Alexander ch35 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 35
Soft-Tissue Injuries
and Burns

• The Advanced EMT applies fundamental
knowledge to provide basic and selected
advanced emergency care and transportation
based on assessment findings for an acutely
injured patient.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Describe each of the following types of soft-tissue injury:
abrasions, amputations, avulsions, closed injury,
contusion, crush injury, hematoma, impaled body parts,
incisions and lacerations, open injury, and punctures.
3. Describe the pathophysiology and management of
complications of soft-tissue injuries and burns, including
the following: bleeding, blood and fluid loss, compartment
syndrome, toxic inhalation, and traumatic
rhabdomyolysis.
Objectives (1 of 5)

4. Engage in a process of clinical reasoning to effectively
prioritize the steps in management of patients with burns
and soft-tissue injuries.
5. Demonstrate effective methods of controlling bleeding,
and dressing and bandaging wounds and burns using a
variety of dressing and bandaging materials.
6. Describe considerations in retrieving, caring for, and
transporting amputated parts.
7. Discuss the epidemiology and significance of burns and
soft-tissue injuries.
Objectives (2 of 5)

8. Describe the structure and function of the skin.
9. Describe the consequences of damage to the skin.
10.Describe special considerations in the scene size-up when
responding to calls involving burned patients.
11.Describe the effects of burns on the circulatory,
respiratory, renal, nervous, and musculoskeletal systems.
12.Identify indications of inhalation injury in the burned
patient.
13.Describe procedures for stopping the burning process
when responding to a burned patient.
Objectives (3 of 5)

14.Given a description or picture of a burn, classify the burn
by depth and body surface area involved, for both adult
and pediatric patients.
15.Consider burn depth, location, body surface area
involved, the patient’s age, and any preexisting medical
conditions in determining the severity of burn injuries.
16.Discuss each of the following types of burns: chemical,
electrical, inhalation, radiation, and thermal.
17.Discuss each of the following mechanisms of burn
injuries: contact, electrical, flame, flash, gas, scald, and
steam.
Objectives (4 of 5)

18.Describe special considerations in responding to,
assessing, and managing patients with chemical and
electrical burns.
19.Demonstrate the ability to calculate proper volumes of
fluid to be infused into the burn patient using the
Parkland burn formula.
Objectives (5 of 5)

• Open soft-tissue injuries and burns compromise
body’s largest organ: the skin.
• Leave patients vulnerable to infection
• When large areas of skin are affected, patients
can lose large amounts of fluid, and
thermoregulatory mechanisms can be impaired.
• Serious burns affect the function of vital body
systems: respiratory, renal, cardiovascular.
Introduction (1 of 2)

• Soft-tissue injuries and burns are often isolated
injuries.
• Life-threatening complication of soft-tissue
injuries: hemorrhage
• Major burns are one of the most catastrophic and
painful soft-tissue injuries.
Introduction (2 of 2)

Think About It
• What does this mechanism of injury suggest?
• How should Wilson and Paige determine whether
the injuries from the motor vehicle crash (MVC) or
the burns are more critical?
• What additional information should they obtain
from the firefighters?

Figure 35-1
Cross section of the skin, showing its detailed anatomy.

Anatomy and Physiology Review (1 of 2)
• Skin is the largest organ of body.
– Regulates fluid balance
– Protects body from environment
– Provides sensory information from environment
– Assists with regulation of body temperature

Anatomy and Physiology Review (2 of 2)
• Epidermis
– Outermost layer
– Barrier between body and environment
• Dermis
– Blood vessels, oil and sweat glands, hair follicles,
sensory nerves
• Subcutaneous layer
– Innermost layer
– Fatty tissue; body temperature regulation

Soft-Tissue Injuries (1 of 32)
• Traumatic injury
– Skin becomes damaged.
▪ Underlying structures may be damaged as well.
– Classified as open or closed
– Always look beyond the obvious.

