BURNIN’ FOR YOU         V. Bonales, M.D.          RMH - PCMDHumCo EMCC - Paramedic Coordinator
BURNSSkinTypes of BurnsTreatment of Burns
BURNS1.4 million people per year suffer a burn20 - 25% of serious burns - work related54 - 180K hospitalized, 5% dieAges 2...
SKIN
SKIN“IT RUBS THE LOTION ON ITS SKIN, OR ELSE IT GETS THE                  HOSE AGAIN...”
SKIN“IT RUBS THE LOTION ON ITS SKIN, OR ELSE IT GETS THE                  HOSE AGAIN...”
BURNSEpidermis  No blood vesselsDermis  Major functions of skinSubcutaneous Tissue  Insulation and shock  absorptionConnec...
BURNSEpidermis  No blood vesselsDermis  Major functions of skinSubcutaneous Tissue  Insulation and shock  absorptionConnec...
BURNSSkin Functions  Barrier  Water Balance  Temperature Regulation  Excretion  Other (i.e.,Vitamin D production)
BURNSSkin as Barrier  Protects against microbes and debrisSkin as Water Regulator  Stores water and lipids  Semi-impermeab...
BURNSSkin as Temperature Regulator  Blood vessels dilate or constrict to control heat  loss  Fat as a thermal insulator  S...
BURNSSkin as Excretory Organ  Salts and excess waterSkin as Sensory Organ  Heat, cold, pain, pressure, vibrationSkin as Ab...
BURNSSkin Layers  Thinnest 0.5mm    Eyelids  Thickest 4mm    Palms & soles
BURNSSkin Layers  Thinnest 0.5mm    Eyelids  Thickest 4mm    Palms & soles
BURN TYPES
BURN TYPESLISTEN, I’M VERY BADLY BURNED, SO IF YOU COULD JUST...                    YOU SHOT ME...!
BURN TYPESLISTEN, I’M VERY BADLY BURNED, SO IF YOU COULD JUST...                    YOU SHOT ME...!
BURNSSeverity related to rate of heat transfer from source to skin   Temperature of the heat source   Duration of contact ...
BURNSThermalElectricalChemicalLightRadiation
BURNSThermal Most common Fire, heat from fire Hot liquid, hot object (iron) Steam
BURNSThermal Scald   Liquid   (immersion, spill),   grease, steam Contact Fire (flash, flame)
BURNSElectrical (1000 deathsper year)  Power source  Voltage  Current
BURNSPower source  Electrical vs. LighteningVoltage (V = I (current) x R)  High (Power lines 100K)  Low (Household 110 - 2...
BURNSCurrent (Iamp = V/R)  Direct Current    Continuous flow of electrons  Alternating Current    Electron flow changes rhyt...
BURNSAC 3x more dangerous than DC DC high voltage causes single large contraction that “throws” victim AC causes tetanus w...
BURNS             Effect                         Current (milliamps)    Tingling perception                               ...
BURNSResistance  Varies on the water content of the tissue    Bone, fat, skin - poor    Blood vessels, muscles, nerves - g...
BURNSConducted ElectricalWeapons (CEWs)  Tasers  50,000V in 5 second  pulse (DC)  2.1 mAmps of current  Injuries due to  c...
BURNSConducted ElectricalWeapons (CEWs)  Tasers  50,000V in 5 second  pulse (DC)  2.1 mAmps of current  Injuries due to  c...
BURNSLightening  Kills more people (US) than hurricanes, volcanoes,  tornadoes and earthquakes combined  10 - 30% of light...
BURNS“Branches” measure 30 - 50mFactors: height, isolation, “pointiness”3 - 5% suffer “direct strike;” majority are energy...
BURNSChemical Acid Base Caustics
BURNSAcids  Coagulation necrosis limits penetrationBases  Liquefaction necrosis allows greater penetration and  injuryCaus...
BURNS2008 - Acids 27K, Bases 40K, other Caustics 71KLong term morbidity is scarringSeverity related to:   pH (acids 1.0 - ...
BURNSRadiation  Sunlight  Beta particles  (radioactive fallout)  X-rays
BURNSRadiation  Sunlight  Beta particles  (radioactive fallout)  X-rays
BURNSUnit is the Gray (Gy) = absorption of one joule ofenergy per kilogram of matterGy = Sievert (Sv) and Sv = 100 rems (R...
BURNSCXR = 100 mrem = 0.1 rem = 0.001 Sv = 0.001GyCT Head = 200 mrem = 0.2 rem = 0.002 Sv =0.002GyCT A&P = 1000 mrem = 1 r...
