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Contents: I. Thermal Burn II. Chemical Burn III. Electrical Burn IV. Radiation Burn/Exposure V. Psychosocial Issues I. THERMAL BURN INJURY A. Introduction 1. Studies have shown that surface temperatures of 44° C (111° F) do not produce burns unless exposure time exceeds 6 hours a. At temperatures between 44° and 51° C (111° and 124° F) the rate of epidermal necrosis approximately doubles with each degree of temperature increase b. At 70° C (185° F) or greater, the exposure time required to cause transepidermal necrosis is less than 1 second 2. The degree of tissue destruction depends on the temperature and duration of exposure to flame, flash, scald or hot objects 3. Factors that influence the body’s ability to resist burn injury include: a. The water content of the skin tissue b. Thickness and pigmentation of the skin c. Presence or absence of insulating substances (e.g., skin oils, hair) d. Peripheral circulation of the skin, which affects dissipation of heat B. Local response to burn injury 1. Burn injury immediately destroys cells, or it disrupts their metabolic functions so completely that cellular death ensues 2. Cellular damage is distributed over a spectrum of injury a. Some cells are destroyed instantly b. Others are irreversibly injured c. Some cells may survive if rapid and appropriate intervention is provided in the prehospital setting 3. Major burns have three distinct zones of injury (Jackson’s thermal wound theory) that usually appear in a “bull’s-eye” pattern a. Zone of coagulation 1) The central area of the burn that has sustained the most intense contact with the thermal source 2) Coagulation necrosis of the cells has occurred 3) The tissue is nonviable b. Zone of stasis 1) Surrounds the critically injured area 2) Consists of potentially viable tissue despite serious thermal injury 3) Cells are ischemic because of clotting and vasoconstriction and die within 24 to 48 hours after injury if no supportive measures are undertaken c. Zone of hyperemia 1) Has increased blood flow because of the normal inflammatory response 2) Tissues recover in 7 to 10 days if infection or profound shock does not develop
Injury to the sodium pump in the cell walls accentuates the increased permeability a. Rhabdomyolysis (muscle necrosis) 1) Subsequent hemoglobinuria and myoglobinuria (myoglobin in the urine) 2) Other systemic responses to major burn injury a) Pulmonary response (1) Hyperventilation to meet increased metabolic needs b) Gastrointestinal response (1) Decrease in splanchnic perfusion that may lead to mucosal hemorrhage and transient adynamic ileus (2) Vomiting and aspiration (3) Stress ulcers c) Musculoskeletal response (1) Decreased range of motion from immobility and edema (2) Possible osteoporosis and demineralization (late) d) Neuroendocrine response (1) Increased amounts of circulating epinephrine and norepinephrine. In a small wound these physiological alterations produce a classic inflammatory response without any major systemic effects a. Decreased cardiac output c. the normal process of evaporative loss of water into the environment is dramatically accelerated (5 to 15 times that of normal skin) through the burned tissue 8. Tissue damage from burns depends on: a. particularly with infection or surgical stress f) Immune response -2– . In a large body surface area burn. Other physiological responses can lead to renal failure a. Systemic response to burn injury 1. the burn wound swells rapidly because of the release of chemical mediators a. As sodium moves into injured cells it causes an increase in osmotic pressure that increases the inflow of vascular fluid into the wound 7. Degree of heat b. As a rule. An early manifestation of the systemic effects of a large thermal injury is hypovolemic shock associated with the following: a. Finally. and transient elevation of aldosterone levels e) Metabolic response (1) Elevated metabolic rate. Pain b. Causes an increase in capillary permeability and a fluid shift from the intravascular space into the injured tissues 6. local tissue responses can produce major systemic effects and life-threatening hypovolemia C. Hemolysis (destruction of red blood cells [RBCs]) b.4. Swelling 9. Redness c. Increased vascular resistance (except in the zone of hyperemia) 3. Duration of exposure to the thermal source 5. Decreased venous return b. which may compromise patient outcome 2. As local events occur at the injury site other organ systems become involved in a general response to the stress caused by the burn.
