Chap 23 Burns

Chapter 23Chapter 23BurnsBurns

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

ObjectivesObjectives Describe incidence, patterns, sources of burn injuryDescribe incidence, patterns, sources of burn injury

Describe local and systemic responses to burn injuryDescribe local and systemic responses to burn injury

Classify burn depth, extent, severity Classify burn depth, extent, severity

Discuss pathophysiology of signs and symptoms of Discuss pathophysiology of signs and symptoms of burn shock burn shock

Outline physical exam of burn patientOutline physical exam of burn patient


ObjectivesObjectives Describe field management of burn injuryDescribe field management of burn injury

Discuss signs and symptoms and management Discuss signs and symptoms and management of patients with:of patients with: Inhalation injuryInhalation injury Chemical injuryChemical injury Electrical injuryElectrical injury Radiation injuryRadiation injury


Scenario,Scenario,

As you pull up to the scene of a house fire you see As you pull up to the scene of a house fire you see firefighters struggling to pull an elderly male out the firefighters struggling to pull an elderly male out the front door. They frantically shout for you. Your patient front door. They frantically shout for you. Your patient is unconscious. You immediately notice soot and is unconscious. You immediately notice soot and burns on his face. His clothing is smoldering, and you burns on his face. His clothing is smoldering, and you note white, leathery, waxy burns on his arms. You note white, leathery, waxy burns on his arms. You can hear the high-pitched stridor as he struggles to can hear the high-pitched stridor as he struggles to breathe, and the acrid smell of his burning flesh fills breathe, and the acrid smell of his burning flesh fills the air.the air.


DiscussionDiscussion What is your first concern as you approach this What is your first concern as you approach this

scene?scene?

What immediate life threats do you anticipate What immediate life threats do you anticipate with this patient?with this patient?

What are your priorities of care for this man?What are your priorities of care for this man?

Why will he need the resources of a burn Why will he need the resources of a burn center?center?


Burn InjuryBurn Injury 10,000 deaths/year10,000 deaths/year

More common in menMore common in men

Death rates high in kids and older adultsDeath rates high in kids and older adults

Most deaths happen in homeMost deaths happen in home

High incidence in low-income householdsHigh incidence in low-income households


Major Sources of BurnsMajor Sources of Burns Interaction between energy (thermal, chemical, Interaction between energy (thermal, chemical,

electrical, or radiation) and biological matterelectrical, or radiation) and biological matter

Thermal burnsThermal burns Most common typeMost common type Flames, scalds, or contact with hot substancesFlames, scalds, or contact with hot substances Frostbite is a type of thermal injuryFrostbite is a type of thermal injury

Chemical burnsChemical burns Substances that produce chemical changes in skin with or Substances that produce chemical changes in skin with or

without heat productionwithout heat production


Major Sources of BurnsMajor Sources of Burns Electrical injuries Electrical injuries

Lightning injuriesLightning injuries Direct contact with electrical currentDirect contact with electrical current Arcing of electricity between two contact points Arcing of electricity between two contact points

near skinnear skin Flash burns if fuel source is ignitedFlash burns if fuel source is ignited


Radiation InjuryRadiation Injury Ionizing and nonionizing radiationIonizing and nonionizing radiation

Burns may result from high level of radiation Burns may result from high level of radiation exposure to a specific areaexposure to a specific area

RareRare


Pathophysiology of Thermal Burn InjuryPathophysiology of Thermal Burn Injury

Tissue destruction depends on:Tissue destruction depends on: Temperature and duration of exposureTemperature and duration of exposure

Ability to resist burn injury depends on:Ability to resist burn injury depends on: Water content of skin tissueWater content of skin tissue Thickness and pigmentation of skinThickness and pigmentation of skin Insulating substances (e.g., skin oils, hair)Insulating substances (e.g., skin oils, hair) Peripheral circulation of skinPeripheral circulation of skin

