chapter 12 soft tissue injuries burns. 2 million/year (reported) ~ 12,000 die annually almost 1...

Chapter 12

Soft Tissue Injuries

Burns

Burns

• 2 million/year (reported)

• ~ 12,000 die annually

• Almost 1 million require long term hospitalization

• Children under 6 YOA burnt most often (usually scald burns)

Classification & Evaluationof Burns

• Agent Source– Thermal Flame, excessive heat from

fire, steam, hot liquids, hot objects

– Chemical Acid, Alkaline– Electricity AC/DC, lightning– Radiation UV, nuclear– Light Intense light source


• Degree– 1st Degree (Superficial)

• Redness, pain, moist appearance to skin

– 2nd Degree (Partial Thickness)• Severe pain, swelling,

• Blistering (within 48 hours)

• Redness (may appear mottled)


• Degree con’t.– 3rd Degree (Full thickness)

• Difficult to distinguish from 2o

• Usually areas charred (maroon to black) or white

• Usually dry in appearance

• Usually no pain (except at periphery)– May require skin grating

– Dense scarring

– Infection of major concern


• 1o 2o 3o


• Severity– Agent & Source– Degree– Body Region

• Face, hands, feet, genitalia• Circumferential burns

– Extent of Body Surface Area (BSA) Involved• Rule of Palm

– Patient’s palm = ~1% of BSA

Region Adult Child/Infant

Head 9% 18%

Anterior Trunk Chest Abdomen

18% (9%) (9%)

18% (9%) (9%)

Posterior Trunk Upper Back Lower back & Buttocks

18% (9%)

(9%)

18% (9%)

(9%)Each UpperExtremity

9% 9%

Each LowerExtremity

18% 14%

Groin 1% 1%

Total BSA 100% 101%

Percentage of Body Surface Area(BSA)


• Severity con’t.– Age– Predisposing Illness or Injury

Burns

• Minor Burns– 1o involving less than 20% of BSA– 2o involving less than 15% of BSA– 3o involving less than 2% BSA

• Excluding face, hands, feet, genitalia

• Moderate Burns– 1o involving 20-75% BSA– 2o involving 15-30% BSA– 3o involving 2-10% BSA

Burns

• Critical Burns– 1o involving more than 75% BSA– 2o involving more than 30% BSA– 3o involving more than 10% BSA

• 2o & 3o burns of the hands, feet, face or genitalia

• Circumferential burns

• All burns complicated by respiratory injuries, other soft tissue injuries, bone/joint injuries, other injuries or illness

Care for Thermal Burns

• Care– Stop Burning Process, Cool Burn– Ensure Airway, Complete Primary Assessment– Treat for Shock, Do Not Clear Debris– Cover With Dressing, Bandage Loosely

• Remove jewelry

• Separate digits, hand should be in position of function

Care for Burns

• Chemical Burns– Flush area with copious amounts of water

• If dry chemical (brush away 1st then flush)

• Do Not allow victim to stand in water

– Flush affected area at least 20 minutes– Apply sterile dressing or burn sheet– Ensure airway– Treat for shock

Smoke Inhalation

• Signs & Symptoms– Respiratory Difficulty– Coughing– Smokey Smell or Odor of Chemicals on Breath– Black Carbon Residue– Singed Nasal or Facial Hair

Smoke Inhalation

• Care– Remove from source– Complete initial patient assessment

• Care for ABC’s

– Provide high flow oxygen if available– Activate EMS

Electrical Burns

• Concerns– Amount of deep tissue injury may be great

• Entrance wound usually small

• Exit wound may be extensive and deep

– Burn may be accompanied by cardiac arrest– Violent muscular contractions possible

• Can result in avulsion fractures or dislocations

Electrical Burns

• Care– Ensure your own safety

• Safety Zones• Turn power off prior to contacting victim

– Complete initial assessment• Care for ABC’s

– Be prepared to perform CPR– Care for any open wounds– Activate EMS

Lightning Burns

• ~ 1,000 injuries per year

• ~ 200 deaths per year

• Involves massive amounts of energy– Up to 50 million volts– Temperature up to 50,000oF

Lightning Related Deaths

• States where most injuries most frequently occur– Florida– North Carolina– Texas– Places where most injuries occur

• Open fields 27%; Under trees 17%; On or near water12%; Near tractors/heavy equipment 6%;

On golf courses 4%; At telephones 1%; Other 33%

Types of Lightning Injuries

– Direct Strike (most serious)• Usually conducted through a metal object being held

– Flashover (less severe)• Travels over surface of person (usually when wet)

– Side Flash• Strikes object near person and “splashes” through the air

to the person

– Stride Potential• Strikes ground near person then travels up one leg and

down the other

Lightning Injuries

• Characteristics– Burns are usually superficial, feathery, branching

appearance– Usually no entrance or exit wounds– May have thermal burn (if clothes burn)– Blunt trauma possible (from falling)– Neurological Problems

• Paralysis, convulsions, amnesia

– Cardiac arrest possible

Lightning Injuries - Care

• Care– Move patient & self out of danger

• (lightning does strike in the same place twice)

– Prolonged resuscitation may be required• Triage

– Normally with multiple victims if there is no spontaneous cardiac or respiratory activity - lowest priority

– However with lightning strike - high priority

chapter 12 soft tissue injuries burns. 2 million/year (reported) ~ 12,000 die annually almost 1...

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