Difficult to do because of the progressive nature of the injury b. and blanch with pressure 2) Typically occur secondary to prolonged exposure to low-intensity heat or short-duration flash exposure to a heat source 3) Only a superficial layer of epidermal cells is destroyed a) They slough (peel away from healthy tissue underneath the wound) without residual scarring 4) Usually heal within 2 to 3 days e. and disability (4) Altered self-image (5) Depression D. burns should be assessed and classified as accurately as possible in the prehospital and ED setting a. Classifications of burn injury 1. wet. Second-degree burns 1) Superficial partial-thickness burns a) Characterized by blisters b) Commonly caused by skin contact with the following: (1) Hot but not boiling water (2) Other hot liquids (3) Explosions producing flash burns (4) Hot grease (5) Flames c) Injury extends through the epidermis to the dermis (1) Basal layers of the skin are not destroyed (2) Skin regenerates within a few days to a week d) Edematous fluid infiltrates dermal-epidermal junction. dry. First-degree burns 1) Are characteristically painful. Ideally. and painful. creating blisters e) Intact blisters provide a seal that protects the wound from infection and excessive fluid loss f) Injured area is usually red. red. Amount of tissue damage from burns may not be evident for hours or sometimes days after the injury 2. Classified as first.and second-degree burns are partial-thickness burns (if uncomplicated by infection or shock) 1) Usually heal without surgery c. usually within 14 days 2) Deep partial-thickness burns a) Depth of burn involves the basal layer of the dermis -3– . Depth of burn injury a. First. and third degree b.(1) Altered immunity resulting in increased susceptibility to infection (2) Depressed inflammatory response g) Emotional response (1) Physical pain (2) Isolation from loved ones and familiar surroundings (3) Fear of disfigurement. second. Third-degree burns are full-thickness burns that usually require skin grafts d. and may blanch when tissue around the injury is compressed g) In the absence of infection these wounds generally heal without scarring. deformities.
the rule of nines is difficult to apply 6) In these situations. Third-degree burns 1) Because the entire thickness of the epidermis and dermis is destroyed. or leathery 3) Definitive sign is a translucent surface in the depths of which thrombosed veins are visible 4) Eschar is present in these injuries 5) Sensation and capillary refill are absent because small blood vessels and nerve endings are destroyed a) Often results in large plasma volume loss. There are several methods used to evaluate burn injury. charred. the American Burn Association (ABA) has devised a categorization of burns to determine severity b. or bone 2) Usually results from incineration-type exposure and electrical burns in which heat is sufficient to destroy tissues below the skin 3. infection. wound may appear red and wet. burn size can be estimated by visualizing the patient’s palm as an indicator of percentage (the “rule of palms”)The palmer surface of a patient’s hand (fingers and palm) equals about 1% of the TBSA -4– . periosteum. and sepsis 6) Natural wound healing may produce contracture deformity and severe scarring 7) Surgical intervention with skin grafting is necessary to: a) Close full-thickness wounds b) Minimize complications c) Allow restoration of maximal function g. skin grafts are necessary for timely and proper healing 2) Injury is characterized by coagulation necrosis of cells and appears pearly white. muscle. injury generally heals within 3 to 4 weeks e) Skin grafting may be necessary to promote timely healing and to prevent scar tissue formation (1) Scar tissue may severely restrict joint movements and cause persistent pain and disfigurement f. Rule of Nines 1) Commonly used in the prehospital and emergency department setting 2) Divides the total body surface area (TBSA) into segments that are multiples of 9% 3) Provides a rough estimate of burn injury size 4) Is most accurate for adults and for children older than 10 years of age 5) If the burn is irregularly shaped or has a scattered distribution throughout the body. fascia. but use of any method should never delay patient care or transport 1) Two common methods include the rule of nines and the Lund and Browder chart 2) In addition.(1) Sensation in and around the wound may be diminished because of the destruction of basal-layer nerve endings b) Depending on the degree of vascular injury. Some burn classifications include a fourth-degree burn 1) Describes a full-thickness injury that penetrates the subcutaneous tissue. Extent and severity of burn injury a. or white and dry c) Major complications are wound infection and subsequent infection d) If uncomplicated.
c. American Burn Association (ABA) categorization 1) Classifies burns as major. hands. or Severe preexisting severe preexisting medical problems medical problem Minor Burn 15% or less body surface area No involvement of face. Lund and Browder chart 1) A more accurate method to determine the area of burn injury a) Assigns specific numbers to each body part 2) Used to measure burns in infants and young children because it allows for developmental changes in percentages of body surface d. or perineum No electrical burns. involvement of hands. feet. severe preexisting medical problems. injury inhalation injury. or perineum face. inhalation injury. or complications -5– . feet. and minor 2) Considers other factors to determine burn severity a) Patient’s age b) Concurrent medical or surgical problems c) Complications that accompany certain burns. or perineum Electrical or inhalation No electrical injury. Concomitant injury concomitant injury. moderate. feet. such as burns of: (1) Face and neck (2) Hands and feet American Burn Association Categorization Major Burn Moderate Burn 25% of the body surface 15% to 25% body or greater surface area Functionally significant No complications of involvement of hands.
