MOD E Tech 35 Burns and Scalds

Question 1

Burns & Scalds

.What causes a burn ?

What causes a scald

Answer 1

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

Question 2

Thermal Burns

3 dangers/complications associated with thermal burns:

Answer 2

1. Hypovolaemic shock
2. Infection
3. Damage to the respiratory tract

Question 3

Complications burns

Answer 3

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

Question 4

Burns

Complications - Infection

Answer 4

• 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

Question 5

Complications – Damage to the Respiratory Tract

Look for:

Answer 5

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

Question 6

Other Complications of Burns

Answer 6

• Pain
• Hidden injury – falls, explosions, electrical injury
• Hypothermia – children especially susceptible due to over enthusiastic irrigation
• Circumferential Burns

Question 7

Specific Types of Thermal Injury

Electrical Burns

Answer 7

• 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

Question 8

Lightning Injury

Answer 8

Classic “Splatter” or “fernlike” pattern

Question 9

Chemical Burns

Immediate treatment should include

Answer 9

• 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

Question 10

Chemical Burns

How would we treat chemical burns to the eyes?

Answer 10

Question 11

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.

Answer 11

1.Superficial (erythema)

●

2.Partial thickness

●

3.Full thickness

rule of 9

Question 12

Burn Assessment - Assessing the Area (BSA)

Answer 12

• 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

Question 13

Assessing the Area of Burn

Answer 13

Wallace’s Rule of Nines (age >14yrs)

OR

The Lund and Browder chart

Question 14

Lund & Browder Chart

Answer 14

Question 15

Time Critical Features of Burns

Answer 15

• 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

Question 16

Burns & Scalds

General Management

Answer 16

• 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)

Question 17

Important information to pass on:

Answer 17

• 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