• General assessment and management
– Scene size-up, scene safety, MOI
– Determine number of patients; request resources.
– Violence results in soft-tissue injuries; look for
indications of violence.
– Obtain details from patient or bystanders.
– Do not let dramatic-appearing, yet non-life-threatening,
injury distract you.

(continued)
– Take Standard Precautions.
– Determine level of responsiveness.
– Evaluate airway, breathing, circulation.
– Control bleeding.
– Perform focused exam or rapid trauma exam.
– En route to hospital, obtain vital signs and medical
history, perform head-to-toe exam.

(continued)
– Closed soft-tissue injury
▪ Pain and tenderness at injury site
▪ Edema at injury site
▪ Discoloration of skin at injury site
▪ Evidence of internal bleeding
▪ Signs of hypoperfusion

(continued)
– Open soft-tissue injuries
▪ Break in integrity of skin
▪ Bleeding
▪ Edema
▪ Signs and symptoms of hypoperfusion

(continued)
– Reassess critical patients every 5 minutes, noncritical
patients every 15 minutes.
– Open and maintain airway; ensure adequate ventilation
and oxygenation.
– Control significant bleeding:
▪ Remove gross contamination and debris from open wounds.
▪ Cover open wounds with dressing and bandage.

Figure 35-2
Contusion of the lower abdomen. (© Edward T. Dickinson, MD)

• Closed soft-tissue injuries
– Skin intact
▪ Blunt trauma or crushing of tissues
– Contusion
▪ Black-and-blue discoloration (bruising)
▪ Rarely life threatening, but must consider organs beneath
– Hematoma
▪ Significant bleeding in tissues, resulting in edema
▪ Size directly related to amount of bleeding

• Closed soft-tissue injuries (continued)
– Crush injuries
▪ Result of considerable blunt forces that compress tissues
▪ Consider potential injury of underlying structures.
▪ May be opened or closed
▪ Can lead to traumatic rhabdomyolysis:
– The breakdown of skeletal muscle cells
– Can cause cardiac dysrhythmias and renal failure

Figure 35-3
Hematoma superior to the left eye. (© Dr. P. Marazzi/Photo Researchers, Inc.)

Figure 35-4
Crush injury to the hand. (© Edward T. Dickinson, MD)

• Closed soft-tissue injuries (continued)
– Compartment syndrome
▪ Edema of extremity reaches point at which nervous function
and circulation to remainder of extremity compromised as
result of being compressed
▪ Can lead to permanent damage to nerves and vessels.
▪ Apply cold packs and elevate to reduce edema.

• Open soft-tissue injuries
– Injury breaks integrity of skin; penetrating or blunt
trauma
– Risk for bleeding and infection
• Types of open soft-tissue injuries
– Abrasion
– Avulsion
– Amputation
– Puncture/penetration
– Lacerations

Figure 35-5
Abrasions to the face. (© Edward T. Dickinson, MD)

• Open soft-tissue injuries—abrasion
– Results from skin being removed from body as result of
friction
– Not considered life threatening
– If epidermis is removed in abrasion, nerve endings are
exposed, causing pain.
– Risk of infection

Figure 35-6
An avulsion injury that caused a degloving. (© Edward T. Dickinson, MD)

• Open soft-tissue injuries—avulsion
– Flap of skin (possibly underlying tissue) is partially
removed or completely torn away.
– In some cases, arteries are damaged, leading to life-
threatening blood loss.
– Avulsions that are the result of accidents involving
machinery often affect fingers, hands, arms.

Figure 35-7
A hand with three amputated fingers. (© Edward T. Dickinson, MD)

• Open soft-tissue injuries—amputation
– Body part severed from body
– Partial amputation:
▪ Body part not completely detached from body
– Ripping, crushing, cutting of tissues
– Can cause life-threatening hemorrhage
– Amputated part requires proper handling to preserve it
for possible surgical reattachment.

• Open soft-tissue injuries—amputation (continued)
– Take Standard Precautions; ensure that you have
managed all life threats.
– Perform gross decontamination of part; flush with
sterile water; brush debris away using gauze.
▪ Do not immerse part in any type of fluid; it may cause damage
to tissues.