Assessment 1. Duration of contact (tissue destruction may continue up to 72 hours) B. Mechanism of injury (local immersion of a body part. The severity of chemical injury is related to: a. Type of chemical substance 1) If the container is available and can be safely transported. Remove all clothing. Chemical burn injury to the eyes a. such as rust removers. burns are result of tissue injury and destruction from necrotizing substances. causing protein hydrolyses & liquefaction b. Alkalis (strong bases with a high pH) 1) Occur in hydroxides and carbonates of sodium. household drain cleaners. Pain C. bathroom cleaners. b. The treatment of chemical injuries varies little from that of thermal burns during the initial assessment. potassium. lithium. Volume of chemical substance d. barium. fertilizers. Irrigate the affected area with copious amounts of water 3. and the structural bonds of cement and concrete 3) Adheres to tissue. including shoes. Organic compounds (chemicals that contain carbon) 1) Most organic compounds are harmless chemicals such as wood and coal 2) Organic compounds that can produce caustic injury to human tissue include phenols and creosote. Appearance (chemical burns vary in color) h. Three types of caustic agents are frequently associated with burn injuries a. Chemical exposure to the eyes irritants) may cause damage ranging from superficial inflammation to severe burns b. Management 1. Patients may have: 1) Local pain 2) Visual disturbance -6– . Chemical agent b. CHEMICAL BURN INJURY A. which can trap concentrated chemicals b. causing serious systemic effects 3. it should be taken to the medical facility b. Caustic chemicals are often present in the home and workplace 2. This can best be accomplished by the following: a. Concentration and volume of the chemical c. Exposure to chemical irritants is common a. Brush off powdered chemicals c. and petroleum products such as gasoline 3) May be absorbed by the skin. Introduction 1.II. and calcium 2) Commonly found in oven cleaners. Treatment is directed at stopping the burning process 2. heavy industrial cleaners. Concentration of chemical substance c. and swimming pool acidifiers c. injection. Time of contamination f. Strong Acids 1) Found in many household cleaners. ammonium. First aid administered before EMS arrival g. splash) e. Ascertain the following exposure factors during the patient history: a.
Use of antidotes or neutralizing agents a. and explosives c.3) Lacrimation 4) Edema 5) Redness of surrounding tissues c. the patient may experience severe hypocalcemia and even death 2) Treatment a) Irrigate the exposed area with copious amounts of water b) Emergency department management may include subcutaneous (SQ) administration of 10% calcium gluconate solution directly into the burn site 3. No agent has been found that is superior to water in copious amounts for treating most chemical injuries D. IV tubing. One of the most corrosive materials known b. In the absence of flame. Petroleum a. Used in industry for: 1) Cleaning fabrics and metals 2) Glass etching 3) Manufacture of silicone chips for electronic equipment c. Widely used in industry as disinfectant in cleaning agents and in the manufacture of plastics. or water from a container 2) If contact lenses are present they should be removed 3) Some agencies use nasal cannulas to irrigate both eyes simultaneously a) The cannula is placed over the bridge of the nose. products such as gasoline and diesel fuel can cause significant chemical burns if prolonged contact occurs b. Management includes: 1) Flushing the eyes with water by using a mild flow from a hose. Specific chemical injuries 1. A soft tissue injury exposure may be painless because of phenol’s anesthetic properties -7– . Hydrofluoric acid a. fertilizers. Fluoride inhibits several chemical reactions essential to cell survival 1) Continues to penetrate and kill cells when it is neutralized by binding to calcium or magnesium e. and run continually into both eyes 4. with the nasal prongs pointing down toward the eyes b) The cannula is attached to an IV administration set using either normal saline solution (NS) or LR solution. Skin contact can result in local tissue coagulation and systemic toxicity if the agent is absorbed d. Lead toxicity can occur if the exposure was from gasoline containing tetraethyl lead 2. endogenous or exogenous hydrofluoric acid can produce very deep and severe injuries 1) If large BSAs are involved. Thus. An aromatic hydrocarbon derived from coal tar b. Phenol (carbolic acid) a. dyes. Both the hydrogen ion and the fluoride ion are damaging to tissue d. Systemic effects from absorption of various hydrocarbons include: 1) Central nervous system (CNS) depression 2) Organ failure 3) Death c.
