering, swelling, and paincharacterized by blistering, swelling, and pain

Full-thickness (third-degree)-Full-thickness (third-degree)- a burn involving all layers a burn involving all layers of the skin as well as fat, muscle, and bone; a third-degree of the skin as well as fat, muscle, and bone; a third-degree burn is characterized by dry, leathery, charred skinburn is characterized by dry, leathery, charred skin

Rule of Nines-Rule of Nines- A method of estimating how much body A method of estimating how much body surface was burned by mentally dividing the body into surface was burned by mentally dividing the body into regions, each representing 9 percent (or a multiple of 9 regions, each representing 9 percent (or a multiple of 9 percent) of the body surfacepercent) of the body surface

Palmar surface method-Palmar surface method- A method of using the A method of using the size of the victim’s palm to estimate the size of the victim’s palm to estimate the percentage of body surface that has been percentage of body surface that has been burnedburned

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PROGRESS CHECKPROGRESS CHECK

1. In a superficial burn, the skin is ____________ and extremely 1. In a superficial burn, the skin is ____________ and extremely painful. painful. (mottled/reddened/moist)(mottled/reddened/moist)

2. A partial-thickness burn affects both the epidermal and dermal 2. A partial-thickness burn affects both the epidermal and dermal layers of skin and is characterized by ____________. layers of skin and is characterized by ____________. (blistering/dryness/charring)(blistering/dryness/charring)

3. A full-thickness burn can extend to the bone and may cause the 3. A full-thickness burn can extend to the bone and may cause the victim little or no pain because ____________. victim little or no pain because ____________. (the victim is in (the victim is in shock/the nerve endings are destroyed/the victim is usually shock/the nerve endings are destroyed/the victim is usually unconscious)unconscious)

4. You can quickly assess the amount of body surface involved by 4. You can quickly assess the amount of body surface involved by using the Rule of Nines, which divides the body into ____________. using the Rule of Nines, which divides the body into ____________.

(regions that each represent 9 percent of the body surface/nine (regions that each represent 9 percent of the body surface/nine regions/nine areas most critical if burned)regions/nine areas most critical if burned)

5. The most serious burn in an adult is ____________. 5. The most serious burn in an adult is ____________. (a full-thickness (a full-thickness burn covering 10 percent of the body/a partial-thickness burn burn covering 10 percent of the body/a partial-thickness burn covering 30 percent of the body/an electrical burn)covering 30 percent of the body/an electrical burn)

6. Burns on the face are considered especially serious 6. Burns on the face are considered especially serious because of possible ____________. because of possible ____________. (disfigurement/injury to the mouth/airway (disfigurement/injury to the mouth/airway closure)closure)

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24.2 Burn Management24.2 Burn Management

Airway or respiratory difficultiesAirway or respiratory difficulties Toxic inhalationToxic inhalation Related musculoskeletal injuriesRelated musculoskeletal injuries Loss of body fluids, contributing to shockLoss of body fluids, contributing to shock Pain, contributing to shockPain, contributing to shock Anxiety, contributing to shockAnxiety, contributing to shock SwellingSwelling Infection due to destruction of skin tissueInfection due to destruction of skin tissue

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First Aid CareFirst Aid Care

1. Remove the victim from the source of the burn.1. Remove the victim from the source of the burn.

2. Eliminate the cause of the burn—put out the fire, 2. Eliminate the cause of the burn—put out the fire, wash away the chemicals, and so on. wash away the chemicals, and so on.

3. Assess ABCDs, and manage respiratory and cardiac 3. Assess ABCDs, and manage respiratory and cardiac complications. complications.

4. Activate the EMS system as soon as possible.4. Activate the EMS system as soon as possible.

5. Continue to assess the victim’s vital signs until 5. Continue to assess the victim’s vital signs until medical help arrives.medical help arrives.

6. Stop the burning process by applying cool water to 6. Stop the burning process by applying cool water to the burn. the burn.