• Open soft-tissue injuries—amputation (continued)
– Wrap amputated part with sterile dressings; follow your
protocol.
– Place amputated part in plastic bag or wrap with plastic
to preserve moisture.
– Place cold packs or ice.
▪ Do not place the part directly on ice because it can damage
tissues.
– Transport amputated body part with the patient.

Figure 35-8
Penetrating injury resulting from a gunshot wound. (© Edward T. Dickinson, MD)

• Open soft-tissue injuries—puncture and
penetration
– Puncture/penetration injury:
▪ Object forced into tissues of body
– Stepping on nail, stab wounds, animal bites, gunshot
wounds

penetration (continued)
– Bleeding can be minor or major.
– High risk for infection
– Animal bites:
▪ Infection from bacteria; exposure to diseases (rabies)
– Human bites:
▪ Exposure to diseases (hepatitis)

Figure 35-9
(A) (B)
(A) A knife impaled in the shoulder. (B) An X-ray of the same wound.
(© Edward T. Dickinson, MD)

penetration (continued)
– Impaled object
▪ Object penetrates skin and remains embedded in tissues
– Do not remove unless it prevents managing airway and
breathing.
– Leave object in place; stabilize for transport.
– Dress wound; apply dressings completely around
wound to prevent movement of object and additional
injury.

Figure 35-10
Lacerations to the face. (© Edward T. Dickinson, MD)

Figure 35-11
Open injury to the neck. (© Edward T. Dickinson, MD)

• Open soft-tissue injuries—laceration
– Open injuries to skin (underlying tissues) from cutting
of tissues
– Linear (incision)
▪ Cut in tissues in straight line (knife)
– Stellate
▪ Starlike laceration commonly from blunt trauma

• Open soft-tissue injuries—laceration (continued)
– Open neck injuries
▪ Can involve large vessels; bleeding can be immediately life
threatening.
▪ Bleeding can also result in hematomas and can jeopardize
airway and circulation.
▪ Air embolism from air entering large vessels

• Open soft-tissue injuries—laceration (continued)
– Immediately cover open injury with gloved hand; apply
occlusive dressing completely covering wound.
– Cover occlusive dressing with gauze.
– Control bleeding with gentle direct pressure.
– Monitor for problems with ABCs.

• Bleeding
– Uncontrolled bleeding can cause rapid deterioration of
patient and death.
– Significant bleeding threat to life; control in primary
assessment
– Two factors related to amount of bleeding:
▪ Size of vessel
▪ Pressure within vessel

Figure 35-12
Types of bleeding.

Figure 35-13
Applying direct pressure to a bleeding wound.

• Control bleeding
– Apply firm direct pressure.
▪ Compression that is applied directly to an injury
▪ Take Standard Precautions.
▪ Cover your fingertips or palm with dressings and apply steady
pressure to the origin of the bleeding.
– If you cannot control bleeding with direct pressure,
apply tourniquet.

• Bleeding (continued)
– For larger, gaping wounds, pack wounds with
dressings before applying direct pressure.
– If the dressing becomes soaked with blood, do not
remove; add clean dressing on top and continue
applying pressure.
– After bleeding controlled, apply pressure dressing.

Figure 35-14
A commercial tourniquet being applied.

– If life-threatening bleeding from extremity is not
controlled with direct pressure, apply tourniquet.
– Ensure tourniquet is at least 4 inches wide.
– Wrap tourniquet around extremity proximal to injury, as
close as possible without covering it.

– Tighten tourniquet until bleeding ceases.
– Secure tourniquet so that it does not loosen.
– Document time of application on piece of tape; attach
to tourniquet.
– Advise receiving facility of application of tourniquet.
– Hemostatic agents
▪ Substances that promote clotting of blood when applied to
bleeding injury
▪ Apply pressure dressing and bandage as usual.