• Affects dissipation of heatAffects dissipation of heat


Local Response to Burn InjuryLocal Response to Burn Injury Burn injury destroys cells or completely Burn injury destroys cells or completely

disrupts their metabolic functionsdisrupts their metabolic functions Cellular death ensuesCellular death ensues Cellular damage is distributed over a spectrum of Cellular damage is distributed over a spectrum of

injuryinjury


Local Response to Burn InjuryLocal Response to Burn Injury

Major burns have three Major burns have three zones of injury zones of injury

Appear in bulls-eye Appear in bulls-eye pattern:pattern: Zone of hyperemia (A)Zone of hyperemia (A) Zone of stasis (B)Zone of stasis (B) Zone of coagulation (C)Zone of coagulation (C)


Systemic Response to Burn InjurySystemic Response to Burn Injury

Hypovolemic shock associated with: Hypovolemic shock associated with: Decrease in venous returnDecrease in venous return

• Decreased cardiac outputDecreased cardiac output

• Increased vascular resistance (except in zone of Increased vascular resistance (except in zone of hyperemia)hyperemia)

Renal failure may occur due to:Renal failure may occur due to:• Hemolysis (destruction of RBCs)Hemolysis (destruction of RBCs)

• Rhabdomyolysis (muscle necrosis)Rhabdomyolysis (muscle necrosis)


Systemic Response to Burn InjurySystemic Response to Burn Injury

Pulmonary Pulmonary

Gastrointestinal Gastrointestinal

Musculoskeletal Musculoskeletal

NeuroendocrineNeuroendocrine

Metabolic Metabolic

Immune Immune

EmotionalEmotional


Classifications of Burn Injury Classifications of Burn Injury Assess and classify as accurately as Assess and classify as accurately as

possible in the prehospital settingpossible in the prehospital setting Difficult because of progressive nature of injuryDifficult because of progressive nature of injury Amount of tissue damage may not be evident Amount of tissue damage may not be evident

for hours/days after injuryfor hours/days after injury


Depth of Burn InjuryDepth of Burn Injury First, second, and third degree (some include First, second, and third degree (some include

fourth degree)fourth degree) First- and second-degree burns are partial-First- and second-degree burns are partial-

thickness burnsthickness burns• Usually heal without surgeryUsually heal without surgery

Third-degree burns are full-thickness burnsThird-degree burns are full-thickness burns• Usually require skin graftsUsually require skin grafts


First‑Degree BurnFirst‑Degree Burn Painful, red, dry, blanch Painful, red, dry, blanch

with pressurewith pressure

Superficial layer of Superficial layer of epidermal cells is epidermal cells is destroyeddestroyed

Heals in 2-3 daysHeals in 2-3 days


Second-Degree BurnSecond-Degree Burn Superficial partial-Superficial partial-

thicknessthickness BlistersBlisters

Injury extends through Injury extends through epidermis to dermisepidermis to dermis If no infection, generally If no infection, generally

heals without scarringheals without scarring


Second-Degree BurnSecond-Degree Burn Deep partial-thicknessDeep partial-thickness

Involves basal layer of dermisInvolves basal layer of dermis Sensation in and around wound may be Sensation in and around wound may be

diminisheddiminished May appear red and wet or white and dry, May appear red and wet or white and dry,

depending on the degree of vascular injurydepending on the degree of vascular injury Major complication is wound infectionMajor complication is wound infection


Deep Partial-Thickness BurnDeep Partial-Thickness Burn


Third-Degree BurnThird-Degree Burn

Full-thickness burnFull-thickness burn

Epidermis and dermis Epidermis and dermis destroyed destroyed Eschar present Eschar present Sensation and capillary Sensation and capillary

refill absent refill absent Skin grafts needed for Skin grafts needed for

timely and proper healingtimely and proper healing


Fourth-Degree BurnFourth-Degree Burn Included in some burn classificationsIncluded in some burn classifications

Full-thickness injury that penetratesFull-thickness injury that penetrates Subcutaneous tissueSubcutaneous tissue MuscleMuscle FasciaFascia PeriosteumPeriosteum BoneBone


Extent and Severity of Burn InjuryExtent and Severity of Burn Injury

Common methodsCommon methods Rule of ninesRule of nines Lund and Browder chartLund and Browder chart

American Burn Association (ABA) has devised American Burn Association (ABA) has devised a categorization of burns to determine severitya categorization of burns to determine severity


