EMT Lecture - Burns

Understanding Burns in EMS

Overview of Burns

• The discussion focuses on burns, a common occurrence in Emergency Medical Services (EMS), and will cover classifications and characteristics of different types of burns.

Classification of Burns

• The primary focus is on thermal burns, which result from exposure to heat sources such as hot liquids, steam, or heated surfaces.

• There are three main classifications of burns that every EMT must understand: superficial (first-degree), partial thickness (second-degree), and full thickness (third-degree).

Superficial Burns (First-Degree)

• A superficial burn is characterized by redness of the skin, similar to sunburn. It occurs when the skin's outer layer is damaged.

• Redness indicates a first-degree burn regardless of how it was caused; it signifies exposure to a heat source.

• These burns are extremely painful but typically heal without significant medical intervention.

Partial Thickness Burns (Second-Degree)

• A second-degree burn involves blisters along with redness. The presence of blisters differentiates it from first-degree burns.

• This type is more serious than first-degree burns and also causes significant pain for the patient.

Full Thickness Burns (Third-Degree)

• Full thickness burns damage all layers of skin down to muscle or bone, often appearing black or white due to charring.

• Unlike other types, third-degree burns may not be painful at the site due to nerve ending destruction; however, surrounding areas can still be very painful.

Clarification on Burn Classifications

• It's important to note that there cannot be a third-degree burn without accompanying first and second degree burns; they occur together in most cases.

Understanding Burns and the Rule of Nines

The Nature of Burns

• Third-degree burns may not cause pain in the burned area due to nerve damage, but surrounding first and second-degree burns can be extremely painful.

• It's a misconception that third-degree burns are less severe; they often coexist with painful first and second-degree burns.

• In practice, about 90% of burn cases are first and second-degree; third-degree burns are rare and involve deeper tissue damage.

• Different types of thermal burns (e.g., from fire, steam, hot water) cause similar damage, while electrical and chemical burns have distinct characteristics.

• Friction burns typically present as first-degree injuries, similar to thermal burns.

The Rule of Nines Explained

• The "Rule of Nines" is a method for estimating body surface area affected by burns; it's essential knowledge for EMTs.

• A simple diagram can help remember the rule: each major body region represents approximately 9% of total body surface area.

• This calculation helps medical professionals communicate effectively about burn severity upon patient arrival at a hospital.

Detailed Breakdown of Body Regions

• For adults, the head (front and back), thorax (anterior and posterior), abdomen, arms, legs, and buttocks each account for specific percentages:

• Head: 9% front + 9% back

• Thorax: 9% anterior + 9% posterior

• Abdomen: 9%

• Each leg: 9% anterior + 9% posterior

Practical Application in Burn Assessment

• In real-life scenarios, it’s uncommon for an entire limb to be burned. Estimations must adjust based on actual burn coverage (e.g., half a leg).

Understanding Burn Severity and Treatment

The Concept of 1% in Medicine

• The discussion begins with the concept that only 99% of knowledge is covered, with the remaining 1% referring to genitalia. This highlights the need for inclusivity in medical education.

• A median number is used to accommodate various demographics, referred to as the "1%" rule in medicine, particularly when discussing body surface area (BSA) affected by burns.

Assessing Burn Severity

• Understanding burn severity involves recognizing five critical locations on the body: hands, face, feet, and genitalia. Burns in these areas elevate a patient's status to critical.

• The importance of assessing BSA after a burn incident is emphasized; specific locations automatically classify a burn as critical regardless of size or degree.

Criteria for Critical Burns

• In New York City, any burn affecting hands, face, feet, or genitalia is classified as critical. This classification helps determine whether a patient should be sent to a regular hospital or a specialized burn center.

• First-degree burns are generally not considered serious unless they cover more than 75% of the body. Second-degree burns become critical if they affect over 30%, especially in designated areas.

Degrees of Burns and Their Implications

• For second-degree burns to be deemed critical, they must exceed 30% coverage elsewhere on the body or occur in one of the four specified areas.

• Third-degree burns are classified as critical if they cover more than 10% of any part of the body. Additionally, respiratory tract involvement from burns also qualifies as critical.

Treatment Protocol for Burns

• The first step in treating burns is stopping the burning process immediately; this includes removing contact with hot substances.

Burn Treatment Protocols

Initial Treatment for Burns

• The primary treatment for first and second-degree burns is cold running water, ideally from a faucet or shower.

• Avoid removing clothing or jewelry that adheres to the skin; cutting away loose clothing is acceptable to prevent further skin damage.

• It’s crucial to expose the burn area, even if it means removing pants, especially in cases of severe burns.

Duration and Method of Cooling

• The cooling process should last as long as possible, ideally 20 minutes, to effectively stop the burning process before transport.

• If transport is necessary before cooling can be completed, wrap the burned area in moist sterile dressings for pain relief and comfort.

Pain Management and Shock Considerations

• Burns are extremely painful; proper analgesia should be provided by medics during transport.