Wounds should be copiously irrigated with large volumes of water 1) After irrigation. Ammonia a. Water is generally contraindicated when these metals are embedded in the skin as they react with water and produce large amounts of heat c. Respiratory injury from ammonia vapors depends on the concentration and duration of exposure 1) Short-term. Physically removing the metal or covering it with oil minimizes the thermal injury -8– . A noxious. low-concentration exposure may damage the lower respiratory tract d.e. Initial care includes: 1) High-concentration oxygen 2) Ventilatory support as needed 3) Rapid transportation 5. medical direction may recommend that the wound be swabbed with a suitable solvent such as glycerol. Sodium and potassium are highly reactive metals that can ignite spontaneously b. high-concentration exposure usually results in upperairway edema 2) Long-term. irritating gas and strong alkali that is very soluble in water b. or soap and water to bind phenol and prevent its systemic absorption 4. Extremely hazardous if introduced into the eye 1) May result in tissue necrosis and blindness 2) Patient will have swelling or spasm of the eyelids. requiring irrigation with water or a balanced saline solution for up to 24 hours c. Minor exposures may cause CNS depression and dysrhythmias f. Alkali metals a. vegetable oil. Significant exposures (10% to 15% TBSA) may require systemic support and should be carefully observed for signs of respiratory failure g.
1 ampere (amp) is a passage of 1 coulomb of charge per second past any point in a circuit 1) A coulomb is a charge transported through a conductor by a current of 1 ampere flowing for 1 second c. Tissue damage produced by electrical current depends on six factors: a. Voltage a. A 10-amp flow means that 10 coulombs of electricity are passing a point per second 3. muscle.000 volts 1) May involve current with as high as 100. Introduction 1. High-tension accidents commonly range from 7200 to 19. Voltage c. Good patient care b.5% of admissions to burn centers and are responsible for about 500 deaths each year 2. Tissue resistance to electrical flow is highest in bone and decreases progressively through fat.000 volts 4. An understanding of the principles of current and the path of destruction it may produce in the body is essential for: a. Personal safety at the scene of an electrocution B.000. Electrical injuries account for 4% to 6. A measure of the current flow (intensity) per unit time b. Type of current e. blood. skin. Think of amperage as flow and voltage as force b. Resistance to the flow of electricity varies greatly within the body because various tissues have different resistance to current flow c. Two basic forms of electric current: 1) Direct current (DC) 2) Alternating current (AC) b. Characteristics of electricity 1. and nerve tissue 5. A continuous force (tension) applied to any electric circuit that produces a flow of electricity.III. High-voltage electrical injuries result from contact with a source of 1000 volts or greater d. Current pathway f. Amperage b. Tissue Resistance a. DC flows in one direction only 1) Frequently used in industry 2) Type of current used by batteries 3) Commonly used in electrosurgical devices and defibrillators -9– . Electrical resistance is composed of four factors: 1) Resistivity (capacity of material to resist current flow) 2) Size of the object pathway 3) Length of the object pathway 4) Temperature b. Tissue Resistance d. Type of current a. ELECTRICAL BURN INJURY A. Amperage a. 1 volt is the force needed to drive 1 amp of current in a circuit with 1 ohm of resistance 1) An ohm is a measure of resistance of an electrical conductor c.000 to 1. Current flow 2.