Rule of NinesRule of Nines Divides total body surface Divides total body surface

area (TBSA) into area (TBSA) into segments that are segments that are multiples of 9%multiples of 9%

Rough estimate of burn Rough estimate of burn sizesize

Most accurate for adults Most accurate for adults and children >10 y/oand children >10 y/o


Lund and Browder ChartLund and Browder Chart Accurate method to determine area of burn Accurate method to determine area of burn

injuryinjury Assigns numbers to each body partAssigns numbers to each body part

Used to measure burns in infants and young Used to measure burns in infants and young childrenchildren Allows for developmental changes in percentages Allows for developmental changes in percentages

of body surfaceof body surface


Lund and Browder ChartLund and Browder Chart


American Burn Association CategorizationAmerican Burn Association Categorization

Classifies burns as major, moderate, and Classifies burns as major, moderate, and minorminor

Considers: Considers: Patient's agePatient's age Medical or surgical problemsMedical or surgical problems Burns of:Burns of:

• Face and neckFace and neck

• Hands and feetHands and feet

• GenitaliaGenitalia


Burn Center Referral CriteriaBurn Center Referral Criteria Burn categorizations used to determine Burn categorizations used to determine

which patients need transport to specialized which patients need transport to specialized burn centersburn centers American College of Surgeons and American American College of Surgeons and American

Burn Association have 10 guidelines for burns Burn Association have 10 guidelines for burns that usually require burn center referralthat usually require burn center referral


Burn ShockBurn Shock Shock results from:Shock results from:

Edema and accumulation of Edema and accumulation of vascular fluid in the tissues in vascular fluid in the tissues in the area of injurythe area of injury

Systemic fluid leakSystemic fluid leak

Burn shockBurn shock Emergent phaseEmergent phase Fluid shift phaseFluid shift phase Hypermetabolic phaseHypermetabolic phase Resolution phaseResolution phase


Burn ShockBurn Shock Therapy aimed at supporting patient through Therapy aimed at supporting patient through

hypovolemic shockhypovolemic shock Crystalloid solution (e.g., lactated Ringer’s solution) Crystalloid solution (e.g., lactated Ringer’s solution)

fluid of choice in initial resuscitation fluid of choice in initial resuscitation Three formulas for calculating fluid replacement Three formulas for calculating fluid replacement

volume:volume:• Parkland formulaParkland formula

• Modified Brooke formulaModified Brooke formula

• Consensus formulaConsensus formula


Assessment of the Burn PatientAssessment of the Burn Patient

Initial assessmentInitial assessment AirwayAirway

• Especially patients with inhalation injuryEspecially patients with inhalation injury

BreathingBreathing CirculationCirculation Neurological statusNeurological status


Probability of Upper Airway ObstructionProbability of Upper Airway Obstruction


HistoryHistory Chief complaint (pain, dyspnea)Chief complaint (pain, dyspnea)

Circumstances of injuryCircumstances of injury Enclosed space?Enclosed space? Explosive forces involved?Explosive forces involved? Hazardous chemicals involved?Hazardous chemicals involved? Related trauma?Related trauma?

Source of burning agent (e.g., flame, metal, Source of burning agent (e.g., flame, metal, liquid, chemical)liquid, chemical)


HistoryHistory Significant medical historySignificant medical history

Patient medications (and drugs/alcohol) Patient medications (and drugs/alcohol)

Loss of consciousness at any timeLoss of consciousness at any time Suspect inhalation injurySuspect inhalation injury

Last tetanus immunizationLast tetanus immunization


Physical ExaminationPhysical Examination Vital signsVital signs

If severe burns or preexisting cardiac or medical If severe burns or preexisting cardiac or medical illness, monitor ECGillness, monitor ECG

Field care and hospital destination determined Field care and hospital destination determined by:by: Burn depthBurn depth Burn sizeBurn size Extent of burned tissueExtent of burned tissue Associated illness or injuryAssociated illness or injury


