Burns

Question 1

Skin provides func crucial to human survival: maintains body temp, barrier to evaporative loss, participates metabolic activity by vit D production, first line against for preventing microbes from entering the body, protects against environment - allows us to feel sensation touch, pressure, pain and makes us stop, skin is the first line of dense
Epidermis: protective outer layer; first layer of skin
Dermis: 2nd layer; most of the inner workings of the skin; sweat, sebacous gland, hair follicles, nerves, caps, sensory fibers that detect pain, touch and temp
Hypodermis: 3rd layer; contains fat, smooth muscle; acts as heat insulator, shock absorber and nutrient deposit

Answer 1

Anatomy of the skin

Question 2

Can vary in way present
Major probs: fluid volume issues
Intravascular fluid volume deficit due to loss of fluids from the intravascular space to the extravascular space results in

Answer 2

Patho of a burn

Question 3

Increased blood viscosity
Increased afterload
Decreased peripheral and capillary flow
Multiple organ systems are affected

Answer 3

Intravascular fluid volume deficit due to loss of fluids from the intravascular space to the extravascular space results in

Question 4

Affected
If most fluid is not in with components of blood, what remains in arteries and veins: concentrated; blood viscosity increases - goes to syrup like
When does: very hard for heart to overcome extra weight of the increased viscosity of the blood to open the aortic valve to get it out

Answer 4

Increased blood viscosity

Question 5

Creating more resistance of the heart pumping = afterload

Answer 5

Increased afterload

Question 6

Affected
Too thick to get into little spaces
O2 exchange and ventilation in alveoli - affected by sludgy blood

Answer 6

Decreased peripheral and capillary flow

Question 7

Severe burn injuries: induces unique complex response: releases stress hormones, pro-inflammatory mediators, immediate response puts pt in hypometabolic state - lasts 3-4 days then goes back to normal state - stress mediators (catecolemines/glucocorticoids/cytokines) - released into sys causing lots of systemic responses
Interplay between all organs - all things going on - stress reaction or trying to compensate for it - all actions accumulate and lead to metabolic and inflammatory overdrive that causes white adipose tissue to brown adipose tissue which releases energy and induces liposis which affects the liver which causes it to fail and not allow it to metabolize the accumulating substances and develops hematomeglia; in turn hyperlipidemia and hyperglycemia - become insulin resistent - worsens hypermetabolic drive and inflammatory response
If do not get whole pathologic process addressed - pt will go from multiple organ dysfunc to multiple organ failure which leads to death - CNS sys not forgiving; heart gives out - if not addressed and not stop natural pathologic processes - pt will die
CV
Renal
Pulmonary
GI
Immunological

Answer 7

Multiple organ systems are affected

Question 8

heart goes into hyperdynamic overdrive increasing circulation and blood flow
Increasing oxygenation and deliver nutrients to damaged areas
Increased stress esp from catecolemines causes change in organ func and metabolic demands
Protein degraded into deliverable energy for hepatic func

Answer 8

CV

Question 9

Hypoperfused
O2 delivery decreased
Leads to AKI and stress signals from kidneys

Answer 9

Renal

Question 10

Develops mucosal atrophy to absorb nutrients but also by doing so enables bacteria to be translocated: increased risk of infection

Answer 10

GI

Question 11

Immediately after injury, the burn wound can be divided into three zones: - diff from staging of wound - determine what areas salvageable and what areas will die off based on the damage
Zone of coagulation:
Zone of stasis or zone of ischemia:
Zone of hyperemia:

Answer 11

Zones of injury

Question 12

Is the central portion with the most damage. Because it’s usually the site of greatest heat transfer happens, leading to irreversible skin death - area more browny, red; high likelihood of getting tissue back is low; zone where know irreversible skin death

Answer 12

Zone of coagulation:

Question 13

Characterized by decreased perfusion (why white - more pale color because not perfused by blood) that is potentially salvageable; white colored; is salvageable if can manage edema and promote perfusion to this zone - will heal

Answer 13

Zone of stasis or zone of ischemia:

Question 14

The outermost region of the wound characterized by increased inflammatory vasodilation. Pinky part; most inflammatory response and vasodilation - why pinker/redder

Answer 14

Zone of hyperemia:

Question 15

All burns cause tissue destruction due to energy transfer - diff causes associated with diff physiologic and pathophysiologic responses
Thermal
Chemical
Radiation
Electrical
Difficult to assess the full extent of the injury
Lightning has both the properties of an AC and DC signal.