BURNSDose at 1000m atHiroshima = 4Gy50% death rate within3/4 mile of epicenterContinued lingeringeffects in subsequentgene...
BURNSDose at 1000m atHiroshima = 4Gy50% death rate within3/4 mile of epicenterContinued lingeringeffects in subsequentgene...
BURNS Acute radiation syndrome Clinical symptoms2-5Gy Hematopoietic syndrome - anemia, neutropenia5-12Gy Gastrointestinal ...
BURNSLethal doses Clinical symptoms3.5 Gy     Lethal without treatment at 60 days>7 Gy      Lethal with treatment at 60 da...
BURNS1st degree2nd degree3rd degree
BURNS1st degree2nd degree3rd degree
BURNS1st degree  Only epidermis  Skin red  Painful  Will heal on own
BURNS2nd degree (Partialthickness)  Epidermis & upper level of  dermis  Deep red  Very painful  Blisters & swelling  Gener...
BURNS3rd degree (Full thickness)  Burn down to SQ layer  Black/white skin  Pain +/-  Blisters +/-  Will need skin grafts t...
FULL THICKNESS BURN    HAND VS. ROAD FLARE
FULL THICKNESS BURN    HAND VS. ROAD FLARE
ABOUT BURNS
ABOUT BURNSHE’S MISTER HEAT BLISTER, HE’S MISTER 101...
ABOUT BURNSHE’S MISTER HEAT BLISTER, HE’S MISTER 101...
BURNSeverity Factors  Agent and Source  Depth  Body Region  Extent of body affected (BSA)  Age  Other medical conditions
BURNSAgent and Source  Chemicals    Left on skin continues to burn    Can be absorbed through the skin  Electric burns    ...
BURNSDepth Increased risk of infection Increased risk of fluid loss and shock Increased risk of hypothermia due to loss of ...
BURNSBody Region Face - risk of injury to eye or airway compromise Hands/Feet - risk of scarring can lead to decreased ran...
BURNSBody Surface Area  Rule of 9’s  Rule of Palm    1%
BURNSBody Surface Area  Rule of 9’s  Rule of Palm    1%
BURNSAge Extremities of age will do worse Healing time lengthened in the elderly
BURNSCo-existing medical conditions  Respiratory illness patients will do worse  Diabetics and heart patients will have a ...
BURNSA. Minor Burns                                                    C. Critical Burns1. Full-thickness burns involving ...
TREATING BURNS
TREATING BURNSI LOVE THE SMELL OF NAPALM IN THE MORNING...
TREATING BURNSI LOVE THE SMELL OF NAPALM IN THE MORNING...
BURNS1st rule of EMS: safety, safety, safety, scene safetyPatient is more than the burnReport agent and source of burn
BURNSDon’t Apply lotions, creams, sprays, or butter Apply ice Break blisters Clear debris
BURNSKeep burn site cleanTreat for shockKeep patient warm
BURNSScene safety  Don’t rescue from a fire unless trained to do so  Think of personal and equipment contamination  Make su...
BURNS1. Stop the burning process.                  7. Wrap burn in dry sterile dressings. If                              ...
BURNS1. Stop the burning.                      5. Apply a dry sterile dressing.a. Dry chemicals - brush off. Then wash   6...
BURNSChemical On-scene Get MSDS from company Bring chemical to E.D. in a safe container
BURNSChemical On-scene Get MSDS from company Bring chemical to E.D. in a safe container
BURNSElectrical Signs and symptoms       f. Elevated BP or hypotension                                    with symptoms of...
BURNSMake sure electricity source is turned off.Provide airway careProvide basic cardiac life support.Care for shock and a...
QUESTIONS...?
BURNSScene safetyPatient is more than the burnRemember to treat for shock and hypothermia
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THANK YOU...!Slideshare.net/docmonteyhcemsgroup.blogspot.comFacebook
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FCA 0712 Burns

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Redwood Memorial Hospital Field Care Audit for July 2012

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  • FCA 0712 Burns

    1. 1. BURNIN’ FOR YOU V. Bonales, M.D. RMH - PCMDHumCo EMCC - Paramedic Coordinator
    2. 2. BURNSSkinTypes of BurnsTreatment of Burns
    3. 3. BURNS1.4 million people per year suffer a burn20 - 25% of serious burns - work related54 - 180K hospitalized, 5% dieAges 20 - 29 highest incidence of severe burn followed bychildren <9 y.o.Best treatment is prevention (smoke detectors - 80%reduction in mortality; lowering water heatertemperature, teaching Stop, Drop, & Roll)
    4. 4. SKIN
    5. 5. SKIN“IT RUBS THE LOTION ON ITS SKIN, OR ELSE IT GETS THE HOSE AGAIN...”