Goals of Prehospital Burn ManagementGoals of Prehospital Burn Management

Preventing further tissue injuryPreventing further tissue injury Maintaining patent airwayMaintaining patent airway Administering oxygen and ventilatory supportAdministering oxygen and ventilatory support Fluid resuscitation (per protocol)Fluid resuscitation (per protocol) Rapid transport to appropriate medical facilityRapid transport to appropriate medical facility Clean technique to minimize patient's exposure to Clean technique to minimize patient's exposure to

infectious agentsinfectious agents Psychological and emotional supportPsychological and emotional support


Stopping the Burning ProcessStopping the Burning Process Provide scene safety for rescue crewProvide scene safety for rescue crew

Minor first-degree burnsMinor first-degree burns Cool the local area with cool waterCool the local area with cool water


Stopping the Burning ProcessStopping the Burning Process Severe burnsSevere burns

Move patient to area of safety Move patient to area of safety If clothing is in flames or smoldering:If clothing is in flames or smoldering:

• Place patient on floor or groundPlace patient on floor or ground• Roll in blanket to smother flames and/or douse with large Roll in blanket to smother flames and/or douse with large

quantities of cleanest available waterquantities of cleanest available water Remove clothing while cooling burn so heat is not Remove clothing while cooling burn so heat is not

trapped under smoldering clothtrapped under smoldering cloth After burn is cooled, cover patient with clean sheet After burn is cooled, cover patient with clean sheet


Airway, Oxygen, and VentilationAirway, Oxygen, and Ventilation

Administer high-concentration humidified (if Administer high-concentration humidified (if available) oxygen available) oxygen

Assist ventilation as neededAssist ventilation as needed

If inhalation injury is suspected, closely observe If inhalation injury is suspected, closely observe for signs of impending airway obstruction:for signs of impending airway obstruction: Laryngeal edema may be progressive and may make Laryngeal edema may be progressive and may make

tracheal intubation difficult or impossibletracheal intubation difficult or impossible Do not delay intubation in these patientsDo not delay intubation in these patients


CirculationCirculation Fluid resuscitation is based on:Fluid resuscitation is based on:

Severity of injurySeverity of injury Vital signsVital signs Transport time to hospitalTransport time to hospital

IV therapyIV therapy

If transport is to be delayed or interfacility transport is If transport is to be delayed or interfacility transport is possible, consider:possible, consider: AnalgesicsAnalgesics——aggressive pain control aggressive pain control NG tube placementNG tube placement Bladder catheterizationBladder catheterization


Special ConsiderationsSpecial Considerations Facial burns swell rapidly Facial burns swell rapidly

Associated with airway compromiseAssociated with airway compromise Elevate stretcher at least 30 degrees (if not Elevate stretcher at least 30 degrees (if not

contraindicated by spinal trauma) to minimize contraindicated by spinal trauma) to minimize edemaedema

Avoid pillow if ears are burned Avoid pillow if ears are burned


Special ConsiderationsSpecial Considerations Extremity burnsExtremity burns

Remove jewelry to prevent vascular compromise Remove jewelry to prevent vascular compromise from edemafrom edema

Assess peripheral pulses frequentlyAssess peripheral pulses frequently Elevate burned limb above patient's heartElevate burned limb above patient's heart

Circumferential burnsCircumferential burns Threat to patient's life or limbThreat to patient's life or limb Tourniquet-like effect on extremity or chestTourniquet-like effect on extremity or chest


Inhalation Burn InjuryInhalation Burn Injury EpidemiologyEpidemiology

IncidenceIncidence

Morbidity/mortalityMorbidity/mortality

Risk factorsRisk factors

Prevention strategiesPrevention strategies


Carbon Monoxide PoisoningCarbon Monoxide Poisoning Colorless, odorless, tasteless gas Colorless, odorless, tasteless gas

Produced by incomplete combustion of carbon fuelsProduced by incomplete combustion of carbon fuels Does not physically harm lung tissueDoes not physically harm lung tissue