– Bleeding from nose (epistaxis) caused by trauma,
hypertension, sinusitis, blood clotting disorders
– Can compromise patient’s airway
– Have patient sit in upright position, leaning slightly
forward, with head in neutral position.
– Provide direct pressure by pinching nostrils together;
hold with steady pressure.
– Apply cold packs during direct pressure.

• Dressings and bandages
– Dressing:
▪ Absorbent gauze; applied directly to open injury; should be
sterile
– Multitude of sizes and types
– Adhesive dressings:
▪ Self-adhering dressings used for dressing smaller open injuries

• Dressings and bandages (continued)
– Gauze pads:
▪ Layered fabric pads; variety of sizes
– Universal or trauma dressings:
▪ Similar to smaller gauze pads but thicker and larger
– After dressing is applied to injury, apply bandage to
hold dressing in place.
– Various sizes; sterile and nonsterile packaging

Figure 35-19
Triangular bandage used as a pressure bandage.

Figure 35-20
Inflatable air splint used as a bandage.

– Gauze rolls
– Triangular bandages
– Self-adhering bandages
– Air splints

– Goal
▪ Control bleeding; cover injury to prevent contamination.
– Remove clothing or jewelry that would prevent injury
from being covered.
– Cover entire injury with dressing.
– After bleeding is controlled, apply pressure dressing.

– Select appropriate bandage.
– Ensure distal circulation, motor function, sensation
present after application.
– Immobilize extremity in position of function.
– Monitor for recurrence of bleeding during transport.

Think About It
• What should be Wilson and Paige’s priorities,
given the available information?
• Are the patient’s burn injuries critical? Why or why
not?
• Does the information available suggest critical
traumatic injury? Why or why not?

Burns (1 of 34)
• Burn injury
– Skin damaged by thermal energy, radiation, caustic
chemical contact
• Zone of coagulation
– Thermal burn severe enough results in area of necrotic
tissue

Burns (2 of 34)
• Zone of stasis
– Blood flow is compromised; tissue may not become
necrotic if blood flow restored.
• Zone of hyperemia
– Outermost zone of burn injury; increase of circulation to
skin results in redness and edema

Burns (3 of 34)
• Effects of burns on the body—circulatory system
– Destruction of tissues; fluid loss
– Fluid loss causes edema.
– Edema increases pressure within tissues and reduces
circulation.
– Fluid leaving intravascular space causes decrease of
circulating blood volume, which can lead to shock.
– Do not let burns distract you so that you fail to
recognize potential for traumatic injury.

Burns (4 of 34)
• Effects of burns on the body—respiratory system
– Patient inhales hot air or chemicals, which causes
burns.
– Tissues of airway are burned; edema results; airway
narrows; fluid accumulates in lungs; singed nasal and
facial hair.
– Laryngeal edema: narrowing of airway in larynx
– May also inhale poisonous gases

Burns (5 of 34)
• Effects of burns on the body—respiratory system
(continued)
– If torso circumferentially burned, eschar may prevent
adequate expansion of chest, leading to respiratory
compromise.
– Signs and symptoms
▪ Singed nasal hair, carbonaceous sputum, hoarse voice, sore
throat, difficulty breathing

Burns (6 of 34)
• Effects of burns on the body—renal system
– If shock progresses, first vital organ system affected by
hypoperfusion is renal system.
– Damage can cause renal failure, which can cause
edema, anemia, metabolic acidosis, hyperkalemia,
difficulty breathing as result of congestive heart failure.

Burns (7 of 34)
• Effects of burns on the body—nervous system
– Motor, sensation, joint dysfunction
– Extensive physical and occupational therapy to regain
or preserve normal function

Burns (8 of 34)
• Sources of burns
– Exposure to heat source
– Inhalation of heated gases or noxious fumes
– Exposure to chemical agents
– Exposure to electrical sources
– Exposure to radiation sources

Burns (9 of 34)
• Sources of burns (continued)
– Flame
– Contact
– Scalds
– Steam
– Gas
– Electricity
– Flash
– Chemical

Burns (10 of 34)
• Classification of burn severity
– Determined by depth of tissue affected and amount of
body surface area (BSA) affected
– Severity affected by
▪ Initial exposure and injury and body’s inflammatory response
to them
– When decrease in circulation to injured tissue occurs
▪ Leads to progression of injury and increasing burn depth

Burns (11 of 34)
• Classification of burn severity (continued)
– Superficial (first degree)
– Partial thickness (second degree)
– Full thickness (third degree)
– Burns develop over time.

