PROTOCOL #7
Burns (Scalds)/Explosion
Hundreds of thousands of patients seek medical
attention for burn injuries each year-more than 2.4 million in the
What is a burn? A burn is an injury
that damages and destroys skin layers. It can be caused by heat, electricity,
chemicals, radiation or frostbite. Burns are usually a result of one of the
following
Scalds -Scalds are the most common cause of burns. They
occur when skin comes into contact with hot liquids. Scalds with hot oil are
generally more severe than with hot water because oil heats to higher
temperatures than water, and the thicker liquid may remain on the skin for a
longer period of time. Similarly, covered areas of skin can yield severe burns
because clothing retains heat, keeping scalding liquid in contact with the skin
longer. Even steam can cause a severe scalding injury.
Thermal - Flame and Flash -Flame is the next most common cause of burn
injuries. Likely sources include careless smoking, improper use of flammable
liquids, auto accidents or clothing ignited by stoves or space heaters. Flash
follows closely behind flame with injuries from natural gas explosions, propane
and gasoline. Flash flames can cause intense heat over a brief time. Clothing,
unless ignited, often protects skin in this type of burn.
Chemical -Most often, chemical burns occur during industrial
accidents, but they can also occur in the home with common battery acids, oils
and gases. Chemical burns can cause progressive damage until the chemical is
inactivated. The severity of this type of burn depends on the kind of chemical,
length of exposure and amount of tissue involved.
Several factors are used to
determine the severity of a burn injury, including the patient's age, size and
depth of burn, and the location of the burn. A "Rule of Nines" chart
is used to determine the total body surface area (TBSA) that has been burned.
The chart divides the body into sections that represent 9 percent of the body surface
area. In determining the TBSA of children and infants the Lund-Browder chart is used. A separate chart is used because the
surface area of the head and neck of children is larger and the limbs are
smaller than adults.
Burns are classified by depth
and they may be first, second or third degrees.
First-degree
burns are red and very sensitive to touch, and the skin will appear blanched
when light pressure is applied. First-degree burns involve minimal tissue
damage and they involve the epidermis (skin surface). These burns affect the
outer-layer of skin causing pain, redness and swelling. Sunburn is a good
example of a first-degree burn.
Symptoms
Redness
Swelling
Pain
Peeling skin
Shock (pale, clammy skin,
weakness, bluish lips and finger nails)
White or charred skin
Second-degree
burns affect both the outer-layer (epidermis) and the under lying layer of skin
(dermis) causing redness, pain, swelling and blisters. These burns often affect
sweat glands, and hair follicles.
If a deep second-degree burn
is not properly treated, swelling and decreased blood flow in the tissue can
result in the burn becoming a third-degree burn.
Symptoms
Redness
Swelling
Pain
Peeling skin
Shock (pale, clammy skin,
weakness, bluish lips and finger nails)
White or charred skin
Third-degree
burns affect the epidermis, dermis and hypodermis, causing charring of skin or
a translucent white color, with coagulated vessels visible just below the skin
surface. These burn areas may be numb, but the person may complain of pain.
This pain is usually because of second-degree burns. Healing from third-degree
burns is very slow due the skin tissue and structures being destroyed.
Third-degree burns usually result in extensive scarring.
Symptoms
Redness
Swelling
Pain
Peeling skin
Shock (pale, clammy skin,
weakness, bluish lips and finger nails)
White or charred skin
An alert burn
patients will
strongly benefit from cooling the burned area.
Instructions for cooling and flushing burns are given on protocol
X-13. These instructions can be given at
ANY TIME DURING CASE ENTRY OR KEY QUESTIONS.
You DO NOT have to wait until PDIs to give
this instruction.
COOLING
and
(Heat
or Fire) “Cool the burn for up to 10 minutes with water.
(Chemical)
Flush the area with a lot of water until help arrives.
A good method of doing this is running a
gentle stream of water across the injury under a faucet or under a garden
hose. If this is not possible then a
clean rag can be dipped in cool water and applied gently to the injury.
Across
2 Burns can be caused by this
6 These are one of the most complex and harmful physical injuries.
9 This is the most common cause of burns.
11 An alert burn patient will benefit from doing this to the burned area
13 Burns are classified by this
15 The rule of this is used to determine the TBSA
17 Burns can be caused by this
18 Auto accidents can cause this type of burn
Down
1 This type of burn can occur during industrial accidents
3 Scalds from this are generally more severe than with hot water.
4 Burns require this type of initial care
5 Following initial trauma care, careful evaluation and appropriate ________management is required.
7 Blistering can occur when this degree of burn is received.
8 A burn damages and destroys this
10 Burns (Scalds)/Explosions is this protocol number in the NAEMD.
11
12 Burns can be caused by this
14 One of the degree of burns, hint....it is not second!
16 This can cause a severe scalding injury
DON’T SCROLL DOWN
UNTIL
YOU WANT THE ANWERS!
