Thermal Burns Flashcards
Thermal Burns - Definition
Heat injury caused by fire or other causes of heat injury
Goal of Care
Minimal scene time and expeditious transport to hospital to minimize complications
Overview
The American Burn Association classifies burns as minor, moderate and major based upon burn depth and size
The traditional classification of burn depth as First, Second, Third or Fourth Degree is being replaced by a system reflecting the future treatment requirements in the continuum of care. Fourth Degree is still used to describe the most severe burns
Superficial Burns
Involves only epidermal layer of the skin and is painful, dry, red and blanches w/ pressure
Superficial Partial-thickness Burns
Involves the epidermis and superficial portions of the derms and is painful, red and weeping, usually from blister, and blanch with pressure
Deep Partial-thickness Burns
Extends into deeper dermis, damaging hair follicles and glandular tissue - painful to pressure only
Almost always blister, are wet or waxy dry, and have variable colour from patchy white to red
Full Thickness Burns
Extends through and destroys the dermis - usually painless
Skin appearance can vary from waxy white to leathery grey to charred and black
Fourth Degree Burns
Extend through the skin into underlying tissues of the fascia or muscle
Guiding Principles
It is critical to maintain the airway and provide supp O2 in pts w/ major burns
Direct heat to the upper airways result in the formation of edema (swelling) which may lead to obstruction
Initially, high flow humidified oxygen should be given to all pts w/ potential airway burns and a high index of suspicion should remain for the rapid development of upper airway obstruction and pulmonary edema.
Clues of airway burns include cough, vocal changes and soot around the mouth or nose or in sputum
Advanced airway management should be considered early when signs of airway swelling appear
Decontamination and Cooling
Decontaminate pt by removing clothes and flushing burns w/ sterile saline if possible. Clean hair, hands and face w/ water and baby shampoo
Cooling the burn quickly may limit the extent of injury. Be cautious to avoid cooling the entire pt, as it may cause hypothermia
Limit cooling to 1-2mins including the decontamination time
Carbon Monoxide Poisoning
In any fire environment carbon monoxide is a by-product of combustion and is one of the many chemical products in smoke
CO is colourless, odourless and tasteless and is virtually impossible to detect w/o special instruments
CO binds to the haemoglobin molecules and prevents oxygenation of the cells in the body
Symptoms of CO poisoning include Headache Dizziness SOB Confusion ALOC Convulsions Apnea Cardiac Arrest
Suspect CO poisioning w/ home space heaters, auto exhaust fumes or material burn
Treatment includes application of high flow oxygen, removal of the pt from the toxic environment and rapid transport to the hospital
Pain Management
Pain management - should be coodinated w/ emergency physician, especially in the case of children
Intravenous opiates are preferred. Entonox can be useful if NO inhalation inj is suspected
Fluid Loss
Burn pts lose fluids rapidly. In the immediate phase of care pts should receive fluid in 500ml bolus up to 2L to maintain blood pressure targeted at the adult normal BP of 120/80
Burns are often associated w/ other types of trauma. Fluid therapy to manage shock due to blood loss must strike a balance between the pt’s fluid requirements resulting from the burn and the need to not promote further bleeding from the traumatic inj
Burn Surface Area
Accurate estimation of burn size is essential. Extensive burns are expressed as the total percentage of total body surface area (TBSA) w/ more than superfical burns
Intervention Guidelines - EMR
EMR Remove the pt from the environment O2 100% if suspected inhalation inj Remove clothes and keep pt warm Flush and decontaminate affected area w/ sterile saline DO NOT cool burns longer than 1-2mins, including decontamination time Clean dry dressings during transport Analgesia - Entonox