Table 35-3
Characteristics of Burn Injuries
Superficial (First
Degree)
Partial Thickness
(Second Degree)
Full Thickness
(Third Degree)
Mechanism Sun or minor flash Hot liquids, flash,
or thermal
Chemicals, thermal,
electricity
Skin color Red Mottled red White and waxy or
dark and charred
Skin surface Dry without blisters Moist/weeping
with blisters
Dry and leatherlike

Figure 35-21
A superficial (first-degree) burn. (© Edward T. Dickinson, MD)

Figure 35-22
A partial-thickness (second-degree) burn. (© Edward T. Dickinson, MD)

Burns (12 of 34)
– Superficial burns (first-degree)
▪ Involves only epidermis
▪ Reddening of skin
▪ Minor to no edema at burn site (sunburn)
▪ Minor to moderate pain
– Partial-thickness burns (second-degree)
▪ Involves epidermis and dermis
▪ Reddening of skin, blisters, edema, mottled appearance
▪ Severe pain

Figure 35-23
A full-thickness (third-degree) burn. (© Edward T. Dickinson, MD)

Burns (13 of 34)
– Full-thickness burns (third-degree burns)
▪ Involves all layers of skin; some cases muscle tissue
▪ Tissue dry and hard; leather-like appearance; white and waxy
or dark and charred in color.
▪ Burned tissue does not cause pain; nerves in affected tissue
destroyed
▪ Scarring may be severe even with skin grafting.

Figure 35-24
The rule of nines.

Burns (14 of 34)
– Rule of nines
▪ Used to determine amount of BSA affected by partial- or full-
thickness burns.
▪ Divides body into areas of either 9% or 18% of total BSA
– Rule of palm
▪ Alternative method of determining total BSA affected; uses size
of patient’s palm as approximate representation of 1% BSA
– Age and preexisting medical conditions
– Severity of burn injury classified as minor, moderate,
critical

Table 35-4
Classification of Burns by Severity: Adult
MINOR BURNS
• Full-thickness burns of < 2 percent, excluding face, hands, feet, genitalia, or respiratory tract
• Partial-thickness burns < 15 percent
• Superficial burns > 50 percent
MODERATE BURNS*
• Full-thickness burns of 2–10 percent, excluding face, hands, feet, genitalia, or respiratory tract
• Partial-thickness burns of 15–30 percent
• Superficial burns > 50 percent
CRITICAL BURNS
• All burns complicated by injuries to the respiratory tract and traumatic injury
• Partial- or full-thickness burns involving the face, hands, feet, genitalia, or respiratory tract
• Full-thickness burns > 10 percent
• Partial-thickness burns > 30 percent
• Circumferential burns
*All burns that are classified as moderate are considered critical in patients 55 years old or older.
Source: Limmer, D., and M. D. O’Keefe. 2016. Emergency Care. 13th ed. Upper Saddle River, NJ: Pearson
Education, p. 705.

Table 35-5
Classification of Burns by Severity: Children < 5
Years
MINOR BURNS
• Partial-thickness burns < 10 percent
MODERATE BURNS
• Partial-thickness burns 10–20 percent
CRITICAL BURNS
• Full-thickness burns of any extent or partial-thickness burns > 20 percent
Source: Limmer, D., and M. D. O’Keefe. 2016. Emergency Care. 13th ed. Upper Saddle River, NJ:
Pearson Education, p. 706.

Burns (15 of 34)
• Burn injury assessment
– Ensure that the scene is safe.
– Never enter space where fire, chemicals, or electricity
are cause of burn injury unless you have proper
training and equipment.
– Identify MOI; possibility of associated trauma.
– Immediately remove patient from burn source.
– Perform primary assessment.

Burns (16 of 34)
• Burn injury assessment (continued)
– Airway burns and smoke inhalation complicate care of
burn patient.
– Ensure open airway; look for evidence of inhalation
injury.
• What are the signs and symptoms of inhalation
injury?

Burns (17 of 34)
– If signs of inhalation injury present:
▪ Consider requesting ALS.
▪ Airway management is extremely difficult with inhalation burns.
▪ Ensure adequacy of breathing.
– Supplemental oxygen and positive pressure ventilation if needed
▪ Control any significant bleeding.

Burns (18 of 34)
– If critical, perform rapid trauma exam.
– Isolated injuries, perform focused exam, obtain
baseline vital signs, medical history.
• What are some questions you would ask to obtain
necessary details of injury?

Burns (19 of 34)
• Emergency management for burn injuries
– Assess and maintain airway, adequate ventilation.
– Inhalation injuries classified as
▪ Carbon monoxide poisoning
▪ Heat-inhalation injury
▪ Smoke-inhalation injury

Burns (20 of 34)
(continued)
– Carbon monoxide poisoning
▪ Air contains high amounts of carbon monoxide
▪ Colorless, tasteless, and odorless
▪ Binds with hemoglobin; when bound oxygen cannot bind with
hemoglobin causing hypoxia
– Treatment
▪ Remove patients
▪ Provide oxygen
▪ Transport

Table 35-6
Signs and Symptoms of Elevated
Carboxyhemoglobin Levels
Carboxyhemoglobin Level Signs and Symptoms
20 percent Throbbing headache, exertional shortness of breath
30 percent Headache, altered judgment, irritability, dizziness, altered vision
40–50 percent Major central nervous system dysfunction, including confusion,
collapse, exertional syncope
60–70 percent Convulsions, unconsciousness, apnea with prolonged exposure
80 percent Death with prolonged exposure
Source: The Merck Manual of Diagnosis and Therapy Online Medical Library.
www.MerckManuals.com/professional

Burns (21 of 34)
(continued)
– Heat-inhalation injury
▪ Person inhales heated gases; trapped in enclosed space that
is on fire
▪ Laryngeal edema results from burns in the larynx, narrowing
airway.
– Look for signs of possible heat-inhalation injury.
– Apply high-concentration oxygen by nonrebreather
mask; secure airway; provide rapid transport.

Burns (22 of 34)
(continued)
– Smoke-inhalation injuries
▪ Inhaling noxious chemicals that cause injury to alveoli
– No way for you to know what types of products are
burning in structure fire
– Burning plastics produce cyanide gas.
– Can produce signs and symptoms of injury up to two
days following exposure

Figure 35-25
Place dry sterile dressings between the toes.

Burns (23 of 34)
(continued)
– Thermal burn injuries
▪ Treat for shock.
▪ Stop burning process.
▪ Remove clothing and jewelry from burn area.
▪ Cover with dry sterile dressing or burn sheets.
▪ Do not force the eyes open to assess them.
– If burns are chemical, flush burns with water and dress the eyes.
▪ Transport to appropriate facility.
▪ Initiate fluid therapy using the Parkland burn formula.

Burns (24 of 34)
(continued)
– Thermal burn injuries (continued)
▪ Parkland burn formula
▪ Adults
– Lactated ringer’s 2–4 mL  kg (body weight)  % BSA burned
(partial and full- thickness burns)
▪ Children
– Lactated Ringer’s 3–4 mL  kg (body weight)  % BSA (partial
and full-thickness burns)

Burns (25 of 34)
(continued)
– Parkland formula:
▪ Identify amount of fluid patient with extensive burns should
receive within first 24 hours post injury.
▪ Once you figure the volume to be infused in 24 hours, divide
by 2 to identify the volume to be infused in the first 8 hours.
– Proper fluid resuscitation is vital to survival of patients
with extensive burn injuries.

Table 35-7
Burn Center Referral Criteria
• Inhalation injury
• Partial-thickness burn >10 percent BSA
• Full-thickness burn
• Burns of the hands, feet, face, genitalia, perineum, or major joints
• Electrical burns (including lightning strikes)
• Chemical burns
• Burns in patients with preexisting medical conditions
Source: American Burn Association. n.d. “Burn Center Referral Criteria.”
http://www.ameriburn.org/BurnCenterReferralCriteria.pdf

Burns (26 of 34)
• Specific burn injuries—chemical burns
– Burning process will continue as long as chemical in
contact with skin.
– Two mechanisms by which chemical burns occur:
▪ Coagulation necrosis
– Death of tissue caused by protein coagulation as result of
exposure to acid
▪ Liquefaction necrosis
– Denaturing of proteins; leads to “melting” of tissues

Burns (27 of 34)
• Specific burn injuries—chemical burns (continued)
– Stop burning process by removing chemical.
– Liquid chemicals
▪ Remove contaminated clothing, taking care not to spread
chemical.
▪ Flush with copious amounts of water, unless chemical reacts
to water.
– Dry chemicals
▪ Brush from skin.
▪ Flush with copious amounts of water, unless chemical reacts
to water.

Burns (28 of 34)
• Specific burn injuries—chemical burns (continued)
– When flushing chemicals from eyes:
▪ Place patient in supine position with head turned in direction of
injured eye to prevent chemicals from entering unaffected eye.
▪ Gently pour sterile water or saline into corner of affected eye
while holding it open.
▪ Continue to flush the eye until burning process has stopped or
you arrive at hospital.

Burns (29 of 34)
• Specific burn injuries—electrical burns
– Never attempt to access patient who is in contact with
electrical lines or within vehicle with power lines
contacting it.
▪ Call power company to disconnect electricity.
– Injury occurs as electricity enters body and travels
through tissues until it exits.

Burns (30 of 34)
• Specific burn injuries—electrical burns (continued)
– Locate contact burn and exit burn.
– Electrical current can cause severe damage to internal
organs, and respiratory arrest and cardiac
dysrhythmias.
– There is no way to determine extent of internal injuries;
assume worst; transport to burn center.

Burns (31 of 34)
– Burns from entrance and exit points caused by
electrical arc; reach temperatures of 2,500 degrees
Celsius.
– In some cases, you will see large areas of tissue
completely destroyed or detached.
• What are some questions to ask to obtain specific
details of the injury?

Burns (32 of 34)
– Manage airway, ensuring adequate ventilation,
oxygenation, circulation.
– Consider requesting ALS response.
– Cardiac dysrhythmia common complication of electrical
injury.
– Assess for entrance and exit wounds.
– Treat as you would thermal injury.

Burns (33 of 34)
• Specific burn injuries—radiation burns
– Ionizing radiation causes burn injuries by breaking
molecular bonds in cells of body.
– Look identical to thermal burns; cared for in same way

Burns (34 of 34)
• Specific burn injuries—radiation burns (continued)
– Develop very slowly over days
– Scene safety and personal protection
– You cannot be contaminated with radiation unless
patient contaminated with radioactive material.

Chapter Summary (1 of 3)
• Control of life-threatening bleeding one of the
most important skills you possess as Advanced
EMT.
• If you cannot control bleeding, patient will
deteriorate, increasing morbidity and mortality
rates.
• Even though fluid therapy often necessary,
initiation of intravenous access should never delay
transport.

• Obtain IV access en route to facility.
• Categorize burns by severity.
• Important not to allow yourself to become
distracted by gruesome injuries and patient’s
emotional distress when managing burn-injured
patient.
• Complete systematic approach to assessment
and management to reduce morbidity and
mortality associated with burn injury.

• Three most important aspects of managing burn
patients:
– Maintain patent airway.
– Identify traumatic injury in conjunction with burn and
treat traumatic injury first.
– Initiate fluid resuscitation using the Parkland burn
formula.

Alexander ch35 lecture

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