    6. 6. SKIN“IT RUBS THE LOTION ON ITS SKIN, OR ELSE IT GETS THE HOSE AGAIN...”
    7. 7. BURNSEpidermis No blood vesselsDermis Major functions of skinSubcutaneous Tissue Insulation and shock absorptionConnective Tissue
    8. 8. BURNSEpidermis No blood vesselsDermis Major functions of skinSubcutaneous Tissue Insulation and shock absorptionConnective Tissue
    9. 9. BURNSSkin Functions Barrier Water Balance Temperature Regulation Excretion Other (i.e.,Vitamin D production)
    10. 10. BURNSSkin as Barrier Protects against microbes and debrisSkin as Water Regulator Stores water and lipids Semi-impermeable barrier
    11. 11. BURNSSkin as Temperature Regulator Blood vessels dilate or constrict to control heat loss Fat as a thermal insulator Sweat glands produce perspiration to help cool
    12. 12. BURNSSkin as Excretory Organ Salts and excess waterSkin as Sensory Organ Heat, cold, pain, pressure, vibrationSkin as Absorption Mechanism Semi-permeable allows for absorption of certain chemicals (i.e., drugs, O2, etc.)
    13. 13. BURNSSkin Layers Thinnest 0.5mm Eyelids Thickest 4mm Palms & soles
    14. 14. BURNSSkin Layers Thinnest 0.5mm Eyelids Thickest 4mm Palms & soles
    15. 15. BURN TYPES
    16. 16. BURN TYPESLISTEN, I’M VERY BADLY BURNED, SO IF YOU COULD JUST... YOU SHOT ME...!
    17. 17. BURN TYPESLISTEN, I’M VERY BADLY BURNED, SO IF YOU COULD JUST... YOU SHOT ME...!
    18. 18. BURNSSeverity related to rate of heat transfer from source to skin Temperature of the heat source Duration of contact Heat transfer Conduction (touch hot iron) Convection (steam, hot oil) Radiation Tissue Conductivity (skin poor conductor)
    19. 19. BURNSThermalElectricalChemicalLightRadiation
    20. 20. BURNSThermal Most common Fire, heat from fire Hot liquid, hot object (iron) Steam
    21. 21. BURNSThermal Scald Liquid (immersion, spill), grease, steam Contact Fire (flash, flame)
    22. 22. BURNSElectrical (1000 deathsper year) Power source Voltage Current
    23. 23. BURNSPower source Electrical vs. LighteningVoltage (V = I (current) x R) High (Power lines 100K) Low (Household 110 - 240V) Highest mortality/morbidity at “third rail” 600V
    24. 24. BURNSCurrent (Iamp = V/R) Direct Current Continuous flow of electrons Alternating Current Electron flow changes rhythmically
    25. 25. BURNSAC 3x more dangerous than DC DC high voltage causes single large contraction that “throws” victim AC causes tetanus which prolongs exposure
    26. 26. BURNS Effect Current (milliamps) Tingling perception 1-4 Let-go current – Children 3-4 Let-go current - Women 6-8 Let-go current – Men 7-9 Skeletal muscle tetany 16-20Respiratory muscle paralysis 20-50 Ventricular fibrillation 50-120 * 15 - 30mAmp common household circuit breaker
    27. 27. BURNSResistance Varies on the water content of the tissue Bone, fat, skin - poor Blood vessels, muscles, nerves - good Sweat or water on skin lowers resistance
    28. 28. BURNSConducted ElectricalWeapons (CEWs) Tasers 50,000V in 5 second pulse (DC) 2.1 mAmps of current Injuries due to concurrent trauma or intoxication
    29. 29. BURNSConducted ElectricalWeapons (CEWs) Tasers 50,000V in 5 second pulse (DC) 2.1 mAmps of current Injuries due to concurrent trauma or intoxication
    30. 30. BURNSLightening Kills more people (US) than hurricanes, volcanoes, tornadoes and earthquakes combined 10 - 30% of lightening strikes hit the ground (30 million times a year in US), most are cloud to cloud Don’t live in Florida, Atlantic coastline or Southeast coast of Gulf
    31. 31. BURNS“Branches” measure 30 - 50mFactors: height, isolation, “pointiness”3 - 5% suffer “direct strike;” majority are energy fromother object struck (ground, tree, etc.)A few people a year are “indoor victims” viatelephone lines
    32. 32. BURNSChemical Acid Base Caustics
    33. 33. BURNSAcids Coagulation necrosis limits penetrationBases Liquefaction necrosis allows greater penetration and injuryCaustics Other corrosive materials (bleach, peroxide, etc.)
