Prehospital Trauma Life Support

Lesson

Thermal Trauma:
Injuries Produced by Heat and Cold

11

PROVIDER COURSE
Copyright © 2003, Elsevier Science (USA). All rights reserved.

Objectives
• Identify, manage, and differentiate critical and noncritical burns • Identify how chemical and electrical burns differ from thermal burns • Discuss assessment and care of CO inhalation • Address the priorities for assessing and managing heat-related injuries • Discuss the priorities for assessing and managing cold-related injuries
11-2
Copyright © 2003, Elsevier Science (USA). All rights reserved.

Anatomy—The Skin
Epidermis
(outermost layer)

Dermis
(nerve endings, blood vessels)

Subcutaneous
(elastic & fibrous tissues; fatty deposits)

11-3
Copyright © 2003, Elsevier Science (USA). All rights reserved.

You are called to care for a patient who has been burned while fueling his lawn mower. Elsevier Science (USA). As you approach you see a 65-year-old male with burns to his right arm and anterior chest. All rights reserved. . The fire is now extinguished. 11-4 Copyright © 2003.

GCS score 15 E .Patent B .Bright red skin with blisters on chest and entire right arm What are the key issues in assessing thermal burns? 11-5 Copyright © 2003. .No external bleeding. All rights reserved.Primary Survey A . Elsevier Science (USA). normal pulse rate D . clear BS C .Normal.

Elsevier Science (USA).Ventilatory Function • Inhalation injury • Toxic byproducts 11-6 Copyright © 2003. All rights reserved. .

Rule of Nines 9% 9% 18% 9% 18% 1% 18% 18% 9% 18% 18% 1% 13. Elsevier Science (USA). .5% 13.5% 9% 18% What percent of BSA is burned? 11-7 Copyright © 2003. All rights reserved.

. All rights reserved.Depth of Burns Partial Full thickness thickness 1st 2nd (Superficial) 3rd 2nd (Deep) What is the depth of this patient’s burns? 11-8 Copyright © 2003. Elsevier Science (USA).

All rights reserved. .What are other factors in assessing patients with thermal burns? How are you going to treat this patient? When is pain management indicated? 11-9 Copyright © 2003. Elsevier Science (USA).

. Elsevier Science (USA).Treatment • First priority is to stop the burning • Airway – Manage airway as needed • Breathing – Oxygen to maintain SpO2  95% – Assist ventilations if needed 11-10 Copyright © 2003. All rights reserved.

Resuscitation • Parkland formula – 4 mL x BSA x weight (kg) Calculate the Parkland formula for this patient (wt = 70 kg) How is this administered? 11-11 Copyright © 2003. . All rights reserved. Elsevier Science (USA).

All rights reserved. clean dressings preferred Do not apply ointments or salves Do not attempt to break blisters Do not remove clothing that is melted to skin 11-12 Copyright © 2003. .Wound Management • Superficial (first degree) – Generally no field treatment needed • Partial thickness/full thickness (second degree/third degree) – – – – Dry. Elsevier Science (USA).

.Pain Management • Administer analgesics if indicated – Intermittent IV doses of narcotics – Nitrous oxide • Moist dressings – ONLY if < 10% BSA burned – If > 10%. All rights reserved. Elsevier Science (USA). wet dressings can cause hypothermia 11-13 Copyright © 2003.

You respond to a structure fire/explosion. All rights reserved. . On your arrival you see a 40-year-old male who has just been removed from the building and appears unresponsive. Elsevier Science (USA). What are your first priorities? 11-14 Copyright © 2003.

Partial-thickness burns of upper chest (9% BSA) What are your immediate concerns? Why is he showing signs and symptoms of shock? 11-15 Copyright © 2003. Oral mucosa appears red B .No external bleeding.Rapid. weak and rapid pulse D . Elsevier Science (USA). rhonchi in all fields C . All rights reserved.GCS score 3 (E-1. V-1. M-1) E . .Stridor noted. BS equal.Primary Survey A .

All rights reserved. Elsevier Science (USA).Possible Injuries • Airway and pulmonary burns secondary to inhalation of superheated gases • Associated injuries • CO poisoning • Burns How are you going to treat this patient? 11-16 Copyright © 2003. .

.Special Burn Situations Chemical burns: What is different about these burns? How would you treat chemical burns? 11-17 Copyright © 2003. Elsevier Science (USA). All rights reserved.

. Elsevier Science (USA). All rights reserved.Electrical Burns • Current burns • Arc (flash) injuries • Contact burns How do you manage these injuries? 11-18 Copyright © 2003.

Elsevier Science (USA). hands. All rights reserved. perineum. feet. genitalia.Patients Requiring Burn Centers • • • • • • • • Inhalation injuries Partial-thickness burns > 10% Full-thickness burns Burns to face. . or major joints Electrical Burns Chemical Burns Burn injury in compromised patient Other special situations 11-19 Copyright © 2003.

Elsevier Science (USA).Burns — Summary • DO NOT become a victim yourself • Airway management and oxygenation are critical • Early shock after burns points to other injuries • Avoid hypothermia • Transport patient to an appropriate facility • Pain management • Fluid therapy as indicated 11-20 Copyright © 2003. . All rights reserved.

. Elsevier Science (USA). All rights reserved.Environmental Injuries 11-21 Copyright © 2003.

Elsevier Science (USA).You are doing race coverage for a 10 km (6 mile) race. All rights reserved. 11-22 Copyright © 2003. On your arrival you find the patient confused. . The temperature is 90° F (32° C) with 90% humidity. On finishing the race a 55year-old male collapsed.

.What places this patient at high risk for a heat emergency? How would you treat him? 11-23 Copyright © 2003. All rights reserved. Elsevier Science (USA).

. All rights reserved.Other Heat-related Injuries How do the presentations and management differ for each of the following? • Heat cramps • Heat exhaustion • Heat stroke 11-24 Copyright © 2003. Elsevier Science (USA).

Elsevier Science (USA). shivering ceases • Below 82° F (28° C). ventricular fibrillation possible 11-25 Copyright © 2003. . and BP begin to decrease – CNS impairment • Below 90° F (32° C). All rights reserved.Hypothermia • Hypothermia begins when body temperature reaches 95° F (35° C) – Shivering begins – Heart rate. ventilations.

. after 10 minutes. the rescue team brings up a limp body. All rights reserved. Elsevier Science (USA). You are on the scene when. 11-26 Copyright © 2003.You respond to the scene where a 34year-old male has slipped in mud and fallen into a sewer.

Water in oropharynx B . V-1. Elsevier Science (USA).Apneic C .Clothing is wet How are you going to manage this patient? 11-27 Copyright © 2003. GCS score 3 (E-1.No active hemorrhage. M-1) E .Unresponsive. All rights reserved. .Primary Survey A . very slow and weak carotid pulse D .

Elsevier Science (USA).Rough handling External warming versus core rewarming The patient is NOT dead until he is WARM and dead 11-28 Copyright © 2003. . All rights reserved.

All rights reserved. Elsevier Science (USA). .Summary Care for thermal injuries includes: • • • • Observing safety Addressing life-threatening conditions Protecting damaged tissue Restoring normal body temperature 11-29 Copyright © 2003.

. Please make a selection from the menu below. Return to Main Menu Return to Provider Course Table of Contents Exit/Quit 11-30 Copyright © 2003.Prehospital Trauma Life Support Lesson Eleven is complete. All rights reserved. Elsevier Science (USA).

Sign up to vote on this title
UsefulNot useful