Answer 15

Several Causes of burns can be exposure from:

Question 16

Hot flame/hot grease - immediate deep burn
Steam - disappear and wound more superficial because disappears in the air
Steam, scalds, contact with heat, or fire

Answer 16

Thermal

Question 17

Acidic agents: Cause coagulation necrosis; come in and look dry
Alkali agents: Cause colliquative necrosis - tissue transformed into liquid, viscous mass; tissue looks wet - like vaseline with tissue in it

Answer 17

Chemical

Question 18

Depends on source
Unique: do not appear immediately - can be days/months/years
Depends on source, amount of radiation
Exposure to industrial equipment, equipment used for medical treatment
Can have strange radiation
Have radiation therapy from cancer
Multiple x-rays - long interventional radiology/cardiology procedure - images throughout whole procedure
Radiation burn and see on back/chest

Answer 18

Radiation

Question 19

Most big enough where have entry and exit
Takes path of least resistance - may go from hand to feet
Entirely diff - deep tissue damage that is greater than see on visible skin - more damage under skin that do not see
Tissue damage correlated with the electrical field stream and resistance of the tissue
Direct Current (DC):
Alternating current (AC):

Answer 19

Electrical

Question 20

Everything that runs off a battery, plugs in to the wall with an AC adapter, or uses a USB cable for power relies on DC
DC causes a single convulsion or contraction, usually propelling the person away from the electrical source - thrown away
Exposure to electrical current - not very long

Answer 20

Direct Current (DC):

Question 21

AC is used to deliver power to delivered to houses, office buildings - lines coming in
Causes tense up and Maintain contract with the source until the source is cut off
May present with only superficial burns, but many devastating injuries if there is prolonged contact or muscle tetany.
cardiac or respiratory arrest; vfib; seizures - see any involuntary muscle movements
Can also have highly destructive thermal burns - huge heat source rather than electrical source

Answer 21

Alternating current (AC):

Question 22

Skin may be intact except for entry and exit wounds (always present - electrical current takes the most direct path and takes everything it goes through), but the current path damages underlying tissue (fat, muscle, nerves), vasculature, muscle, and organs - be in surveillance for those types of injuries
Severe acid-base imbalances
Aware of muscle break down: Rhabdomyolysis (releases myoglobin into vasculature which is then kidneys trying get rid of causing this) → myoglobinuria → AKI: look at urine color (brown-tinged) and if output is affected
All underlying soft tissue damage can cause edema - assessing pt - assess for compartment - underlying structures compromised

Answer 22

Difficult to assess the full extent of the injury

Question 23

It has polarity and always travels in a single direction (DC). However, the voltage of lightning is not constant, it has variable amplitude.

Answer 23

Lightning has both the properties of an AC and DC signal.

Question 24

In addition to determine cause; determine depth and size
1st degree burns:
2nd degree burns
A full-thickness (third-degree) burn
Fourth-degree burn
Superficial thickness (first degree)
Partial or intermediate thickness (second degree)
Full thickness (third degree)
Fourth degree

Answer 24

Depth of injury

Question 25

Does not vary too much when present Redden skin Dry Typ not as swollen Burns that affect the uppermost layer of the skin (epidermis only) are classed as superficial (first-degree) burns; the skin becomes red/pink and the pain experienced is limited in duration. Painful Common causes include sunburns and minor steam burns

Answer 25

1st degree burns:

Question 26

Vary in way present: blisters - ready to pop; more than red - blisters popped - look wet - serosangenous fluid from fluid shift; whitened area on skin 2 categories Where nice and pink Result of extended contact with liquids/solids or intense radiation injury; longer exposures to heat source Superficial partial-thickness burns involves Deep partial-thickness

Answer 26

2nd degree burns

Question 27

all the epidermis and part of the underlying dermis. Appearance: light to bright red or mottled appearance; may appear wet and weeping, may contain bullae/blisters, are extremely painful and sensitive to air currents. These burns blanch painfully - push on them go to white and then color returns painfully Common Causes include brief contact with flames, hot liquid, or exposure to dilute chemicals Microvessels injured resulting in leaking of plasma into the interstitial space - causes the blisters; despite loss entire basal layer - burn takes longer than 1st degree to heal Heal: 7-21 days Some minimal scarring Gen do not require surgery to fix