Common injury sites include the face and eyes (Welder’s flash) . If the current travels from one hand to the other it may flow across the heart. fascia. muscle. Temperatures generated by these sources can be as high as 2000° to 4000° C (3632° to 7232° F) and the arc may jump as far as 10 feet 3. injury is directly proportional to the duration of contact with the electrical source C. Tissue injury a.10 – . The pathway of the current through the body gives clues about what anatomical structures may be damaged b. the greater the current flow. Foot is a common exit site d. and bone f. Flame and flash burns a. Occur when electric current directly penetrates the resistance of the skin and underlying tissues b. Hands and wrists are common entrance sites c. AC reverses the direction of flow at regular intervals 1) Alterations in current direction can cause tetanic muscle contractions that may “freeze” the victim to the source until the current is terminated 2) Household current in the United States is generally AC and either 120 or 220 volts 3) AC is a more common cause of electrical injury 6. producing ventricular fibrillation or other dysrhythmias 8.4) Characterized by high amperage and low voltage c. Skin may initially resist the flow of current 1) Continued contact with the source lessens resistance and permits increased current flow e. Results from the conversion of electrical energy into heat. Therefore. The amount of heat produced is directly proportional to the square of the current strength multiplied by the resistance of the tissue multiplied by the duration of the current flow (Joule’s law) c. Although tissue destruction may be massive at entrance and exit sites. Direct contact burns Electrical injuries may be a combination of the following types of injury both direct and flash burn a. Types of electrical injury 1. Arc injuries a. Are produced when the heat of electric current ignites a nearby combustible source b. Occur when a person is close enough to a high-voltage source that the current between two contact points near the skin overcomes the resistance in the air 1) Passing the current flow through the air to the bystander b. it is the area between these wounds that poses the greatest threat to the patient’s life 2. The greatest tissue damage occurs directly under and adjacent to the contact points and may include fat. Current flow a. the greater the heat generated 7. Electricity normally flows along a continuous pathway (electrical circuit) 1) The current pathway can be somewhat unpredictable 2) Low-voltage current (less than 1000 volts) usually follows the path of least resistance 3) High-voltage current usually follows the shortest pathway b. Current pathway a. In either case.coagulation necrosis that is caused by intense heat from an electrical current b.
CNS damage may result in seizure or coma with or without focal neurological findings b. Embolism with subsequent complications 10. Oral burns are frequently seen in children less than 2 years old a. Acute renal failure is a serious complication of direct-contact electrical injuries. Prompt resuscitation and management of shock may have a positive impact on these patients . leathery. Hemolysis releases hemoglobin. charred. even of major joints as patient may fall after the electrical shock and sustain significant skeletal trauma. If the current passes through the brain stem respiratory arrest or depression. Direct contact and passage of current may produce extensive areas of coagulation necrosis b. Effects of electrical injury 1. including damage to the cervical spine 11. Severe muscle spasms can produce bony fractures and dislocations. Flash burns may also ignite a person’s clothing or cause fire in the surrounding environment d. which may precipitate in the renal tubules and produce acute renal failure c. The exit wound may be ulcerated and may have an “exploded” appearance where areas of tissue are missing 4. Electrical injury can cause extensive necrosis of blood vessels a. Damage within the extremities after electrical burn is similar to crush injury a.c. Electrical injuries are often unpredictable. Severe muscle necrosis releases myoglobin b. May be associated with injury to the tongue. palate. and damage to the myocardium as it passes through the body-can be delayed 24-48 hours 7. Hypertension and tachycardia associated with a large release of catecholamines is a common finding in electrical injury 6. The skin is usually the first point of contact with electrical current a. and face 5. Nerve tissue is an excellent conductor of electrical current a. success rates are high 8. including ventricular fibrillation (VF) and asystole. or cerebral edema or hemorrhage may rapidly lead to death 9. May result from a combination of: 1) Myoglobin or hemoglobin sludging in the renal tubules 2) Disseminated intravascular coagulation (DIC) secondary to tissue damage 3) Hypovolemic shock 4) DC damage b. Peripheral nerve injury may lead to permanent motor or sensory deficits and may be permanent c. Electrical current may cause significant dysrhythmias. Arterial or venous thrombosis c. or depressed 3. No electrical current passes through the body in this type of burn D. and affects 10% of patients a.11 – . Typically caused by chewing or sucking on low-tension electrical cord b. If the patient has suffered cardiac arrest and early rescue and resuscitation can be initiated by the paramedic. Entrance site is often a characteristic “bull’s eye” wound 1) May appear dry. but certain physiological effects should be anticipated 2. May not be immediately evident and many cause immediate or delayed internal hemorrhage b.
