1. Chapter 19
Burns

2. 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

3. 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.

4. Topics Anatomy and Physiology Burn Sources Burn Classifications
Assessment
Management
Chapter Summary

5. 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.
Discussion Point:
What should you do?

6. 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
Discussion Points: What are some of the important functions?
Protection of underlying structures—organs
Protection from invading pathogens
Temperature regulation, prevention of fluid loss
Synthesis of vitamin D

7. Anatomy and Physiology
The anatomy of the skin.

8. Burn Sources Thermal Chemical Electrical
Heat comes directly into contact with skin
Chemical
Exposure to a caustic substance
Electrical
Contact with an electrical current
Discussion Points:
Thermal burns need temps greater that 46 C of 115 F. Common causes open flames, hot water or steam or superheated air
Chemical burns can occur with either acid or bases; depending on the pH of the substance. Strong acid has pH of 1, strong base has pH of 14.
Electrical burns: AC (alternating current) is more dangerous than DC (direct current)
continued

9. Burn Sources Radiation Exposure to a radiation emitting object
UV Light exposure
Discussion Points: Exposure can be either brief as in exposure to radiation (X-rays). 3 types of natural radiation: alpha, beta and gamma radiation. Gamma is the most dangerous and penetrates the skin the deepest.
Another source of radiation burn is from UV light. Be careful at higher altitudes with the less-dense atmosphere.

10. Burn Classifications Determined by depth of skin damage
Thickness-based
Superficial
Partial thickness
Full thickness
Degree-based
First
Second
Third
Fourth
Discussion Points: Both thickness-based and degree-based terminology is used emergency and burn medicine.
Superficial burn (first degree) mildest form
Partial thickness (second degree) affects both epidermis and dermis
Full thickness (third degree) is devastating that affects all layers of skin and can extend into underlying structures
Fourth degree burn the skin is blackened and includes muscle and bone.

11. Burn Classifications Copyright Charles Stewart M.D. and Associates
Copyright Edward Dickinson, M.D.
• A partial-thickness burn; note redness and blisters.
• A full-thickness burn.
• This full-thickness burn is an electrical burn.

12. 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.
Discussion Points: What is the first thing the patroller does for the burn patient?
How does the patroller determine the severity of the injury?
What other information should the patroller be documenting?

13. 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 method
Discussion Points:
Always look for changes indicating inhalation injury which could compromise airway including: obvious burns to face, head or neck; singed hair or eyebrows; soot around mouth/nostrils; hoarseness/voice changes; airway swelling
continued

14. 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
Discussion Points:
Where is the nearest burn center to your area?

15. Assessment
The Rule of Nines for estimating the proportion of the body surface affected by burns.

16. Assessment
The criteria for designating burns as critical.

17. 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 water
Discussion Points:
Remember that safety of the rescuer is of top importance. DO NOT go into a situation where you could be burned as well!
continued

18. Management continued • Emergency supplies needed to care for burns.
• The first goal of initial burn care is to stop the burning process.
• Extinguish any burning or smoldering clothes before removing them.
continued

19. 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

20. 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

21. 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.
Discussion Points:
What are some of the transport considerations if the entire body is burned?

22. 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
Discussion Points:
Be sure to remove jewelry near the affected area.

23. 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 #:
Discussion Points:
Neutralizing a chemical burn may cause a thermal reaction worsening the injury.

24. 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.
• Flush chemical substances from the eyes.
• After flushing, apply sterile gauze pads to both eyes.

25. 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
Discussion Points:
Remember that patients injured by electricity are worse off than they present. Many of the injuries are beneath the surface. Very important to take vitals frequently.

26. 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).
Electricity passing through an individual may cause a variety of injuries in addition to entrance and exit burns.

27. 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.
Discussion Points:
DO NOT enter an area where patient has been contaminated by radioactive material—need special protective gear

28. Case Disposition What are the patroller’s findings?
What treatment and transportation choices were made?

29. 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.
Discussion Points: What kinds of burns might we encounter?
What should be the first priority in burn situations?
How do we assess burns?
What are common steps in treating burns?
What are some of the specific treatments for specific burns?
continued

30. 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.
Always be aware of any changes that would indicate a compromised airway
continued

31. 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

32. Chapter Summary
Transport burn patients to a burn center or trauma center, whenever possible.