Answer 27

Superficial partial-thickness burns involves

Question 28

Deeper in tissue involves the entire epidermal layer and deeper layers of the dermis - throughout whole dermis Appearance: red with patchy white areas that blanch with pressure. The appearance of the deep-dermal wound changes over time. Dermal necrosis and surface coagulated protein turn the wound from white to yellow. - not lot plasma leaking; no blisters; change in appearance with time as body tries to heal: go from white to yellow Long time to heal Can heal with no intervention at all - to do so need adequate perfusion to the site and must make sure not get infected - if either happens - lose perfusion to area/infection - can turn second degree burn to third degree because of depth of damage Do require surgery and skin grafting May require a skin substitute or surgical excision and grafting for wound closure. Partial-thickness injuries can become full-thickness injuries if they become infected, if blood supply is diminished, or if further trauma occurs to the site. The treatment of choice is surgical excision and skin grafting.

Answer 28

Deep partial-thickness

Question 29

Usually see third degree, second degree, sometimes first degree Depending on source: open flame - see consequence of that - charred skin, smoky residue until cleaned up Looks wet; deeper See just adipose layer of dermis layer involves the destruction of all the layers of the skin down (epidermis, dermis, subdermis, subQ tissue, hair follicle, sweat glands, adipose tissue, nerve endings, pressure sensation cells - all gone) to and including the subcutaneous fat and is poorly vascularized. Full-thickness burns usually are painless and insensitive to palpation/pain. Most not have 3rd degree - most on edge of this is 2nd degree that is very painful Because all the epithelial elements are destroyed, the wound does not heal by re-epithelialization. - cannot heal; does not have any mechanism to heal A full-thickness burn appears pale white or charred, red or brown, and leathery. The surface of the burn may be dry, and if the skin is broken, fat may be exposed. - does not look like healthy tissue Skin does break - see underlying adipose tissue that does look wet Wound closure for larger ones - surgery - skin grafting Smaller - close on own Full-thickness wounds require skin grafting for closure. These patients are at VERY high risk for infections, fluid and electrolyte imbalances, alterations in thermoregulation, and metabolic disturbances. Very ill Require a lot of treatment

Answer 29

A full-thickness (third-degree) burn

Question 30

Get into deeper tissue Burn affects bone and muscle involves injury to deeper tissues, such as muscle or bone, is often blackened, and frequently leads to loss of the burned part.

Answer 30

Fourth-degree burn

Question 31

Painful Does not blister Does not scar

Answer 31

Superficial thickness (first degree)

Question 32

Superficial partial thickness burns do not require surgery but may scar and be more painful Deep partial thickness burns require surgery and form more scars and are less painful Blisters and weeps With increasing depth, increased risk of infection and scarring

Answer 32

Partial or intermediate thickness (second degree)

Question 33

Dry Insensate to light touch and pin prick Small areas will heal with substantial scar or contracture Large areas require skin grafting High risk of infection

Answer 33

Full thickness (third degree)

Question 34

Involves muscle or bone Leads to loss of of the burned part

Answer 34

Fourth degree

Question 35

Sev diff to estimate total burn surface area - one most commonly used - rule of 9s Anterior chest - 18%; posterior chest - 18% - divided = 9% = whole torso if ant and post = 36%; whole arm = 9% - if divided in half 4.5% - front of the forearm,etc is 2.25%; legs 18% each - divide as each - 9% for whole anterior and posterior - if just one 4.5% Helps determine fluid resuscitation The extent of the burn is the percent of TBSA burned. Fluid resuscitation for patients with full and partial-thickness burns is calculated from the percent of TBSA burned The most common methods are the Rule of Nines and the Lund and Browder Chart The Rule of Nines divides the TBSA into areas comprising 9% or multiples of 9% except for the perineum which is equal to 1% This is strictly an estimate and most useful for adults and children > 10 yrs To measure the extent of irregular burns, the percentage of burned surface can be estimated by considering the palm of the pts hand = 1% of the total body surface and then estimating the TBSA burned in reference to the palm - roughly size of hand = 1%

Answer 35

Size of injury

Question 36

Can occur in presence/absence of cutaneous injuries Imp rule these out - high mortality with these 3 diff types Carbon monoxide poisoning Upper airway injury: lower airway injury:

Answer 36

Inhalation injury

Question 37

Deadly Colorless, odorless, tasteless gas Come from fires; from household appliances Dangerous: occupies one of the four oxygen receptor sites on the RBC - if one of our four sites from carbon monoxide - oxygen carrying capacity reduced- causing hypoxemia/hypoxia Shortage of oxygen in tissue level worsened: because now each RBC not have 4 because has 3 - tissue perfusion drastically reduced Clinical manifestations Vague sx Early signs: Headache, dizziness, nausea, vomiting, dyspnea, tachycardia (try compensate for lower O2 on RBC), tachypnea, confusion, and lightheadedness - end organ perfusion type sx - not perfused Severe cases/long exposures: myocardial ischemia - cardiac dysfunctions, CNS comps - reduced oxygen/hypoxemia As carbon monoxide levels rise - go from vague sx to completely unresponsive and complete pulm failure and die Later signs (higher carbon monoxide levels): Decreased end-organ perfusion. Heart: myocardial ischemia & cardiac dysfunction. CNS: decreased LOC, unconsciousness, coma, unresponsiveness. Respiratory: respiratory failure Treatment: High-flow oxygen administered at 100% through a tight-fitting nonrebreathing mask (noncompliant/cannot or upper airway injury then intubate) or endotracheal intubation (high flow oxygen this way)

Answer 37

Carbon monoxide poisoning

Question 38

Burns to upper respiratory tract Burns (injuries from heat or chemicals) of the upper respiratory tract include burns involving the pharynx, larynx, glottis, trachea, and larger bronchi Can also have necrosis - typ from chemicals Can get blisters in upper airway; classic burns, blisters, sloughing tissue - all affects upper airway and ability to get O2 into lungs Usually confined here Heat damage - severe enough to cause this at any time Imp be vigilant Initial assessment: Assessment: Extent of injury to the face and neck, assess for presence of blisters on or redness of the posterior pharynx, signs of singed nasal hair - breathing in hot air, draw blood and look for increased HbCO (oxyhemoglobin) levels, increased rate and decreased depth of breathing - quality of breathing, talk: hoarseness (not normal - epiglottis starting to get obstructed because of edema) and stridor (lose diameter at bronchus level - if bronchial tube constricted - air not getting in and out effectively), increased amount of sputum (look for black specks to see if trapped in there), and circumstances of the burn event Frequent airway assessment during the hospital stay is essential in this population as Supraglottic edema may be delayed until fluid resuscitation begins and third spacing occurs. - may not be enough circulating volume to produce edema - may present ok then after 4-18 hrs after fluid resuscitation - face swollen and pharynx closed to pt and cannot move - cannot intubate at that point Clinical Manifestations: hoarseness, stridor, audible airflow turbulence (squeking when trying to get air in and out), and the production of carbonaceous sputum. Treatment: Early intubation - before airway goes down - easier when no edema present After airway secured then minimize edema, maintain pulmonary hygiene, treat bronchospasms with meds, help edema: elevating HOB with 30 degrees so goes downwards; Deep breathing, coughing; in chair; mobilize; suction - careful - esp with this injury - can cause damage and bleeding easily

Answer 38

Upper airway injury:

Question 39

Chemical injuries to the mucosal surfaces Not seen as often; heat/chemical dissipates in upper airway When seen, very sick and high death rate

Answer 39

lower airway injury:

Question 40

Airway Management Focus is to save life, minimize disability, and prepare for definitive care Respiratory Management

Answer 40

Emergency burn management

Question 41

Very imp If not recognize and treat airway issue - die All patients with major burns or suspected inhalation injury are initially administered 100% oxygen = regardless oxygen saturation - via nonrebreather or high flow nasal cannula Assess for s/s of impaired oxygenation/oxygen deprivation such as tachypnea, agitation, anxiety Assess for upper airway obstruction Hoarseness - talk; glottal level; edema/burns on glottis Stridor - at the main bronchus Wheezing - at the main bronchus Partial obstruction of air getting into lungs Look for overt swelling in face, lungs, lips, tongue; need to be able see in each of them Look for signs of burning - signs of soot in them - look for burns - suspect burns or compromise - not wait - intubate early - once edema happens - impossible to visualize and get into pharynx/lower to visualize vocal cords Early intubation may be lifesaving and is key in a patient who has an inhalation injury, because it may be impossible to perform this procedure later when edema has obstructed the larynx.