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PROGRESS CHECKPROGRESS CHECK

1. One of the most common types of burn is __________. 1. One of the most common types of burn is __________. (chemical/thermal/electrical)(chemical/thermal/electrical)

2. The first priority in burn care is __________. 2. The first priority in burn care is __________. (preventing further injury/removing the source of the (preventing further injury/removing the source of the burn/moving the victim away from the source of the burn/moving the victim away from the source of the burn)burn)

3. You should always check for __________ 3. You should always check for __________ complications immediately. complications immediately. (burn/shock/airway and (burn/shock/airway and respiratory)respiratory)

4. If less than 10 percent of the body surface is burned, 4. If less than 10 percent of the body surface is burned, cover the burned area with __________. cover the burned area with __________. (ice (ice packs/adherent gauze/wet sterile dressings)packs/adherent gauze/wet sterile dressings)

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24.3 Inhalation Injuries24.3 Inhalation Injuries

Signs and Symptoms:Signs and Symptoms:

Facial burnsFacial burns Singed nasal hairsSinged nasal hairs Burned specks of carbon in the salivaBurned specks of carbon in the saliva A sooty or smoky smell on the breathA sooty or smoky smell on the breath Respiratory distress, accompanied by: Respiratory distress, accompanied by:

Restriction of chest-wall movementRestriction of chest-wall movement RestlessnessRestlessness Chest tightnessChest tightness Difficulty in swallowingDifficulty in swallowing HoarsenessHoarseness CoughingCoughing CyanosisCyanosis Noisy breathingNoisy breathing

Actual burns of the mucous membranes in the mouth or noseActual burns of the mucous membranes in the mouth or nose

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Carbon MonoxideCarbon Monoxide

HeadacheHeadache WeaknessWeakness Nausea and/or vomitingNausea and/or vomiting Loss of manual dexterityLoss of manual dexterity Confusion, lethargy, irrational or Confusion, lethargy, irrational or

reckless behaviorreckless behavior

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First Aid CareFirst Aid Care

1.1. Activate the EMS system immediately. Activate the EMS system immediately. 2.2. Remove the victim as far as possible from the Remove the victim as far as possible from the

source of the toxic fumes, especially if it is a fire; source of the toxic fumes, especially if it is a fire; try to situate the victim in fresh air. try to situate the victim in fresh air.

3.3. Clear the airway and provide artificial ventilation if Clear the airway and provide artificial ventilation if breathing is absent or ineffective. breathing is absent or ineffective.

4.4. Place the victim in an upright position to allow for Place the victim in an upright position to allow for easier breathing unless injuries contraindicate it. easier breathing unless injuries contraindicate it.

5.5. Remove any clothing that may restrict chest Remove any clothing that may restrict chest movement, including neckties and necklaces if movement, including neckties and necklaces if they are not sticking to the skin. they are not sticking to the skin.

6.6. If respiratory distress occurs, maintain an If respiratory distress occurs, maintain an adequate airway. adequate airway.

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PROGRESS CHECKPROGRESS CHECK

1. Suspect inhalation injury in any victim of thermal burn, 1. Suspect inhalation injury in any victim of thermal burn, especially if the victim was ____________. especially if the victim was ____________. (in contact with (in contact with chemicals/in an enclosed space/lying down when burned)chemicals/in an enclosed space/lying down when burned)

2. The most common cause of an upper airway burn is 2. The most common cause of an upper airway burn is ____________. ____________. (smoke/heat/carbon monoxide)(smoke/heat/carbon monoxide)

3. The signs and symptoms of inhalation injury may be 3. The signs and symptoms of inhalation injury may be delayed because the ____________associated with it is delayed because the ____________associated with it is progressive. progressive. (shock/swelling/infection)(shock/swelling/infection)

4. Always assume respiratory injury if the __________ is 4. Always assume respiratory injury if the __________ is burned.burned.(face/chest/upper extremities)(face/chest/upper extremities)

5. Always assume that any burn victim who is ____________ is 5. Always assume that any burn victim who is ____________ is suffering from carbon monoxide poisoning. suffering from carbon monoxide poisoning. (in a confined space/burned on (in a confined space/burned on the face/unconscious)the face/unconscious)

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VocabularyVocabulary

Inhalation injury-Inhalation injury- An injury caused by breathing in An injury caused by breathing in heat, toxic chemicals, smoke, or carbon monoxideheat, toxic chemicals, smoke, or carbon monoxide

Carbon monoxide-Carbon monoxide- An odorless, colorless, tasteless, An odorless, colorless, tasteless, poisonous gas resulting from incomplete combustion poisonous gas resulting from incomplete combustion of anything containing carbonof anything containing carbon

ToxicToxic- Poisonous- Poisonous Thermal burn- Thermal burn- A burn caused by flamesA burn caused by flames Contact burn- Contact burn- A burn caused by touching either a A burn caused by touching either a

hot surface or a live electrical circuithot surface or a live electrical circuit Arcing injury (flash burn)- Arcing injury (flash burn)- An injury caused when An injury caused when

an electrical current jumps from one surface to an electrical current jumps from one surface to another; nearby skin is burned, but another; nearby skin is burned, but electricity does not actually pass electricity does not actually pass through the skinthrough the skin

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24.4 Chemical Burns24.4 Chemical Burns

1. Brush any dry powder off the skin, then flush the burned 1. Brush any dry powder off the skin, then flush the burned area vigorously in a steady stream of water; a shower or area vigorously in a steady stream of water; a shower or garden hose is ideal. garden hose is ideal.