Affinity for hemoglobin 250x oxygenAffinity for hemoglobin 250x oxygen Small concentrations of CO can cause severe physiological Small concentrations of CO can cause severe physiological

impairmentsimpairments Effects of carbon monoxide poisoning related to blood CO Hgb Effects of carbon monoxide poisoning related to blood CO Hgb

levellevel

TreatmentTreatment


Inhalation Injury above the GlottisInhalation Injury above the Glottis

Upper airway structures Upper airway structures susceptible to injury if susceptible to injury if exposed to high exposed to high temperaturestemperatures Signs and symptomsSigns and symptoms

Prehospital carePrehospital care


Inhalation Injury below the GlottisInhalation Injury below the Glottis

Mechanisms of direct injury to lung Mechanisms of direct injury to lung parenchyma areparenchyma are HeatHeat Toxic material inhalationToxic material inhalation

Signs and symptoms often delayed Signs and symptoms often delayed

Prehospital care Prehospital care


Chemical Burn InjuryChemical Burn Injury Three common types of caustic agentsThree common types of caustic agents

Alkalis (strong bases with a high pH)Alkalis (strong bases with a high pH)• Hydroxides and carbonates of:Hydroxides and carbonates of:

Sodium, potassium, ammonium, lithium, barium, calciumSodium, potassium, ammonium, lithium, barium, calcium Oven cleaners, drain cleaners, fertilizers, heavy industrial Oven cleaners, drain cleaners, fertilizers, heavy industrial

cleaners, cement and concretecleaners, cement and concrete

Strong acidsStrong acids• Rust removersRust removers

• Bathroom cleanersBathroom cleaners

• Swimming pool acidifiersSwimming pool acidifiers Organic compounds (chemicals that contain carbon)Organic compounds (chemicals that contain carbon)

• WoodWood

• CoalCoal


Chemical Burn InjuryChemical Burn Injury Intraoral chemical burns Intraoral chemical burns

sustained by a boy who sustained by a boy who ingested bleachingested bleach


Chemical Burn InjuryChemical Burn Injury Severity of chemical injury related to:Severity of chemical injury related to:

Chemical agentChemical agent Concentration and volume of chemicalConcentration and volume of chemical Duration of contactDuration of contact


AssessmentAssessment——Chemical InjuryChemical Injury Determine:Determine:

Type of chemicalType of chemical Concentration of chemical Concentration of chemical Volume of chemical Volume of chemical Mechanism of injuryMechanism of injury

• Local immersion of body part, injection, splashLocal immersion of body part, injection, splash

Time of contaminationTime of contamination First aid before EMS arrivalFirst aid before EMS arrival Appearance (chemical burns vary in color)Appearance (chemical burns vary in color) PainPain


ManagementManagement Scene safetyScene safety

Consider protective gearConsider protective gear

Remove all clothing, including shoesRemove all clothing, including shoes

Brush off powdered chemicalsBrush off powdered chemicals

Irrigate affected area with copious amounts of waterIrrigate affected area with copious amounts of water


Chemical Burn Injury to the EyesChemical Burn Injury to the Eyes

CausesCauses

Signs and symptomsSigns and symptoms

Management Management Antidotes or neutralizing Antidotes or neutralizing

agentsagents No agent superior to water No agent superior to water

for treating most chemical for treating most chemical injuriesinjuries Use of nasal cannula for eye irrigation


Specific Chemical InjuriesSpecific Chemical Injuries PetroleumPetroleum

Hydrofluoric acidHydrofluoric acid

Phenol (carbolic acid)Phenol (carbolic acid)

AmmoniaAmmonia

Alkali metalsAlkali metals


Electrical Burn InjuriesElectrical Burn Injuries EpidemiologyEpidemiology

IncidenceIncidence

Morbidity/mortalityMorbidity/mortality


Types of Electrical InjuryTypes of Electrical Injury Tissue damage produced by electrical current Tissue damage produced by electrical current

depends ondepends on Amperage (current flow)Amperage (current flow) Voltage (force)Voltage (force) ResistanceResistance Type of currentType of current

• AlternatingAlternating

• DirectDirect

Current pathwayCurrent pathway Duration of current flowDuration of current flow


Types of Electrical InjuryTypes of Electrical Injury Direct contact burnsDirect contact burns

