Prehospital and Emergency Room Care for Burns

Teodoro J. Herbosa MD FPCS!Department of Emergency Medicine!Division of Trauma Dept of Surgery!

Philippine General Hospital!University of the Philippines, Manila!

Former Undersecretary DoH

BURN INJURIES:A SERIOUS PUBLIC HEALTH PROBLEM

• Globally a serious public health problem • Devastating injury - 4th most common

injury • >195,000 deaths yearly from fires alone • More deaths from scald, electrical

burns, & other forms of burns • Global data are not available

• Fire-related deaths rank among the 15 leading causes of death - children & young adults 5-29 yrs !

• > 95% of fatal burns occur in low/middle-income countries !

• < 5 yrs and elderly (> 70 yrs) - highest mortality rates

• millions left with disabilities & disfigurement resulting in stigma

• more tragic as burns are so eminently preventable

BURN TREATMENT The nature and complexity of severe burn injury requires a collaborative approach to patient care. This is provided by a multi-disciplinary team with expertise in the management of severe burns with supporting services such as: prehospital, emergency room, critical care, surgery, reconstruction and rehabilitation.

• Bringing together the expertise required to coordinate clinical services across the continuum of care - from first responder, prehospital, initial hospital admission through to hospital discharge, rehabilitation and ongoing care.

• Sharing clinical expertise • Developing standardized clinical practice

guidelines for patient care • Increasing the focus on prevention, improving

links to community outreach services for patients and undertaking research to improve patient care

A great number of patients who had burn injuries were alive upon reaching the hospital

Most patients with burn injuries are treated and sent home while some are being admitted

Most burn patients improved after treatment.

PATHOGENESIS OF BURN INJURY (INITIAL AND DELAYED)

KEY INSULTS Heat Induced Injury !Inflammatory Mediator Injury !Ischemia Induced Injury

Burns : results from dry heat, corrosive substances/friction!

!

!! Scalds: caused by wet heat!!General Principles:! first address your own safety! stop burning! cover injury! obtain medical aid

Classification of burns!

! ! ! thermal! !chemical! !electrical

Burn Patient

First Degree BurnInvolves the epidermis!Redness, mild swelling!

Tenderness, pain!E.g. mild sunburn!

First aid! relieve pain! dec pain/infl! moisturizer

Second Degree BurnDermis and epidermis!

Blister formation, looks raw!

Swelling ,severe pain!First aid!

analgesic! hospital!

cover!Topical antibiotic

Third Degree BurnSkin, fats, muscles!

Leathery,waxy charred!No pain!Hospital!

Cover !Treat for shock

Extent of BurnsEstimating the body surface !

Rule of palm! victims hand,it

represents 1% ! for small of scattered

burn!Large burn, unburned

subtract to 100%

Thermal Burn

Pointers: seek medical attention !Burns of face, hands, feet and genital

are more severe!Circumferential burn!Age( < 5 y/o,>55 y/o)!

Electrical injury!Child abuse is suspected!

Surface of 2 degree >15% of BSA!3rd burn

Chemical Burn

Chemical burns:

!

caustic or corrosive substance! alkalis ( drain cleaners)!

acids (battery acids)! organic compounds(petroleum

products)!First Aid:!

flood flush with water > 20 min

remove contaminated clothing! sterile dressing!

hospital! chemical burn to eye flush with

water

Electrocution Current of 1,000 volts or > high

voltage!Entrance and exit wound!

Disrupt normal heart rhythm!First Aid:!

safety first! check ABC!Treat for shock!

hospital

Electrical Injuries

Approaching the Victim

ABC’s of Life Support

Call an ambulance

Summary of First Aid for Burns

Stop the burning and cool area!Check ABC!

Depth and extent!Determine other injuries!

Burn severity!Seek medical attention

Inhalational Injuries

CARBON MONOXIDE TOXICITYCarbon monoxide toxicity - leading

cause of death in fires While oxygen is being used during

combustion, carbon monoxide is being released -

it is a basic by-product of combustion. Carbon monoxide is rapidly

transported across the alveolar membrane (lungs)

and preferentially binds with the hemoglobin molecule (RBC) in place

of oxygen.

CARBON MONOXIDE TOXICITY shifts the Hb-O2 curve to the left, impairing oxygen unloading at the

tissues a major impairment in oxygen delivery, since 98% of oxygen is carried to the

tissues on Hb prolonged exposure, CO can saturate

the cell, binding to cytochrome oxidase,

thereby further impairing mitochondrial function and

adenosine triphosphate (ATP) production.

CARBON MONOXIDE TOXICITYSYMPTOMS:

usually not present until carboxyhemoglobin > 15%.

those of decreased tissue oxygenation, initial manifestations being neurologic

due to the impairment in cerebral oxygenation.

myocardial dysfunction can also develop,

with evidence of myocardial ischemia or even infarction,

especially with preexisting coronary artery disease.

CARBON MONOXIDE TOXICITYSYMPTOMS:

neurologic dysfunction can lead to a progressive/permanent cerebral

dysfunction. patient will awaken transiently after severe inhalation injury only to have

progressive neurologic deterioration 24 to 48 hrs later.

Cyanide toxicity - very similar to carbon monoxide, with severe metabolic

acidosis and obtundation in severe cases.

Diagnosis - more difficult because cyanide levels not readily available

EFFECTS OF CARBON MONOXIDE POISONING

ALTERED JUDGMENTCONFUSION

DISORIENTATION LETHARGY,

STUPOR RESPIRATORY

ARRESTDEATH

Thank you very muchTeodoro J. Herbosa M.D. Dept. of Emergency Medical Services Philippine General Hospital University of the Philippines,

Manila !twitter Teddybird fb Ted Herbosa