    34. 34. BURNS2008 - Acids 27K, Bases 40K, other Caustics 71KLong term morbidity is scarringSeverity related to: pH (acids 1.0 - 7.4 (neutral) - bases 14.0) Concentration Length of contact time Volume Physical form (pellets vs liquid vs concentrated forms)
    35. 35. BURNSRadiation Sunlight Beta particles (radioactive fallout) X-rays
    36. 36. BURNSRadiation Sunlight Beta particles (radioactive fallout) X-rays
    37. 37. BURNSUnit is the Gray (Gy) = absorption of one joule ofenergy per kilogram of matterGy = Sievert (Sv) and Sv = 100 rems (Roentgenequivalent man)X-ray output measured in millirems 1/1000th rem
    38. 38. BURNSCXR = 100 mrem = 0.1 rem = 0.001 Sv = 0.001GyCT Head = 200 mrem = 0.2 rem = 0.002 Sv =0.002GyCT A&P = 1000 mrem = 1 rem = 0.01 Sv = 0.01 GyAtm = 58 mrem = 0.058 rem = 0.00058 Sv = 0.00058Gy per year (Cosmic and ground rays)
    39. 39. BURNSDose at 1000m atHiroshima = 4Gy50% death rate within3/4 mile of epicenterContinued lingeringeffects in subsequentgenerations
    40. 40. BURNSDose at 1000m atHiroshima = 4Gy50% death rate within3/4 mile of epicenterContinued lingeringeffects in subsequentgenerations
    41. 41. BURNS Acute radiation syndrome Clinical symptoms2-5Gy Hematopoietic syndrome - anemia, neutropenia5-12Gy Gastrointestinal syndrome - nausea, vomiting,dehydration, weight loss, anorexia, bloody diarrhea>30Gy Cerebrovascular syndrome - cerebral edema,ataxia, hypotension, convulsions
    42. 42. BURNSLethal doses Clinical symptoms3.5 Gy Lethal without treatment at 60 days>7 Gy Lethal with treatment at 60 days>100 Gy Lethal within hours
    43. 43. BURNS1st degree2nd degree3rd degree
    44. 44. BURNS1st degree2nd degree3rd degree
    45. 45. BURNS1st degree Only epidermis Skin red Painful Will heal on own
    46. 46. BURNS2nd degree (Partialthickness) Epidermis & upper level of dermis Deep red Very painful Blisters & swelling Generally will heal on own
    47. 47. BURNS3rd degree (Full thickness) Burn down to SQ layer Black/white skin Pain +/- Blisters +/- Will need skin grafts to heal
    48. 48. FULL THICKNESS BURN HAND VS. ROAD FLARE
    49. 49. FULL THICKNESS BURN HAND VS. ROAD FLARE
    50. 50. ABOUT BURNS
    51. 51. ABOUT BURNSHE’S MISTER HEAT BLISTER, HE’S MISTER 101...
    52. 52. ABOUT BURNSHE’S MISTER HEAT BLISTER, HE’S MISTER 101...
    53. 53. BURNSeverity Factors Agent and Source Depth Body Region Extent of body affected (BSA) Age Other medical conditions
    54. 54. BURNSAgent and Source Chemicals Left on skin continues to burn Can be absorbed through the skin Electric burns Small lesions on skin can hide deep internal injuries
    55. 55. BURNSDepth Increased risk of infection Increased risk of fluid loss and shock Increased risk of hypothermia due to loss of temperature regulation
    56. 56. BURNSBody Region Face - risk of injury to eye or airway compromise Hands/Feet - risk of scarring can lead to decreased range of motion Circumferential burns - risk of edema leading to vascular compromise Genitals - increased risk of bacterial contamination
    57. 57. BURNSBody Surface Area Rule of 9’s Rule of Palm 1%
    58. 58. BURNSBody Surface Area Rule of 9’s Rule of Palm 1%
    59. 59. BURNSAge Extremities of age will do worse Healing time lengthened in the elderly
    60. 60. BURNSCo-existing medical conditions Respiratory illness patients will do worse Diabetics and heart patients will have a harder time with the stress and have a more severe reaction
    61. 61. BURNSA. Minor Burns C. Critical Burns1. Full-thickness burns involving less than 2% of the body 1. All burns complicated by injuries of the respiratory track,surface, excluding face, hands, feet, genitalia, or respiratory other soft tissue injuries and injuries to bones.track. 2. Partial or full-thickness burns involving the face, hands,2. Partial-thickness burns that involve less than 15% of the genitalia or respiratory track.body surface. 3. Full-thickness burns involving more than 10% of the body3. Infants & children – any partial-thickness burn of < 10%. surface. 4. Partial-thickness burns involving more than 30% of the body surface.B. Moderate Burns 5. Burns complicated by painful, swollen, or deformed1. Full-thickness burns that involve 2% to 10% of the body extremitiessurface, excluding face, hands, feet, genitalia, or respiratorytrack. 6. Burns which by classification are moderate but appear in a person less than 5 y/o or greater than 55 y/o2. Partial-thickness burns that involve 15% to 30% of thebody surface. 7. Circumferential burns.3. Superficial burns that involve more than 50% of the body 8. Infants & children – any full or partial-thickness burn of >surface. 20%.4. Infants & children – any partial-thickness burn of10%-20%
    62. 62. TREATING BURNS
    63. 63. TREATING BURNSI LOVE THE SMELL OF NAPALM IN THE MORNING...