Arc injuriesArc injuries

Flame and flash burnsFlame and flash burns


Direct Contact BurnDirect Contact Burn Direct contact burnDirect contact burn——

entry wound (hand)entry wound (hand)

Exit woundExit wound


Effects of Electrical InjuryEffects of Electrical Injury Musculoskeletal Musculoskeletal

Similar to crush injurySimilar to crush injury Myoglobin released from muscle damageMyoglobin released from muscle damage

Cardiovascular Cardiovascular Significant dysrhythmiasSignificant dysrhythmias TachycardiaTachycardia HypertensionHypertension Hemolysis releases hemoglobinHemolysis releases hemoglobin Blood vessel necrosisBlood vessel necrosis


Effects of Electrical InjuryEffects of Electrical Injury External burnsExternal burns

Respiratory injuryRespiratory injury Ventilation impaired Ventilation impaired

Neurological injuriesNeurological injuries Respiratory center depressionRespiratory center depression Brain tissue injuryBrain tissue injury

Myoglobin release and renal involvementMyoglobin release and renal involvement


Assessment and ManagementAssessment and Management Scene safety for rescuers or bystandersScene safety for rescuers or bystanders

If patient is in contact with electrical source, If patient is in contact with electrical source, consult appropriate personnel before consult appropriate personnel before touching patienttouching patient Once scene is safe, patient care can beginOnce scene is safe, patient care can begin


Initial AssessmentInitial Assessment Proceed as for all other trauma patientsProceed as for all other trauma patients

Immobilize cervical spineImmobilize cervical spine

If apnea, provide assisted ventilation:If apnea, provide assisted ventilation: Intubation because apnea may persist for lengthy periodsIntubation because apnea may persist for lengthy periods

For breathing patient, maintain a patent airway and For breathing patient, maintain a patent airway and support with supplemental high-concentration oxygensupport with supplemental high-concentration oxygen


Initial AssessmentInitial Assessment If patient is in cardiac arrest, resuscitation If patient is in cardiac arrest, resuscitation

efforts should be implemented according to efforts should be implemented according to protocolprotocol


HistoryHistory History History

Chief complaint (e.g., injury, disorientation)Chief complaint (e.g., injury, disorientation) Source, voltage, and amperage of electrical injurySource, voltage, and amperage of electrical injury Duration of contactDuration of contact Level of consciousness before and after injuryLevel of consciousness before and after injury Past significant medical historyPast significant medical history


Physical ExaminationPhysical Examination Search for:Search for:

Entrance and exit woundsEntrance and exit wounds Trauma caused by tetany or a fallTrauma caused by tetany or a fall

Remove all clothing and jewelryRemove all clothing and jewelry Assess and document distal pulses, motor Assess and document distal pulses, motor

function, and sensation in all extremities function, and sensation in all extremities Cover wounds with sterile dressingsCover wounds with sterile dressings Manage associated trauma appropriatelyManage associated trauma appropriately Monitor ECGMonitor ECG


ManagementManagement Early fluid resuscitation is critical Early fluid resuscitation is critical

Establish two large-bore IV lines in extremity Establish two large-bore IV lines in extremity without entry or exit woundswithout entry or exit wounds

• Fluid of choice is LR or NSFluid of choice is LR or NS

• Flow rate determined by patient’s clinical statusFlow rate determined by patient’s clinical status


Lightning InjuryLightning Injury 70 deaths/year70 deaths/year

DC of 200,000 ampsDC of 200,000 amps

Potential of 100 million voltsPotential of 100 million volts

Injury by direct strike or side flashInjury by direct strike or side flash

Cardiac arrest possibleCardiac arrest possible


Lightning InjuryLightning Injury

Pathway of damage Pathway of damage often often overover rather than rather than throughthrough skin skin Lightning burns are Lightning burns are

linear, feathery, and linear, feathery, and punctate (pinpoint) punctate (pinpoint)