• Large burns can lead to significant plasma loss, potentially resulting in hypovolemic shock due to fluid loss.

Managing Shock in Burn Victims

• Understanding that patients with extensive burns may enter shock requires knowledge of appropriate treatments for both shock and burns.

• Keeping the patient warm is essential when managing shock alongside burn treatment.

Dressing Techniques Based on Burn Severity

• For burns covering 10% or less of body surface area, moist dressings can be used; for larger areas, dry dressings are recommended post-cooling.

• Proper wrapping prevents infection; antibiotics are no longer routinely administered prophylactically due to past practices being deemed ineffective.

Infection Prevention Strategies

Understanding Burn Treatment Protocols

Initial Considerations for Unconscious Patients

• When dealing with unconscious patients, immediate transport to the closest trauma center is crucial, as time may not allow for transfer to a specialized burn center.

• The cause of unconsciousness must be assessed; it could stem from cardiac arrest due to fire exposure rather than burns alone.

Decision-Making in Patient Transport

• The decision on where to take a patient depends on multiple factors, including stability and airway issues. Stable patients can be transported to burn centers if they do not have airway or blood pressure problems.

• Conscious patients should receive cold water irrigation for burns, while unconscious ones require different protocols involving sterile dressings.

Special Considerations for Burn Severity

• Assessing shock is vital when treating burn victims; treatment varies significantly based on the percentage of body surface area burned (less than or more than 10%).

Electrical Burns: Key Insights

• The primary concern with electrical burns is cardiac health rather than the burn itself. Immediate assessment of heart function is essential.

• Electrical burns typically present with entrance and exit wounds, similar to gunshot injuries.

Chemical Burns: Treatment Protocol

• Chemical burns require thorough irrigation for at least 20 minutes. This protocol is critical in minimizing damage.

• Common household chemicals like oven cleaners can cause severe chemical burns; proper protective measures are necessary during their use.

Case Study: Chemical Burn Incident

• A notable case involved a young man who suffered severe chemical burns from an exploding paint can. Quick action in irrigating his injuries helped save his eyesight.

General Guidelines for Chemical Exposure

• Always use water for irrigation of chemical burns—neutralizing agents should never be attempted as they may worsen the situation.

Understanding Electrical Burns and Their Implications

The Nature of Electrical Burns

• Discussion on how electrical burns can lead to heart failure, emphasizing the need for awareness of symptoms related to arrhythmias.

• Explanation that not all electrical injuries present with clear entry and exit wounds; variations exist based on the nature of the incident (e.g., explosion vs. direct contact).

Respiratory Burns from Electrical Injuries

• Description of a case involving respiratory burns due to inhalation of boiling air, highlighting signs such as singed facial hair and skin.

• Urgency in calling paramedics for patients with respiratory burns, stressing the risk of airway closure without warning.

Importance of Burn Centers

• Commentary on the lack of burn centers in certain areas, specifically mentioning Brooklyn and alternatives like Cornell or Jacobi hospitals.

• Personal anecdote about a physician's sudden death impacting hospital choices, underscoring the importance of reliable medical facilities.

Vital Signs Monitoring in Emergency Situations

Essential Skills for Medical Personnel

• Emphasis on having a watch to measure vital signs accurately during emergencies; understanding seconds is crucial.

• Introduction to assessing skin condition using CTC (Color, Temperature, Condition), which helps identify shock states.

Patient Assessment Techniques

• Overview of key assessment points: lung sounds, mental status, and blood pressure measurements are critical for patient evaluation.

Utilizing SAMPLE Acronym for Patient History

• Explanation of SAMPLE acronym (Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake/Events leading up), which should be asked consistently regardless of injury severity.

• Real-life example illustrating how asking about other pains can reveal critical information that may otherwise be overlooked.

Common Pitfalls in Patient Communication

Understanding Patient History and Communication

The Importance of Accurate Medical History

• Discussion on the significance of understanding a patient's medical history, particularly regarding past surgeries like coronary artery bypass graft (CABG), often referred to as "cabbage" in medical terms.

• Challenges faced by healthcare providers when patients are not forthcoming with their medical history; reasons include forgetfulness or reluctance to share information.

• Anecdote about how nurses sometimes receive more accurate patient histories than doctors, highlighting the communication gap between patients and healthcare professionals.

Common Issues in Patient Communication

• Patients often provide irrelevant details from their past instead of focusing on significant medical events that impact current health, such as major surgeries or diagnoses.

• Emphasis on the need for specific information regarding serious conditions like thyroid cancer or diabetes, which are crucial for effective treatment planning.

Critical Questions During Assessment

• The importance of asking about the last meal or drink consumed by a patient; this is vital for surgical procedures where anesthesia is involved.

• Surgeons' preferences regarding fasting before elective surgery to prevent complications during operations.

Psychological Factors in Physical Symptoms

• Understanding that physical symptoms can be influenced by psychological stressors; healthcare providers should consider these factors when assessing a patient's condition.