    64. 64. TREATING BURNSI LOVE THE SMELL OF NAPALM IN THE MORNING...
    65. 65. BURNS1st rule of EMS: safety, safety, safety, scene safetyPatient is more than the burnReport agent and source of burn
    66. 66. BURNSDon’t Apply lotions, creams, sprays, or butter Apply ice Break blisters Clear debris
    67. 67. BURNSKeep burn site cleanTreat for shockKeep patient warm
    68. 68. BURNSScene safety Don’t rescue from a fire unless trained to do so Think of personal and equipment contamination Make sure electricity is turned off before approaching patient
    69. 69. BURNS1. Stop the burning process. 7. Wrap burn in dry sterile dressings. If possible to not use gauze or other2. Ensure an open airway. Assess material that sheds.breathing. Look for airway injury: sootdeposits, burnt nasal hairs and facial 8. Burns to hands and/or feet:burns i. Remove rings and jewelry that may3. Complete initial assessment. constrict with swelling.4. Treat for shock. Provide high-flow ii. Separate digits with sterile gauzeoxygen. pads5. Evaluate burn - depth, extent, severity. 9. Burns to eyes:Determine priority. i. Do not open eyes6. Remove clothing and jewelry. ii. Apply moist sterile gauze pads to both eyes.
    70. 70. BURNS1. Stop the burning. 5. Apply a dry sterile dressing.a. Dry chemicals - brush off. Then wash 6. Treat for shock.area with copious amounts of water. 7. Chemical burns to eyesb. Wet chemicals - wash area with wateror saline for 20 minutes. Use copious a. Immediately flood both eyes withamount of water in a gentle flow. water. Hold eyes open. Flush from medial part of eye to lateral with2. Remove patients clothing to make affected eye lower than unaffectedsure none of the chemical is trapped in eye.the clothing. b. Wash for a minimum of 203. Do not contaminate skin that has not minutes.been in contact with the chemical. c. Cover both eyes with moist4. Wear protective clothing and eye dressings.protection.
    71. 71. BURNSChemical On-scene Get MSDS from company Bring chemical to E.D. in a safe container
    72. 72. BURNSChemical On-scene Get MSDS from company Bring chemical to E.D. in a safe container
    73. 73. BURNSElectrical Signs and symptoms f. Elevated BP or hypotension with symptoms of shocka. Entrance and exit burns g. Restlessness or irritability orb. Disrupted nerve pathways loss of consciousnessdisplayed as paralysis h.Visual difficultiesc. Muscle tenderness, with orwithout twitching i. Fractured bones and dislocationsd. Respiratory arrest or distress j. Seizures (severe cases)e. Irregular heartbeat or cardiacarrest
    74. 74. BURNSMake sure electricity source is turned off.Provide airway careProvide basic cardiac life support.Care for shock and administer high flow oxygenCare for spinal injuries, head injuries and severe fractures.Look for two external burns.Cool burn areas and smoldering clothing as with flameApply dry sterile dressing.
    75. 75. QUESTIONS...?
    76. 76. BURNSScene safetyPatient is more than the burnRemember to treat for shock and hypothermia
    77. 77. THANK YOU...!Slideshare.net/docmonteyhcemsgroup.blogspot.comFacebook
    78. 78. THANK YOU...!Slideshare.net/docmonteyhcemsgroup.blogspot.comFacebook

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