Chapter 11-14

Answer 1

Burns occur in every age group and in a
variety of settings
 Skin death and injury occur as heat exceeds
the body’s ability to disperse it
 Damage depends on:
 Intensity of heat
 Duration of contact
 Thickness of skin

Answer 2

THERMAL
 Flames
 Hot objects
 Flammable vapor
 Steam
 Hot liquids

 CHEMICAL
 Caused by a wide range of chemicals
 Acids
 Alkalis
 Organic compounds

 ELECTRICAL
 Caused by contact with electric current
 Injury depends on:
 Type of current
 Voltage
 Area exposed
 Duration of contact

Answer 3

To evaluating a thermal burn you must
determine:
1. Depth of burn
2. Extent of burn
3. Body parts
4. Respiratory involvement
5. Severity of burn

Answer 4

Depth of Burn
 First-degree (superficial)
 Redness, mild swelling,
tenderness, pain
 Second-degree (partial-thickness)
 Blisters, swelling, weeping of
fluids, severe pain
 Third-degree (full-thickness)
 Leathery , waxy, or pearly grey
skin that can be charred

Answer 5

Extent of the Burn
 Estimate how much body surface area (BSA)
the burn covers
 The rule of nines
 The rule of the hand
 A hand represents about 1% of a person’s total
body surface

Which Body Parts are Burned
 Burns on the face, hands, feet and genitals are
most severe
 Circumferential (goes around toe, finger, arm,
leg, neck, or chest) burns are more severe than
noncircumferential burns because of possible
constriction to function

Answer 6

Respiratory Involvement
 Superheated air can be absorbed
by the upper respiratory tract
 Signs: Burns around nose, mouth,
breathing difficulty,
coughing/wheezing, soot, swollen
nostrils or throat
 Swelling occurs in 2 to 24 hours
 Restricts or shuts off airway
Also Determine…
 Whether other injuries exist
 Preexisting medical problems
 If the person is older than 55
years
 If the person is younger than 5
years

Question 7

First Degree (Superficial) Burns

Answer 7

What to Look For?
 Redness
 Mild swelling
 Tenderness
 Pain
What to Do?
 Give ibuprofen
 Elevate arm or leg
 Have the person drink water
 Apply aloe vera or other lotion

Question 8

Second-Degree (Partial Thickness) Burns

Answer 8

Small Second-Degree
 What to Look For?
 Blisters
 Swelling
 Weeping of fluids
 Severe pain

 What to Do?
 Follow the first three steps for first-degree
burns
 Apply antibacterial ointment
 Cover with a loose, dry, nonstick, sterile
dressing

Large Second-Degree
 What to Do?
 Follow the first three steps for first-degree
burns
 Apply cold
 Monitor for hypothermia
 Call 9-1-1

Question 9

Third-Degree (Full Thickness) Burns

Answer 9

What to Look For?
 Dry, leathery, gray colored, or charred skin

What to Do?
 Cover burn with a dry, nonstick sterile
dressing
 Call 9-1-1

Question 10

Scald Burns

Answer 10

The result of contact with hot liquids
 Immersion burns: area of the body is fully
immersed in a hot liquid
 Spill burns: liquid spills, drops, or is thrown on
a person

Question 11

Sunburns

Answer 11

The skin’s response to the trauma of ultraviolet radiation
* Can result in first- or second-degree burns
Care for Sunburns:
* Apply cool compress for up to 45 minutes
* Take cool showers and baths
* Do not use benzocaine
* Use ibuprofen to reduce pain and inflammation
* Drink a lot of water
* Use aloe vera or another body lotion
Aftercare:
* Apply antibiotic ointment to a second-degree sunburn
* If blisters break, gently wash twice daily
* Seek medical care if eyes are affected or if infection
occurs

Question 12

Chemical Burns

Answer 12

Result of an acid or an alkali substance touching the skin
** Chemicals burn as long as they are in contact with skin.Chemicals burn as long as they are in contact with skin.
** Check the safety data sheet, if availableCheck the safety data sheet, if available

Question 13

Chemical Burns

Answer 13

What to Look For?
 Pain
 Burning
 Breathing difficulty
 Eye pain or vision change

What to Do?
 Brush dry chemical off skin
 Flush burn with large amounts
of water for at least 20 minutes
or until EMS arrives
 Call 9-1-1
 For chemical in eye:
 Tip head so affected eye is
below nose
 Wash eye with warm water
from nose out to side of face
for at least 20 minutes

Question 14

Electrical
Burns

Answer 14

1. Thermal burn (flame)
2. Arc burn (flash)
3. True electrical injury (contact)

Answer 15

Contact with Outdoor Power Line
 Power must be turned off
 A tingling sensation signals that you
are on energized ground
 Raise one foot off ground, turn
around, and hop to safe area
 Do not attempt to move any wires
Contact Inside Buildings
 Turn off electricity
 Unplug appliance
 Do not touch appliance or
person until current is off
 Damage occurs under
skin

Question 16

Electrical Burns Cont’d

Answer 16

What to Look For?
 Burn wound, which might
appear small
 Entrance and exit wounds
 Multiple burns
 Absent breathing/pulse
What to Do?
 Check breathing
 Call 9-1-1
 Check for broken bones
 Treat the person for shock
 Cover wounds with sterile
dressings

Question 17

HEAD INJURIES

Answer 17

Head injuries include:
 Scalp wounds
 Skull fractures
 Brain injuries
 Spinal injuries can also be present in people with a head injury

Question 18

SCALP WOUNDS

Answer 18

May bleed profusely due to a
large number of blood vessels in
the scalp.
* However this would not
affect blood supply to the
brain.
* Be mindful of other potential
injuries such as a concussion,
skull fracture, brain or spinal
injury, etc.
* Call 911 if:
* The wound is extensive
* There is significant facial
damage

Apply direct pressure with
a dry, sterile dressing to
control the bleeding
Apply pressure around the
edges of the wound to
control bleeding from a
suspected skull fracture

Question 19

Skull Fracture

Answer 19

Break or crack in the
cranium
 Two types of skull fractures:
1. Open (with an accompanying
scalp laceration)
2. Closed (without an an
accompanying scalp
laceration) Make a donut for skull fracture-related bleeding and to
surround an eye for protection when a short object is
embedded in an eye
1. Using the cravat bandage or strip of cloth, wrap
about half the length into a circle large enough to
surround the injured area
2. Pass the tail through the hole repeatedly to form a
circle
3. The completed dressing should have a hole large
enough to surround the injury

Question 20

TRAUMATIC BRAIN INJURY

Answer 20

Injury to the brain can cause most short and
long term problems
 The brain is struck causing it to bounce against
the skull
 Swelling in the brain interferes with brain function
 Any swelling or accumulation of blood in the skull
compresses the brain and increases pressure
 Nerve cells of the brain/spinal cord are unable to
regenerate
 When they die, they are lost forever and cannot be
replaced
 Brain injuries can be caused by:
− A penetrating foreign object
− Bony fragments from a skull fracture
− The brain striking the inside of the skull
 Deceleration injury: person’s head hits a
stationary object
 Acceleration injury: person has been hit by a
moving object

Question 21

TYPES OF TRAUMATIC BRAIN INJURIES

Answer 21

Concussions (mild traumatic brain injury
(MTBI))
 Contusion
 Direct blow to head can bruise brain
 Coup-contrecoup
 Impact of blow causes contusion at site of impact
and on opposite side of head
 Diffuse axonal
 Shaking or strong rotation of head causing tearing
injury (ex. Shaken baby syndrome)
 Penetration
 Bullet, knife, or other sharp object enters the brain
causing contamination from hair, skin, skull, and
pieces of penetrating object. These may not be
retrievable.
Different Types of Critical Traumatic
Brain Injuries

Question 22

CONCUSSIONS

Answer 22

Suspect a
Concussion
 High-speed activities
 Sports or rec activities
 Falls
 Suspected child maltreatment
 Exposure to blasts
 Injuries to external parts of head and/or scalp

Question 23

SYMPTOMS OF CONCUSSION OR MTBI

Answer 23

Thinking/
Remembering Physical
Emotional/
Mood Sleep
Difficulty thinking clearly Headache
Fuzzy or blurry vision
Irritability Sleeping more than usual
Feeling slowed down Nausea or vomiting
(early on)
Dizziness
Sadness Sleep less than usual
Difficulty concentrating Sensitivity to noise or light
Balance problems
More emotional Trouble falling asleep
Difficulty remembering new
information
Feeling tired, having no
energy
Nervousness or anxiety

Question 24

EYE INJURIES

Answer 24

Eyes are easily damaged by trauma
 Blow to the Eye..
 A direct blow or a flying object that lands against
the eye or pierces it can potentially cause a severe
injury
 Partial/complete vision loss is especially high if
there is leakage or fluids coming from the eye
 Examination by an ophthalmologist or other
physician should occur as soon as possible after
injury

Question 25

EAR INJURIES

Answer 25

Most are not life-threatening
 Disk batteries and live insects must be removed
immediately
 First aid providers should seek medical care for
the person.

Question 26

NOSE INJURIES

Answer 26

Seldom require medical attention
 In cases of accompanying head or neck injuries, stabilize
head and neck for protection
 Some cases, loss of blood can lead to shock
Caution…
 DO NOT allow the person to tilt the head
backwards
 DO NOT probe the nose with a cotton-tipped
swab
 DO NOT move the person’s head and neck if a
pinal injury is suspected

Question 27

SPINAL INJURIES

Answer 27

All unresponsive people with an injury should be
treated as though they have a spinal injury
 If broken vertebrae pinches spinal nerves
paralysis can occur
 Paralysis occurs when neural connections
between the brain and extremities are severed
or damaged
 Paraplegia: spinal damage that affects the legs
 Quadriplegia: spinal damage that affects the arms
and legs
 Most who suffer total loss of sensation/function
above the C3 (third cervical vertebrae) die
before medical care can be provided

 Types of Paralysis
 Monoplegia: damage that affects one limb
 Hemiplegia: damage that affects an arm and leg on
the same side of the body
 Paraplegia: damage that affects the legs
 Quadriplegia (tetraplegia): damage that affects the
arms and legs

Question 28

SPINAL INJURIES

Answer 28

Suspect a possible spinal injury anytime one of
the following occurs:
 Motor vehicle crashes (includes motorcycles,
snowmobiles, and all-terrain vehicles)
 Pedestrian-motor vehicle crashes
 Falls from heights
 Penetrating injury to the head, neck, back, or torso
 Violent assaults and direct blows
 Driving incidents
 Sports injuries

Answer 29

Checking for Spinal Injuries in a Responsive
Person
1. Have the person wiggle his/her fingers
2. Squeeze the persons fingers
3. Have the person squeeze your hand
4. Have the person wiggle his/her toes
5. Squeeze the person’s toes
6. Have the person push his/her foot a

Question 30

Chest injuries

Answer 30

Two categories
 Open (penetrated by an object)
 Closed (blunt trauma)
 All people with chest injuries should have
airway, breathing, and circulation checked
and rechecked
 A responsive person should sit up or be
placed with injured side down

Question 31

Closed chest injuries

Answer 31

Skin is not broken
 Injuries include:
 Rib fractures
 Flail chest

Question 32

Rib fractures

Answer 32

Broken ribs usually occur along the side of
the chest
 Symptoms:
 Pain at the injured rib site
 Pain when the person breathes, coughs, or
moves
 Pain when the area is touched
A. stabilize the ribs
by holding or tying
in place
B. a soft object
such as a
pillow, coat or
blanket
Tell the person to
take very deep, slow
breaths every few
breaths

Answer 33

Skin has been broken and the chest is
penetrated
 Injuries include:
 Sucking chest wound
 Allows air to pass in and out, may bubble at
site.
 Impaled object in the chest IMPALED OBJECT IN THE
CHEST
* STABILIZE A
PENETRATING OBJECT
WITH BULKY PADDING
* SECURE THE PADDING
AND OBJECT

Question 34

ABDOMINAL INJURIES

Answer 34

INJURIES ARE EITHER CLOSED OR
OPEN
 CAN INVOLVE HOLLOW AND/OR SOLID
ORGANS
 HOLLOW ORGAN RUPTURE: SPILLS
CONTENTS OF ORGAN INTO ABDOMEN
 SOLID ORGAN RUPTURE: RESULTS IN
INTERNAL BLEEDING

Question 35

CLOSED ABDOMINAL INJURY

Answer 35

OCCUR WHEN THE INTERNAL
ABDOMINAL TISSUES ARE DAMAGED
BUT THE SKIN IS UNBROKEN
(AKA…BLUNT INJURIES)
 HOW THEY OCCUR?
 STRIKING THE HANDLEBAR OF A
BYCICLE ORTHE STEERING WHEEL OF A
CAR
 BEING STRUCK BY A BOARD OR
BASEBALL BAT
 EXAMINE BY GENTLY PRESSING ALL
FOUR QUADRANTS
 A NORMAL ABDOMEN IS SOFT AND NOT
TENDER WHEN PRESSED

Question 36

OPEN ABDOMINAL INJURY

Answer 36

SKIN HAS BEEN BROKEN
 KNOWN AS PENETRATING
INJURIES
 INJURIES INCLUDE:
 PENETRATING INJURIES
 Stabilize penetrating object and
control bleeding with bulky dressing
 PROTRUDING ORGANS
 Do not try and reinsert
 Tell person to lay with legs pulled up
toward abdomen
 Cover organs with moist clean
dressing and loosely tape in place

Question 37

Pelvic injuries

Answer 37

Pelvic fractures are usually caused by
falling or a motor vehicle crash
 Check pelvis by gently pressing inward
and downward on the tops of the hips
− If pain results, suspect a fracture. Do not
move, keep person lying flat, call 911 and
treat for shock.

Question 38

Bone
Injuries

Answer 38

Associated with a forceful cause of injury
* The real problems associated with fractures are the
potential injury to the vital organs next to them

Question 39

Fractures

Answer 39

Break or crack in a bone
* Two categories:
− Closed (skin is intact)
− Open (skin has been broken

Question 40

Types of
Fractures

Answer 40

Greenstick—incomplete fracture
* Traverse—cut across bone at right angles
* Oblique—cross bone in a slanting direction
* Comminuted—bone is fragmented into more than two
pieces
* Impacted—broken ends are jammed together
* Spiral—results from a twisting injury

Question 41

Checking CSM in a
Upper Extremity

Answer 41

. Circulation…check an upper extremity for
ciruclation using the radial pulse (located on
the thumb side of the wrist)
2. Sensation…lightly touch or squeeze one of
the person’s fingers while his/her eyes are
closed, and ask the person which finger he/she
feels being squeezed
3. Movement…Ask the person to wiggle the
fingers

Question 42

Checking CSM in a
Lower Extremity

Answer 42

1. Circulation…check a lower extremity for
   ciruclation using the posterior tibial pulse
   (located between the inside ankle bone and
   the Achilles tendon)
2. Sensation…lightly touch or squeeze one of
   the person’s toes while his/her eyes are
   closed, and ask the person which toe he/she
   feels being squeezed
3. Movement…Ask the person to wiggle the
   toes

Question 43

Dislocations

Answer 43

Occurs when a joint comes apart and stays apart with the
bone ends no longer in contact
* Most frequently affects:
– Shoulders
– Elbows
– Fingers
– Hips
– Knee caps
– Ankles

Question 44

A joint is where two or more bones come together

Question 45

What to
Look For…
What to Do

Answer 45

Obvious deformity, tenderness, severe pain,
swelling, inability to move injured part, numbness
or impaired circulation
1. Call 911 if extremity looks blue or pale, or if
transporting the patient is too difficult
2. Check the CMS
3. Support injury from further movement while
waiting for EMS
4. If transporting, use the RICE procedure.
1. Rest, Ice, Compression, And Elevation
5. DO NOT try to replace dislocated part.

Question 46

Sprains

Answer 46

Occurs when a joint is twisted or stretched beyond its normal range of motion
* Results in partially or completely torn ligaments
* Most often occur in ankle
– 2 types of sprains
* Inversion
– outer, or lateral, ligaments are stretched too much
* Eversion
– tear of the deltoid ligaments, on the inside of the ankle
– Three grades of ankle sprains

Grade I:
ligaments
stretched, not
torn
* Grade II (most
common): partial
tearing of
ligament
* Grade III:
ligament is
completely torn

Question 47

Muscle
Injuries

Answer 47

STRAINS
* Occurs when a muscle is stretched beyond its normal range
of motion
* Inflammation begins immediately.
− Can take 24 to 72 hours for pain and stiffness to begin
CRAMPS
* Occurs when a muscle goes into an uncontrolled spasm
and contraction
* Muscle cramps
– Night cramps
– Heat cramps
CONTUSIONS
* A muscle contusion or bruise results from a blow to the
muscle