DISASTER LECTURE- MIDTERMS

MANAGEMENT OF BURNS: Mass Casualty

Incidence

BURNS
- Occur when there is an injury to the tissues
of the body (primarily the skin) caused by
heat, chemicals, electric current radiation

CLISSIFICATION OF BURNS

1. SUPERFICIAL PARTIAL- THICKNESS

- Epidermis is destroyed or injured and a 2. LUND AND BROWDER METHOD
portion od dermis may be injured - Recognizes that the percent-age of TBSA of
- Painful and appear red and dry, as in various anatomic parts, especially the head
sunburn, or it may blister and the legs, and changes with growth.
2. DEEP PARTIAL- THICKNESS
- Destruction of epidermis and upper layers of
dermis and injury to deeper portions of the
dermis
- Painful, appears red, and exudes fluids
3. FULL-THICKNESS
- Total destruction of epidermis and dermis
and in some cases, underlying tissue as well.
- Wound color rages widely to white to red,
brown, or black.
- Painless cause the nerve fibers are
destroyed.

LOCAL PHYSIOLOGIC ALTERATIONS

- Loss of protective barriers
- Escape of body fluids
- Lack of temperature control
- Diminished sensory receptor 3. PALM METHOD
- SCATTERED BURNS – a method to
EXTENT OF BODY SURFACE ARE INJURED estimate the percentage of burn is the palm
methos. The size of the patient’s palm is
1. RULES OF NINES approximately 1% of TBSA
- The system assigns percentages in multiple
of nine to major body surfaces

BURN TRIAGE IN MASS CASUALTY

INCIDENTS

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o Patients with electrical injury, the elderly,

 PRIMARY TRIAGE
- Local disaster triage criteria
- Occurs at the site
 SECONDARY TRIAGE
- Occurs in the hospital or burn center
- ABA (American Burn Association) Triage
policy
- All burn patients should be transferred to a
burn center within 24 hours of the injury.
MANAGEMENT of a MASS CASUALTY
INCIDENCE Burn Patient
- STOP the burning process
o Extinguish the flame (stop, drop,
roll)
o Irrigate with cool water
o Use ice or ice water is
CONTRAINDICATED
or those with cardiac or pulmonary disease
and compromised response to burn injury
o The amount of fluid should maintain a
urinary output of 30 – 50 ml/hr.
 Successful fluid resuscitation is evidenced
by:
o Stable VS – Palpable peripheral pulse
o Adequate urine output – clear sensorium
- Urinary output is the most common
and most sensitive assessment
parameter for cardiac output and
tissue perfusion
- Keep the patient WARM
- EVALUATE for other life- threatening
injuries

- Manage ABC
 Endotracheal Intubation
o Hoarseness
o Stridor
o Excessive use of accessory muscle
o Difficult Respirations
o Decreased LOC
 100% oxygen – smoke inhalation
 Two large- bore peripheral IV catheters

- Begin FLUID RESUSCITATION

o 2nd and 3rd degree burn greater than 10-20%
TBSA
o Significant smoke inhalation injury
 Insertion of urine catheter
 Indications:
o Adults with burns involving more than
10% - 20% TBSA
o Children with burns involving more than
10% - 20% TBSA

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- Oral and subcutaneous routes should not be

used to treat burns greater than 20% TBSA

OTHER CONSIDERATIONS
 ON- SITE:
- Keep the patient warm: rescue blankets or
dry sheets
- Remove constrictive clothing and jewelry
 HOSPITAL CARE:
- Keep the room to a minimum of 30 Celsius
- Keep the pt. warm: warm blankets in the
hospital
- Assess PR hourly: Radial, Ulnar PT,
Dorsalis Pedis
Mngt: SECONDARY SURVEY
- Accurate hx
- Complete examination
- Close re-examination of the burn wound
- Pt. pre-transport checklist
o Primary and secondary survey are
complete
o IV fluid resuscitation
o Pt is warm, wrapped in blankets
o ET Tube, IV Catheters, urine
catheters, NG tube are secure and
functioning
o Documentation is complete

BURN WOUND CARE IN MCI

 Principles:
- Keep the wound clean, moist, and covered
- May keep the wound covered for transport
- When the pt. arrives in the facility, cleanse
with soap and warm water
- Remove any debris and loose, dead skin, and
pat dry

PAIN CONTROL
- IV narcotics are usually sufficient to
maintain adequate pain control

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INFECTIOUS DISEASES EMERGENCIES AND

COVID-19

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