Classified as minor, Classified as minor, moderate, or severemoderate, or severe


Assessment and ManagementAssessment and Management Scene safety Scene safety Prevent injury from subsequent lightning strikesPrevent injury from subsequent lightning strikes Airway and ventilatory supportAirway and ventilatory support Basic and advanced life supportBasic and advanced life support Patient immobilizationPatient immobilization Fluid resuscitation to prevent hypovolemia and renal failureFluid resuscitation to prevent hypovolemia and renal failure Pharmacological therapy (per protocol) Pharmacological therapy (per protocol) Wound careWound care Rapid transport to appropriate hospitalRapid transport to appropriate hospital


Radiation ExposureRadiation Exposure Industrial radiography is sourceIndustrial radiography is source

Rarely requires emergency careRarely requires emergency care

Scene safety is a priorityScene safety is a priority


Radioactive ParticlesRadioactive Particles Alpha particlesAlpha particles

Skin will stopSkin will stop Dangerous if ingested or inhaledDangerous if ingested or inhaled

Beta particlesBeta particles Penetrate subcutaneous tissuePenetrate subcutaneous tissue Full PPE, including SCBA, neededFull PPE, including SCBA, needed

Gamma rays and x-raysGamma rays and x-rays Most dangerousMost dangerous Lead shields neededLead shields needed


Radiation ExposureRadiation Exposure Nonionizing radiationNonionizing radiation

Not usually considered dangerousNot usually considered dangerous Radio waves and microwavesRadio waves and microwaves

Ionizing radiationIonizing radiation Nuclear weaponsNuclear weapons ReactorsReactors Radioactive materialRadioactive material X-ray machinesX-ray machines Threat to rescue personnelThreat to rescue personnel


Measurements of RadiationMeasurements of Radiation RoentgensRoentgens

RAD (radiation absorbed dose)RAD (radiation absorbed dose)

REM (roentgen equivalent man)REM (roentgen equivalent man)

Radiation dosesRadiation doses


Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents

Approach with cautionApproach with caution

Do not enter scene until it is secured Do not enter scene until it is secured Rescue personnel, emergency vehicles, and Rescue personnel, emergency vehicles, and

command post positioned 200-300 ft upwind of sitecommand post positioned 200-300 ft upwind of site Should not eat, drink, or smoke at accident site or in Should not eat, drink, or smoke at accident site or in

any rescue vehicleany rescue vehicle


Emergency Response to Emergency Response to Radiation AccidentsRadiation Accidents

Contact appropriate local authorities Contact appropriate local authorities

Wear suitable protective clothing Wear suitable protective clothing

Dose meters should be available for all rescue Dose meters should be available for all rescue personnelpersonnel


Personal Protection from RadiationPersonal Protection from Radiation

FactorsFactors TimeTime DistanceDistance ShieldingShielding QuantityQuantity


Emergency Care for Victims of Emergency Care for Victims of Radiation AccidentsRadiation Accidents

Patients who have been irradiated are not radioactivePatients who have been irradiated are not radioactive Follow protocol for removing radioactive material from a Follow protocol for removing radioactive material from a

patient's clothing, skin, or open woundspatient's clothing, skin, or open wounds Treat patients in normal fashionTreat patients in normal fashion Move patient away from radiation sourceMove patient away from radiation source Do not delay lifesaving care for patient transfer or Do not delay lifesaving care for patient transfer or

decontaminationdecontamination IV fluid replacement should be initiated if indicated using strict IV fluid replacement should be initiated if indicated using strict

aseptic techniqueaseptic technique


Radiation DecontaminationRadiation Decontamination Radiation emergencies may be defined as:Radiation emergencies may be defined as:

CleanClean• Patient exposed but not contaminatedPatient exposed but not contaminated

DirtyDirty• Patient contaminatedPatient contaminated

• Only properly trained personnel should attempt to Only properly trained personnel should attempt to decontaminate radiation victimsdecontaminate radiation victims

Patients who are transported should be isolated from Patients who are transported should be isolated from the environmentthe environment

Transport all patient’s effects with patientTransport all patient’s effects with patient


ConclusionConclusionUnderstanding the consequences of burn Understanding the consequences of burn

injuries and appropriate prehospital injuries and appropriate prehospital management can reduce morbidity and management can reduce morbidity and mortality in this complex patient group.mortality in this complex patient group.


Questions?Questions?


Chap 23 Burns

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Transcript of Chap 23 Burns