Answer 41

Airway Management

Question 42

Emergency healthcare professionals Remove all rings, watches, and jewelry - as becomes edematous - can cause tourniquet effect - decrease blood flow causing them to lose extremity; once swelling - hard to get off without cutting it off Obtain large bore IV access Obtain the history of the injury - Detailed hx of injury Was the pt thrown? The explosion of a water heater, propane gas, or grain elevator and other types of explosions often throw the patient some distance and may result in concomitant orthopedic, neurologic, and internal trauma. Worry about orthopedic/neurologic injuries; scan for internal trauma Were chemicals involved? Get the name of the chemical. Did the chemical come in direct contact or was it inhaled? Get chemical packaging Know if acid/base so know what care appropriate for chemical How long was the exposure? and how long the patient was exposed to smoke or superheated air. A detailed patient history should include detailed trauma, the mechanism of injury, patient’s age, estimation of location and size of burn, type and amount of fluid already administered when get there - start fluid resuscitation for us because needs to start immediately, known allergies, status of tetanus immunization, and significant medical history

Answer 42

Focus is to save life, minimize disability, and prepare for definitive care

Question 43

If has Circumferential, full-thickness burns to the chest wall can lead to restriction of chest wall - cannot have expansion and has decreased compliance of the lung Pt not getting adequate TV - lungs not expanding all the way because chest wall will not move enough Pt not intubated - slow, rapid respirations - when look at chest rise and fall - minimal; pt becomes intubated; intubated on scene - ventilator has high pressure because cannot get TV necessary Decreased compliance requires higher ventilatory pressures to provide the patient with adequate tidal volumes. Non-intubated pt.: Clinical manifestations of chest wall restriction include rapid, shallow respirations; poor chest wall excursion; and severe agitation. Intubated pt.: Increasing peak airway pressure values ABG: begin see ↑ PaCO 2. Lungs not expanding - not get adequate exhale then CO2 retained If case need do Escharotomies (burn eschar incisions) may be needed immediately to increase compliance and for improved ventilation (with sedation); make scoring lines in eschar tissue and allows the chest wall to move; These incisions usually are made bilaterally along the anterior axillary lines and are connected by a transverse incision at the costal margin; once line drawn eschar and edema goes through it but only through dermis - necessary when immediate compliance issues identified; made with a scalpel; thin line; make wide - pts edema

Answer 43

Respiratory Management

Question 44

Circulatory Management Pathophysiology of Burn Shock Kidney Management: Gastrointestinal System Management: Extremity Pulse Assessment: Laboratory Assessment: Wound Care:

Answer 44

Emergency management

Question 45

Focuses on fluid resuscitation Emergency HCP surveys The extent and depth of the burn are assessed - determine how much fluid necessary following the Parkland formula The extent of TBSA of the burn is calculated for the estimation of fluid resuscitation requirements; the Parkland formula is the most widely used method of calculation. According to the Parkland formula Fluid resuscitation necessary to prevent burn shock as fluid is going from intravascular to extravascular place and can cause relative hypovolemia - can put in shock state The rate of fluid administration is adjusted according to the individual’s response/assessment Underresuscitation may result in inadequate cardiac output, leading to inadequate organ perfusion and the potential for wound conversion from a partial-thickness to full-thickness injury. Overresuscitation may lead to moderate to severe pulmonary edema, to excessive wound edema causing a decrease in perfusion of unburned tissue in the distal portions of the extremities, or to edema inhibiting perfusion of the zone of stasis resulting in wound conversion. Heart is part of this - watch ECG - high risk for electrolyte imbalance - may have cardiac rhythm issues - esp electrical burn pts

Answer 45

Circulatory Management

Question 46

1st 8 hours: 50% of the calculated amount of fluid is administered 2nd 8 hours (hours 9-16): 25% is given 3rd 8 hours (hours 17-24): last 25% is given

Answer 46

According to the Parkland formula

Question 47

cannot use skin assessment for this Monitor urine output, heart rate, blood pressure, and level of consciousness. Document intake and output is imperative to ensure that he or she is appropriately resuscitated. - IMP

Answer 47

The rate of fluid administration is adjusted according to the individual’s response/assessment

Question 48

Very dangerous Decreased CO - leads to end-organ perfusion issues - organs not perfused and see issues with those

Answer 48

Underresuscitation may result in inadequate cardiac output, leading to inadequate organ perfusion and the potential for wound conversion from a partial-thickness to full-thickness injury.