2. While flushing the burn area, remove the victim’s 2. While flushing the burn area, remove the victim’s clothing, shoes, stockings, and jewelry.clothing, shoes, stockings, and jewelry.

3. If the victim is able, have him or her wash with soap and 3. If the victim is able, have him or her wash with soap and water, then rinse thoroughly, after you have finished water, then rinse thoroughly, after you have finished irrigating the burn.irrigating the burn.

4. If any chemicals splash into the victim’s eyes, use a 4. If any chemicals splash into the victim’s eyes, use a faucet or hose on low pressure to irrigate the eyes for at faucet or hose on low pressure to irrigate the eyes for at least 20 minutes; make sure contact lenses are removed. least 20 minutes; make sure contact lenses are removed. You can also use a pan, bucket, cup, or bottle; make sure You can also use a pan, bucket, cup, or bottle; make sure to irrigate well underneath the lids.to irrigate well underneath the lids.

5. When you have finished flushing, cover the burned area 5. When you have finished flushing, cover the burned area with a dry sterile dressing.with a dry sterile dressing.

6. Activate the EMS system as soon as possible6. Activate the EMS system as soon as possible

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24.5 Electrical Burns24.5 Electrical Burns

Protecting Yourself and the VictimProtecting Yourself and the Victim

Look for downed wires whenever a vehicle has struck a power 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 pole. If it is dark, use a flashlight to inspect the poles and the surrounding area.surrounding area.

Never attempt to move downed wires! Never attempt to move downed wires! Notify the power Notify the power company and request an emergency crew.company and request an emergency crew.

If a downed power line is lying across a wrecked vehicle, If a downed power line is lying across a wrecked vehicle, do not do not touch the vehicle, touch the vehicle, even if the victims inside are seriously even if the victims inside are seriously injured. If you touch the vehicle, you will likely be electrocuted. injured. If you touch the vehicle, you will likely be electrocuted. If the victims in the car are conscious, warn them not to leave If the victims in the car are conscious, warn them not to leave the vehicle.the vehicle.

If a victim is holding a power tool, look for cords; the tool does If a victim is holding a power tool, look for cords; the tool does not have to be on to present an electrical hazard.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 If a victim is in a pool, turn off all power at the main switch before entering the water.before entering the water.

If a victim is found in a bathtub with an electrical appliance If a victim is found in a bathtub with an electrical appliance that has energized the water, that has energized the water, pull the plug of pull the plug of the appliance before you touch the victim.the appliance before you touch the victim.

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Severity of Electrical ShockSeverity of Electrical Shock

Voltage and amperage of the currentVoltage and amperage of the current Amount of time the victim was exposed to the shockAmount of time the victim was exposed to the shock Amount of moisture on the victimAmount of moisture on the victim Amount of the victim’s body surface that is in Amount of the victim’s body surface that is in

contact with watercontact with water Amount of insulation worn by the victimAmount of insulation worn by the victim Area of the body through which the current passesArea of the body through which the current passes Type of current (AC or DC)Type of current (AC or DC)

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Signs and Symptoms of Signs and Symptoms of ElectrocutionElectrocution

Dazed and confused conditionDazed and confused condition Obvious and severe burns on the skin surfaceObvious and severe burns on the skin surface UnconsciousnessUnconsciousness Weak, irregular, or absent pulseWeak, irregular, or absent pulse Shallow, irregular, or absent breathingShallow, irregular, or absent breathing Possibility of multiple severe fractures due to intense Possibility of multiple severe fractures due to intense

muscular contractions muscular contractions

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First Aid Care for Electrical ShockFirst Aid Care for Electrical Shock

1. Activate the EMS system immediately.1. Activate the EMS system immediately.2. Your first priority is to protect yourself. Do not 2. Your first priority is to protect yourself. Do not

approach the victim unless you can do so safely.approach the victim unless you can do so safely.3. Check the victim’s breathing and pulse; immediately 3. Check the victim’s breathing and pulse; immediately

start CPR and apply the AED if available, even if you start CPR and apply the AED if available, even if you are unsure about the extent of injury. are unsure about the extent of injury.

4. If the victim fell or was thrown, treat for spinal 4. If the victim fell or was thrown, treat for spinal injuries.injuries.

5. If the victim is conscious and his or her condition is 5. If the victim is conscious and his or her condition is not urgent, provide basic burn care for source and not urgent, provide basic burn care for source and ground wounds and splint fractures.ground wounds and splint fractures.

6. Treat the victim for shock.6. Treat the victim for shock.

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Lightning InjuriesLightning Injuries

Lightning strike victims usually sustain injury to Lightning strike victims usually sustain injury to the following body systems:the following body systems:

The nervous systemThe nervous system The skinThe skin The heart and the vascular systemThe heart and the vascular system

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First Aid Care of Lightning InjuriesFirst Aid Care of Lightning Injuries

1. Activate the EMS system immediately.1. Activate the EMS system immediately.2. Survey the scene, assess what happened, and make sure the 2. Survey the scene, assess what happened, and make sure the

victim is safe from further injury. Remove debris that has fallen victim is safe from further injury. Remove debris that has fallen on the victim, and move the victim away from any source of on the victim, and move the victim away from any source of electricity.electricity.

3. Assess breathing and pulse; if appropriate, begin artificial 3. Assess breathing and pulse; if appropriate, begin artificial ventilation or CPR. Apply an AED if the victim is pulseless. ventilation or CPR. Apply an AED if the victim is pulseless. The The key to survival is early, vigorous, prolonged resuscitation key to survival is early, vigorous, prolonged resuscitation efforts. efforts. Hold the head in a neutral position and bring the jaw Hold the head in a neutral position and bring the jaw forward gently in case of spinal injury.forward gently in case of spinal injury.

4. Stabilize the victim’s neck to prevent aggravating a possible 4. Stabilize the victim’s neck to prevent aggravating a possible cervical spine injury. If possible, move the victim to dry ground cervical spine injury. If possible, move the victim to dry ground after stabilizing the neck.after stabilizing the neck.

5. If the victim is conscious, check movement in all extremities; 5. If the victim is conscious, check movement in all extremities; determine the victim’s reaction to pain. determine the victim’s reaction to pain.

6. While waiting for medical help to arrive, assess the victim for 6. While waiting for medical help to arrive, assess the victim for open wounds or fractures, and provide appropriate care.open wounds or fractures, and provide appropriate care.

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PROGRESS CHECKPROGRESS CHECK

1. If a downed power line is lying across a vehicle, ____________. 1. If a downed power line is lying across a vehicle, ____________. (have occupants of the car get out/use a wooden pole to move (have occupants of the car get out/use a wooden pole to move the line/do not touch the vehicle)the line/do not touch the vehicle)

2. If a victim is found in the bathtub with an appliance that has 2. If a victim is found in the bathtub with an appliance that has energized the water, ____________. energized the water, ____________. (unplug the appliance/drain (unplug the appliance/drain the bathtub)the bathtub)

3. An arcing injury occurs when ____________. 3. An arcing injury occurs when ____________. (an extremity is (an extremity is struck by lightning/a current enters the body/a current jumps struck by lightning/a current enters the body/a current jumps from one surface to another)from one surface to another)

4. Your first priority in treating an electrical shock victim is 4. Your first priority in treating an electrical shock victim is to__________. to__________. (remove the source of electricity/ protect (remove the source of electricity/ protect yourself/get the victim away from the electrical source)yourself/get the victim away from the electrical source)

5. Always assume a victim of lightning strike has sustained 5. Always assume a victim of lightning strike has sustained ____________. ____________. (multiple injuries/cardiac arrest/internal burns)(multiple injuries/cardiac arrest/internal burns)

6. Victims of lightning strike have a greater chance of 6. Victims of lightning strike have a greater chance of resuscitation than victims of arrest from other causes because resuscitation than victims of arrest from other causes because ____________. ____________. (the heart may restart on its (the heart may restart on its own/body temperature is slightly elevated)own/body temperature is slightly elevated)

7. The goal of first aid for lightning victims is to ____________.7. The goal of first aid for lightning victims is to ____________.(prevent further injury/oxygenate the heart and brain/ restore (prevent further injury/oxygenate the heart and brain/ restore

circulation) circulation)