MOD E Tech 35 Burns and Scalds Flashcards
Burns & Scalds
.What causes a burn ?
What causes a scald
Burns are caused by dry heat:
- Flame or radiation
- Electricity
- Friction
- Corrosive chemicals
Scalds are caused by wet heat:
- Water
- Steam
- Fat
- Hot liquid chemicals
Thermal Burns
3 dangers/complications associated with thermal burns:
- Hypovolaemic shock
- Infection
- Damage to the respiratory tract
Complications burns
Shock:
•All patients suffering burn injury will be suffering from both clinical and psychological shock
•
•Loss of fluid from the circulation leads to hypovolaemic shock
Burns
Complications - Infection
- Do not touch the burn unnecessarily
- Wear sterile gloves
- Remove burnt, non-adherent clothing
- Cover with a sterile dressing, “waterjel” or “cling film”
- Do not burst blisters
Complications – Damage to the Respiratory Tract
Look for:
Look for:
- Facial or neck burns
- Sooty sputum
- Singed nasal hair, eyebrows
- Soot in the nose and mouth
- Hoarse voice, persistent cough
- Altered breath sounds – stridor, wheezing
- Loss of consciousness
Other Complications of Burns
- Pain
- Hidden injury – falls, explosions, electrical injury
- Hypothermia – children especially susceptible due to over enthusiastic irrigation
- Circumferential Burns
Specific Types of Thermal Injury
Electrical Burns
- Caused by AC or DC electrical current
- Isolate any electrical current before beginning your assessment
- Attach the cardiac monitor – 12 lead
- Treat as for a normal burn
- There may be 2 burn points
- deep dermal injury may have occurred
- Assess for other injuries (Consider C-spine)
- Be aware of possible tetany
Lightning Injury
Classic “Splatter” or “fernlike” pattern
Chemical Burns
Immediate treatment should include
- Removing all contaminated clothing
- Irrigating freely with tepid water/saline (min. 15 minutes)
- Do not use Clingfilm – use wet dressings
- Treating as for a normal burn
- Keeping phosphorous burns continually wet
- It is vital to note the nature of the chemical
- Alkalis, in particular, may cause deep, penetrating burns – it may take hours of irrigation to neutralise the alkali
- Certain chemicals such as phenol or hydrofluoric acid can cause poisoning by absorption through the skin
Chemical Burns
How would we treat chemical burns to the eyes?
Classification & Assessment of Thermal Injury
i. Name and briefly describe the three different classifications of burn depth.
ii. State how you would assess the area of burn.
1.Superficial (erythema)
●
2.Partial thickness
●
3.Full thickness
rule of 9
Burn Assessment - Assessing the Area (BSA)
- BSA is more significant than depth
- Age of patient is significant
- Superficial burns are usually more painful than deep ones
- (If age + % BSA is > 100 the prognosis is poor)
- Consider all of the burn – do not differentiate (erythema should not be included as it can be transient initially)
- Give a rough indication of the extent of the burn
- Note the time that the burn occurred
Assessing the Area of Burn
Wallace’s Rule of Nines (age >14yrs)
OR
The Lund and Browder chart
Lund & Browder Chart
Time Critical Features of Burns
- Any major ABCD problems
- Any signs of airway burns
- History of inhalation of hot gases / air
- Respiratory distress
- Evidence of circumferential burns to the chest or neck (or limbs)
- Any significant facial burns
- Adults with > 15% BSA (>10% in children)
- Presence of other major injuries
Burns & Scalds
General Management
- Stop the burning process – if safe
- Ensure an open airway
- High levels of oxygen (15 litres/min target SpO2 of 94-98%) – don’t rely on pulse oximetry (carboxyhaemaglobin)
- Consider nebulisation if the patient is wheezing
- Remove anything constrictive
- Irrigate with copious amounts of water – 15 to 20 mins.
- Remove clothing which is hot and wet and not adherent to the skin – after irrigation with water
- Consider “Waterjel” for burns <12.5% BSA – Water treatment preferred
- If burn gel not appropriate - Cover the burn with “cling film” – overlapping rather than bound and continue to irrigate over the cling film – max. 10 mins
- Do not use cling film on chemical burns
- Be aware of hypothermia!
- Provide analgesia as required. (Morphine if severe pain)
- (Entonox is not considered appropriate if >50% O2 is required)
Important information to pass on:
- Extent of burn
- Time of burn
- Burning agent
- Whether first aid was undertaken
- Any indication of airway burns
- Any evidence of potential for circumferential burns