Question 49

End up with pulm edema; wounds more edematous than should be and decreases area of the burn tissue which affects healing

Answer 49

Overresuscitation may lead to moderate to severe pulmonary edema, to excessive wound edema causing a decrease in perfusion of unburned tissue in the distal portions of the extremities, or to edema inhibiting perfusion of the zone of stasis resulting in wound conversion.

Question 50

Purpose of fluid resuscitation - prevent this Pathophysiology of burn - intravascular contents going to extravascular space - puts in hypovolemic state - once state get to end organ perfusion affected, call shock state Pt may present in shock r/t intravascular volume loss, decreased tissue perfusion This occurs as a result of direct injury to the capillaries and the release of vasoactive substances The capillaries become more permeable, and proteins move out of the intravascular spaces into the interstitium; hypovolemia and edema result Rate of fluid loss from intravascular spaces depends on: The hemodynamic alterations: Only thing that works is fluid resuscitation

Answer 50

Pathophysiology of Burn Shock

Question 51

Age Burn size and depth Intravascular pressures Time elapsed since burn injury

Answer 51

Rate of fluid loss from intravascular spaces depends on:

Question 52

↓ myocardial contractility and decreased cardiac output (due to a low preload) despite adequate volume resuscitation ↑ increased systemic vascular resistance (SVR), and increased pulmonary vascular resistance (PVR) - both compensatory mechanisms - both work for a short period of time - at the end - maladaptive. Increased PVR can lead to pulmonary edema.

Answer 52

The hemodynamic alterations:

Question 53

Focused on fluid resuscitation If fluid resuscitation is inadequate, AKI may occur. - can progress to acute kidney failure Indwelling urinary catheter may be placed to monitor the effectiveness of fluid resuscitation. A catheter may be necessary if the burn extends into the perineal area because of the presence or development of edema.

Answer 53

Kidney Management:

Question 54

Require Ng or OG tube: to prevent abdominal distention, emesis, and potential aspiration. Do receive prophylaxis with histamine blockers or sucralfate is initiated because patients with burns are prone to ileus. - high risk to develop ileus Enteral nutrition Enteral feeds should be promptly initiated for patients with burns delivered via nasoduodenal or nasojejunal tube. - usually postpyloric feeding because if NG suctioning would have to be turned off

Answer 54

Gastrointestinal System Management:

Question 55

IMP Edema formation (will happen) may cause neurovascular ompromise to the extremities; frequent assessments are necessary to evaluate pulses, skin color, capillary refill, and ability on sensation. Must do CMS Pts who have circumferential burns at highest risk for vascular compromise - if not corrected - go from tingling and decreased sensation, to ischemia and necrosis = amputation Arterial circulation is at greatest risk with circumferential burns. If not corrected, reduced arterial flow causes ischemia and necrosis. The Doppler flow probe is one of the best ways to evaluate arterial pulses - hard feel with finger tips - let settle through so can feel pulse - usually get via doppler An escharotomy may be required to restore arterial circulation and to allow for further swelling - go from Doppler to not being able to find; allows from extremity without squishing on underlying structures

Answer 55

Extremity Pulse Assessment:

Question 56

Initial laboratory studies include baseline complete blood count, electrolytes, blood urea nitrogen (BUN), creatinine, urinalysis, glucose, and blood screening - type and closs. Need uranlysis Inhalation injury warrants arterial blood gas measurements, HbCO level determination, cultures, alcohol and drug screens, and cyanide levels. A baseline nutrition status: albumin and prealbumin Burns: Creatine kinase, urinalysis, and urine myoglobin - are good indicators of rhabdomyolysis Serum lactate: inflammatory marker indicating burn severity. - know baseline inflammatory markers An ECG is obtained for all patients esp for those with electrical burns or preexisting heart disease. - issues with dysrhytmias so need baseline ECG

Answer 56

Laboratory Assessment:

Question 57

Not big focus in emergency After wounds have been assessed, topical antimicrobial therapy is not a priority during emergency care. Wounds must be covered with clean, dry dressings or sheets. EMS take Measures to prevent hypothermia and give live-saving Tetanus prophylaxis shot

Answer 57

Wound Care: