1. Soft Tissue Injuries Burns
Chapter 12
Soft Tissue Injuries
Burns

2. 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)

3. 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

4. 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)

5. 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

6. Classification & Evaluation of Burns
1o 2o 3o

7. 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

8. Percentage of Body Surface Area (BSA)

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

10. 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

11. 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

12. 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

13. 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

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

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

16. 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

17. 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

18. 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

19. 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%

20. 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

21. 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

22. 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