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Prehospital burns
The document discusses burn injuries and their treatment. It notes that burns are a major global public health problem, causing over 195,000 deaths per year from fires alone. Burn treatment requires a multidisciplinary approach across various stages of care from first responders to long-term rehabilitation. The key types of burns are thermal, chemical, and electrical, with first aid including stopping the burn, assessing airway/breathing/circulation, and seeking prompt medical attention. Inhalation injuries can also occur and carbon monoxide poisoning is a leading cause of fire-related deaths. Proper first aid and emergency care is essential for burn patients.
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Prehospital burns
- 1. Prehospital and Emergency RoomCare for Burns Teodoro J. Herbosa MD FPCS! Department of Emergency Medicine! Division of Trauma Dept of Surgery! Philippine General Hospital! University of the Philippines, Manila! Former Undersecretary DoH
- 2. BURN INJURIES: A SERIOUSPUBLIC HEALTH PROBLEM • Globally a serious public health problem • Devastating injury - 4th most common injury • >195,000 deaths yearly from fires alone • More deaths from scald, electrical burns, & other forms of burns • Global data are not available
- 3. • Fire-related deathsrank among the 15 leading causes of death - children & young adults 5-29 yrs ! • > 95% of fatal burns occur in low/middle- income countries ! • < 5 yrs and elderly (> 70 yrs) - highest mortality rates
- 4. • millions leftwith disabilities & disfigurement resulting in stigma • more tragic as burns are so eminently preventable
- 5. BURN TREATMENT The natureand complexity of severe burn injury requires a collaborative approach to patient care. This is provided by a multi-disciplinary team with expertise in the management of severe burns with supporting services such as: prehospital, emergency room, critical care, surgery, reconstruction and rehabilitation.
- 6. • Bringing togetherthe expertise required to coordinate clinical services across the continuum of care - from first responder, prehospital, initial hospital admission through to hospital discharge, rehabilitation and ongoing care. • Sharing clinical expertise • Developing standardized clinical practice guidelines for patient care • Increasing the focus on prevention, improving links to community outreach services for patients and undertaking research to improve patient care
- 7. A great numberof patients who had burn injuries were alive upon reaching the hospital
- 8. Most patients withburn injuries are treated and sent home while some are being admitted
- 9. Most burn patientsimproved after treatment.
- 10. PATHOGENESIS OF BURNINJURY (INITIAL AND DELAYED) KEY INSULTS Heat Induced Injury ! Inflammatory Mediator Injury ! Ischemia Induced Injury
- 11. Burns : resultsfrom dry heat, corrosive substances/friction! ! !! Scalds: caused by wet heat! ! General Principles:! first address your own safety! stop burning! cover injury! obtain medical aid
- 12. Classification of burns! !! ! thermal! !chemical! !electrical
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- 14. First Degree Burn Involvesthe epidermis! Redness, mild swelling! Tenderness, pain! E.g. mild sunburn! First aid! relieve pain! dec pain/infl! moisturizer
- 15. Second Degree Burn Dermisand epidermis! Blister formation, looks raw! Swelling ,severe pain! First aid! analgesic! hospital! cover! Topical antibiotic
- 16. Third Degree Burn Skin,fats, muscles! Leathery,waxy charred! No pain! Hospital! Cover ! Treat for shock
- 17. Extent of Burns Estimatingthe body surface ! Rule of palm! victims hand,it represents 1% ! for small of scattered burn! Large burn, unburned subtract to 100%
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- 19. Pointers: seek medicalattention ! Burns of face, hands, feet and genital are more severe! Circumferential burn! Age( < 5 y/o,>55 y/o)! Electrical injury! Child abuse is suspected! Surface of 2 degree >15% of BSA! 3rd burn
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- 21. Chemical burns: ! caustic orcorrosive substance! alkalis ( drain cleaners)! acids (battery acids)! organic compounds(petroleum products)! FirstAid:! flood flush with water > 20 min
- 22. remove contaminated clothing! steriledressing! hospital! chemical burn to eye flush with water
- 24. Electrocution Current of 1,000volts or > high voltage! Entrance and exit wound! Disrupt normal heart rhythm! FirstAid:! safety first! checkABC! Treat for shock! hospital
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- 27. ABC’s of LifeSupport Call an ambulance
- 28. Summary of FirstAid for Burns Stop the burning and cool area! CheckABC! Depth and extent! Determine other injuries! Burn severity! Seek medical attention
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- 30. CARBON MONOXIDE TOXICITY Carbonmonoxide toxicity - leading cause of death in fires While oxygen is being used during combustion, carbon monoxide is being released - it is a basic by-product of combustion. Carbon monoxide is rapidly transported across the alveolar membrane (lungs) and preferentially binds with the hemoglobin molecule (RBC) in place of oxygen.
- 31. CARBON MONOXIDE TOXICITY shiftsthe Hb-O2 curve to the left, impairing oxygen unloading at the tissues a major impairment in oxygen delivery, since 98% of oxygen is carried to the tissues on Hb prolonged exposure, CO can saturate the cell, binding to cytochrome oxidase, thereby further impairing mitochondrial function and adenosine triphosphate (ATP) production.
- 32. CARBON MONOXIDE TOXICITY SYMPTOMS: usuallynot present until carboxyhemoglobin > 15%. those of decreased tissue oxygenation, initial manifestations being neurologic due to the impairment in cerebral oxygenation. myocardial dysfunction can also develop, with evidence of myocardial ischemia or even infarction, especially with preexisting coronary artery disease.
- 33. CARBON MONOXIDE TOXICITY SYMPTOMS: neurologicdysfunction can lead to a progressive/permanent cerebral dysfunction. patient will awaken transiently after severe inhalation injury only to have progressive neurologic deterioration 24 to 48 hrs later. Cyanide toxicity - very similar to carbon monoxide, with severe metabolic acidosis and obtundation in severe cases. Diagnosis - more difficult because cyanide levels not readily available
- 34. EFFECTS OF CARBONMONOXIDE POISONING ALTERED JUDGMENT CONFUSION DISORIENTATION LETHARGY, STUPOR RESPIRATORY ARREST DEATH
- 35. Thank you verymuch Teodoro J. Herbosa M.D. Dept. of Emergency Medical Services Philippine General Hospital University of the Philippines, Manila ! twitter Teddybird fb Ted Herbosa