Soft Tissue Injuries Burns Chapter 12 Soft Tissue Injuries Burns

Burns 2 million/year (reported) ~ 12,000 die annually Almost 1 million require long term hospitalization Children under 6 YOA burnt most often (usually scald burns)

Classification & Evaluation of Burns Agent Source Thermal Flame, excessive heat from fire, steam, hot liquids, hot objects Chemical Acid, Alkaline Electricity AC/DC, lightning Radiation UV, nuclear Light Intense light source

Classification & Evaluation of Burns Degree 1st Degree (Superficial) Redness, pain, moist appearance to skin 2nd Degree (Partial Thickness) Severe pain, swelling, Blistering (within 48 hours) Redness (may appear mottled)

Classification & Evaluation of Burns Degree con’t. 3rd Degree (Full thickness) Difficult to distinguish from 2o Usually areas charred (maroon to black) or white Usually dry in appearance Usually no pain (except at periphery) May require skin grating Dense scarring Infection of major concern

Classification & Evaluation of Burns 1o 2o 3o

Classification & Evaluation of Burns Severity Agent & Source Degree Body Region Face, hands, feet, genitalia Circumferential burns Extent of Body Surface Area (BSA) Involved Rule of Palm Patient’s palm = ~1% of BSA

Percentage of Body Surface Area (BSA)

Classification & Evaluation of Burns Severity con’t. Age Predisposing Illness or Injury

Burns Minor Burns Moderate Burns 1o involving less than 20% of BSA 3o involving less than 2% BSA Excluding face, hands, feet, genitalia Moderate Burns 1o involving 20-75% BSA 2o involving 15-30% BSA 3o involving 2-10% BSA

Burns Critical Burns 1o involving more than 75% BSA 2o & 3o burns of the hands, feet, face or genitalia Circumferential burns All burns complicated by respiratory injuries, other soft tissue injuries, bone/joint injuries, other injuries or illness

Care for Thermal Burns Care Stop Burning Process, Cool Burn Ensure Airway, Complete Primary Assessment Treat for Shock, Do Not Clear Debris Cover With Dressing, Bandage Loosely Remove jewelry Separate digits, hand should be in position of function

Care for Burns Chemical Burns Flush area with copious amounts of water If dry chemical (brush away 1st then flush) Do Not allow victim to stand in water Flush affected area at least 20 minutes Apply sterile dressing or burn sheet Ensure airway Treat for shock

Smoke Inhalation Signs & Symptoms Respiratory Difficulty Coughing Smokey Smell or Odor of Chemicals on Breath Black Carbon Residue Singed Nasal or Facial Hair

Smoke Inhalation Care Remove from source Complete initial patient assessment Care for ABC’s Provide high flow oxygen if available Activate EMS

Electrical Burns Concerns Amount of deep tissue injury may be great Entrance wound usually small Exit wound may be extensive and deep Burn may be accompanied by cardiac arrest Violent muscular contractions possible Can result in avulsion fractures or dislocations

Electrical Burns Care Ensure your own safety Safety Zones Turn power off prior to contacting victim Complete initial assessment Care for ABC’s Be prepared to perform CPR Care for any open wounds Activate EMS

Lightning Burns ~ 1,000 injuries per year ~ 200 deaths per year Involves massive amounts of energy Up to 50 million volts Temperature up to 50,000oF

Lightning Related Deaths States where most injuries most frequently occur Florida North Carolina Texas Places where most injuries occur Open fields 27%; Under trees 17%; On or near water 12%; Near tractors/heavy equipment 6%; On golf courses 4%; At telephones 1%; Other 33%

Types of Lightning Injuries Direct Strike (most serious) Usually conducted through a metal object being held Flashover (less severe) Travels over surface of person (usually when wet) Side Flash Strikes object near person and “splashes” through the air to the person Stride Potential Strikes ground near person then travels up one leg and down the other

Lightning Injuries Characteristics Burns are usually superficial, feathery, branching appearance Usually no entrance or exit wounds May have thermal burn (if clothes burn) Blunt trauma possible (from falling) Neurological Problems Paralysis, convulsions, amnesia Cardiac arrest possible

Lightning Injuries - Care Move patient & self out of danger (lightning does strike in the same place twice) Prolonged resuscitation may be required Triage Normally with multiple victims if there is no spontaneous cardiac or respiratory activity - lowest priority However with lightning strike - high priority