patient care can begin 4. Look between the patient’s fingers and toes examining for sites of entry or exit d. Each patient requires a thorough assessment and a high degree of suspicion for associated trauma E. and sensation in all extremities e. If the patient is not breathing. ECG monitoring should be implemented at the scene and continued during patient transport . Assessment and management 1. If the patient is in cardiac arrest. Numerous other structures may be damaged secondary to electrical injury including: a. Various forms of ulceration 15. and ruptured tympanic membranes are common in some electrical injuries a. If the patient is still in contact with the electrical source. Patient’s chief complaint (e. Manage associated trauma appropriately 7. voltage. Physical examination a.. Initial assessment a. Carefully assess and document distal pulses. hypoventilation may lead to death b. Cover entrance and exit wounds with sterile dressings f. Past significant medical history 6. Electric company b. Contact with AC sources has been documented to produce respiratory arrest and death from tetany of the muscles of respiration 13. Fractures of long bones & vertebra 16. provide assisted ventilation immediately 1) Intubation should be performed as soon as possible because apnea may persist for lengthy periods d. If the respiratory center is disrupted. Be particularly thorough to search for: 1) Entrance and exit wounds 2) Associated trauma caused by tetany or a fall b.g. and amperage of the electrical injury c. maintain a patent airway and support with supplemental high-concentration oxygen e. Duration of contact d.12 – . Other specially trained personnel 3. Remove all clothing and jewelry c. disorientation) b. contact appropriate personnel before approaching the patient a. Proceed as for all other trauma patients b. Immobilize the cervical spine c. Submucosal hemorrhage in the bowel c. injury. motor function. Level of consciousness before and after the injury e. Once the scene is safe. Ventilation may be impaired when electrical burns produce CNS injury or chest wall dysfunction a. Abdominal organs and urinary bladder b.12. resuscitation efforts should be implemented according to protocol 5. For the breathing patient. Fire department c. Source. Obtain a history if possible a. Conjunctival and corneal burns. Cataracts and hearing loss may appear as late as 1 year after the event 14. Begin by ensuring scene safety for rescuers or bystanders 2. Frequent reassessment is necessary because of the progressive nature of electrical injury a.
Dysrhythmias are common. Apply dry.b. minimizing the incidence of renal failure d. Emergency department or interhospital transfer care may include: 1) Regulation of IV infusion rates to maintain a urine output of 75 to 100 ml/hr a) Decreases the potential for renal damage caused by myoglobin 2) Administration of sodium bicarbonate to maintain an alkaline urine a) Increases the solubility of hemoglobin and myoglobin. Early fluid resuscitation is critical in managing patients with severe electrical injury to prevent hypovolemia and subsequent renal failure b. some can be lethal 8.13 – . Establish two large-bore IV lines in an extremity without entry or exit wounds 1) The fluid of choice is usually LR or NS without glucose 2) Flow rate should be determined by the patient’s clinical status c. sterile dressings to entry and exit wounds . Management a.
Harmful effects from radiation exposure 1. Ionizing radiation a. May enter the body through inhalation.IV. clothing. or absorption 1) Can damage internal organs and interfere with chemical functions 2) Considered the most dangerous form of internal radiation exposure g. Require full protective clothing. Victims of these types of accidents rarely require emergency care B. Have more energy and penetrating power c. Require full protective clothing. Protective clothing will not stop gamma rays 1) Require lead shields for protection c.000 times the penetrating power of alpha particles. Roentgens 1) The amount of emitted radiation produced in the air by gamma or xradiation b. May produce both internal and external hazards 1) Localized skin burns 2) Extensive internal damage C. including positive pressure SCBA 4. Radiation absorbed dose (rad) 1) Measurement of both the amount of ionized radiation being emitted and the amount absorbed and active within body tissue . Introduction 1. Considered the least dangerous external radiation source f. 100 times that of beta particles b. Have minimal penetrating ability d. 1/7000 the size of alpha particles b. or skin e. Not usually considered dangerous b. Can penetrate subcutaneous tissue 1) Usually enter the body through damaged skin. Large b. Nonionizing radiation a. Characteristics of radioactive particles 1. Poses a threat to rescue personnel 3. RADIATION BURN/EXPOSURE A. Gamma rays and x-rays a. Beta particles a. inhalation d. ingestion. Radioactive particles generally are classified into three types: alpha. Produced by: 1) Nuclear weapons 2) Reactors 3) Radioactive material 4) X-ray machines b. Most radiation accidents involve sealed radioactive sources used in industrial radiography and nondestructive testing a. Radio waves and microwaves 2. Alpha particles a. and gamma 2. Measurements of radiation a.14 – . including positive pressure self-contained breathing apparatus 3. Travel only a few millimeters c. The most dangerous forms of penetrating radiation 1) Gamma rays have 10. beta. May be stopped by paper. ingestion.
the less the radiation exposure b )Use a rotating team approach to minimize individual radiation exposure 2) Distance a) The further a person is from the source. Emergency response to radiation accidents 1. If advised that radioactive materials are present at an emergency scene. Appropriate local authorities should be contacted (state radiological health office. emergency vehicles. and diarrhea within 2 to 4 hours 5) After an exposure of 450 rem. or gas is present 4. Protective clothing suitable for other hazardous material releases should be worn by all emergency workers a. assume that 1 roentgen=1 rad=1 rem d. Aside from removing contaminants. Follow protocol for removing radioactive material from a patient’s clothing. 50% mortality can be expected within 30 days without medical care D. vomiting. SCBAs should be used if fire. and the command post should be positioned 200 to 300 feet upwind of the site b.c. or open wounds 3. Dose meters should be available for all rescue personnel b. Emergency care for victims of radiation accidents 1. Patients who have been irradiated are not radioactive 2. the lower the radiation dose b) Even moving several feet away from a radioactive source greatly reduces the level of exposure 3) Shielding a) The denser the material. Four factors for basic radiation protection 1) Time a) The less time spent in the radiation field. the greater the protection b) If adequate shielding is not available. Personal protection from radiation a. local specialists). Radiation doses 1) Persons routinely exposed must have continuous monitoring 2) Doses less than 100 rem usually do not cause significant acute problems 3) Doses from 100 to 200 rem may cause symptoms. and medical direction should be notified 3. Roentgen equivalent man (rem) 1) Used to assess the biological effects of the different types of radiation 2) For emergency purposes. drink. skin. but are not lifethreatening 4) Doses of 200 rem cause nausea. smoke. approach the site with caution and do not enter the scene until it has been secured by proper authorities a. treat patients following trauma guidelines . use the time and distance factors to reduce exposure 4) Quantity a) Limit the amount of radioactive material in a specific area to lessen exposure b) Remove and bag contaminated clothing and other items c) Move containers of radioactive material from the area E. or smoke at the accident site or in any rescue vehicle 2. Emergency workers should not eat. Rescue personnel.15 – .
Cover open wounds d. meaning the patient was exposed but not contaminated b. Clean.. using strict aseptic technique F. meaning the patient was contaminated 2. state. Do not delay lifesaving care for patient transfer or decontamination 6.a. Dirty. Only properly trained personnel (e.g.16 – . Immobilize fractures 4. Move the patient from the radiation source 5. or federal health department personnel) should attempt to decontaminate radiation victims . Radiation decontamination procedures 1. IV fluid replacement should be initiated if indicated. Control all external bleeding b. Hazmat teams and qualified county. Immobilize the spine if indicated c. Radiation emergencies may be defined as either: a.
Considerations 1. Social Work and clinical psychology provide assessment and intervention to burn patients from a wide range of psychosocial backgrounds. Caring for burn patients can cause extreme stress on clinical patient care staff. General information should be provided to the family of a burn patient prior to their initial encounter with that patient. and dealing with changes in body image. in order to ensure adequate compliance with treatment initially. Assessment and management of emotional distress. 7. B. identify a family spokesperson and clarify any information provided from the medical team as it becomes necessary. grief and bereavement. Psychosocial assessment and treatment begins during the initial phase of treatment and is continuous throughout as patients’ and families’ needs change at different stages of recovery. Shock and disbelief are early emotional responses to traumatic events. pain-coping strategies. Intervention must start initially. religious customs. 3. 2. particularly those associated with anxiety and depression. DNR orders. Introduction 1. 4. 6. as well as attributing blame fault or feeling guilt.V. cognition will be greatly diminished and the ability to reason and problem solve will become impaired. reassure that measures are being taken to provide for the patient’s comfort. 5. Given the nature of burn injury and its treatment there are many stressors that may trigger psychological problems. 2. Introduce the personnel who will be caring for the patient. . A burn injury is a frightening & potentially life-changing event for patients and families. throughout. Because of this loss/change in their lives. are necessary in the case of the patient with a severe burn injury. survival and mental health issues. Critical Stress Defusing/Debriefing sessions must be made available early and often for staff. One implication of the increasing survival of patients with a severe burn injury is the need for psychosocial support for patients and their families/significant others. PSYCHOSOCIAL ISSUES A. and during rehabilitation goals. legal issues may have to be addressed and resolved early. recognizing the psychological reactions to trauma. Anger can also be a component of the early emotional response. Answer their questions honestly and provide emotional support. For most individuals. 3. The impact of the burn can result in permanent disability and disfigurement.17 – . they can often face many difficult emotions at varying stages after the injury.
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