EMR CH 22

Signs & Symptoms of Electrocution

Dazed and confused condition Obvious severe burns to the skin Unconsciousness Weak, irregular or no pulse Shallow, irregular, or no respirations Multiple severe fractures

Electrical Burns

Electrical burns may be the result of contact with high- or low-voltage electricity. - The human body, which is primarily water, is a good conductor. - Electrical burns occur when part of the body completes a circuit connecting a power source to the ground.

Burn Classifications: Moderate Burns

Full-thickness burns involving 2% - 10% of the body's total surface area (excluding critical areas). - Partial-thickness burns covering 15% - 30% of the body's total surface area. - Superficial burns covering > 50% of the body's total surface area.

Burn Classifications: Critical Burns

Full-thickness burns involving the body's critical areas. - Full-thickness burns covering > 10% of the body's total surface area. - Partial-thickness burns covering > 30% of the body's total surface area. - Burns associated with respiratory injury (smoke inhalation). - Burns complicated by fractures. - Burns on patients < 5 or > 55 years of age that would be classified as "moderate" on young adults.

First Degree Burn (superficial)

Involve only the epidermis (the top layer of skin). - The skin turns red but does not blister or actually burn through. - The burn site is painful. - A sunburn is an example of a first degree burn.

Chemical Burn On the Skin

Remove contaminated clothing and flush the skin with saline or water for twenty minutes If contaminant is dry powder, brush off thoroughly before flushing the skin

General Treatment

Remove the patient from the burn or radiation source - Stop the burning process - Consider cervical spine precautions - Maintenance of an open airway and ensuring adequate respirations has priority over all other treatments including control of the cervical spine - Calm and reassure the patient

Burn Severity cont

The three remaining factors to determine burn severity are: - Involvement of critical areas (face, upper airway, hands, feet, & genitalia) - Preexisting medical conditions - Age < 5 or > 55 years

Dangers of Electrical Burns

There are two dangers specifically associated with electrical burns. - First, there may be a large amount of deep tissue injury. - Second, the patient may go into cardiac arrest from the electrical shock.

General Treatment cont

- Consider an inhalation injury with potential airway compromise if any or all of the following clinical indicators are present: - History of altered mental status - History of confinement in a burning environment (e.g. trapped in a closed fire environment) - burns to the head, face, nose, mouth, neck, or torso - Singed eyebrows and nasal hair - Carbon deposits in the nose or mouth - Acute inflammatory changes in the oropharynx - Carbonaceous sputum Stridor - Explosion with burns to head and torso - Presence of any of these findings suggest acute inhalation injury - These injuries require immediate and definitive care and close monitoring for changes in the patient's respiratory status

Burn Classifications: Minor Burns

- Full-thickness burns covering < 2% of the body's total surface area. - Partial-thickness burns covering < 15% of the body's total surface area. - Superficial burns covering < 50% of the body's total surface area.

Chemical Burns

A chemical burn can occur whenever a toxic substance contacts the body. - Most chemical burns are caused by strong acids or alkalis. - The fumes of strong chemicals can also cause burns especially to the respiratory tract

GT cont

Administer 100% oxygen and support respirations as required Estimate percentage of body surface area injured by using the Rule of Nines Estimate depth of burn Remove jewelry from any extremity that has been burned without further injuring the patient Treat burns Do not apply any ointment to a burn Do not break blisters Treat for shock, if indicated Treat other injuries if the patient's condition permits Cold compresses should not be used for pain control Do not continue to apply cool saline or water once the burning process has been stopped

Treatment: Chemical Burns

Attempt to identify the contaminant Remove contaminant - see Poisoning Guideline Flush the contaminated areas on the patient with saline or water Extensive flushing of the patient's skin or eyes may be required (often 20 minutes) Load and go should be immediately initiated only once the contaminant is removed

Fourth Degree Burns

Burn involves the tissues beneath the deepest layers of the skin, including muscles, tendons and even bones. - Burned area is dry and leathery and may appear white, dark brown, or even charred.

Burns

Burns are among the most serious and painful of all injuries. - A burn occurs when the body, or a body part, receives more energy than it can absorb without injury. Potential sources of this energy include: - Heat - Toxic Chemicals - Electricity - Although a burn may be the patient's most obvious injury, always perform a complete assessment to determine whether there are other serious injuries.

Degree/Depth of Burn

Burns are first classified according to their depth. There are four common types of burns: 1° burn (superficial) 2°burn (partial thickness) 3° burn (full thickness) 4° burn

EB types

Electrical burns, like gunshot wounds, have entrance and exit wounds. entrance can be small, exit can be extnesive and deep

Treatment: Electrical Burns

Eliminate the electrical contact or shut off the power Monitor the patient for possible cardiac arrhythmias If the patient is in cardiac arrest initiate CPR and defibrillate per Defibrillation Protocol Consider cervical spine injuries Consider load and go Treat as thermal burns Consider other possible injuries (fractures, dislocations) Immobilize if required Treat for shock, if indicated

Third Degree (full thickness) Burns

Extends through all skin layers and may involve subcutaneous layers. - Burned area is dry and leathery and may appear white, dark brown, or even charred. - If the nerve endings have been destroyed, burned area may have no feeling.

Burn Severity

Five factors are used to determine the severity of a burn. The two most important factors are: - The depth of the burn - The extent of the burn

Chemical Burns In the eye

Flood the eye with lukewarm saline or water for twenty minutes Position the patient so runoff from the eye does not contaminate the other eye or other areas of the patient Have the patient blink frequently during irrigation Cover burned eye with moist dressings, then cover moist dressings with dry dressings

Second Degree (partial thickness) Burns

Involve the epidermis and some portion of the dermis and cause intense pain. - Does not destroy the entire thickness of the skin, nor is the subcutaneous injured. - The skin is moist, mottled, and white to red. - Blisters are common.

Treatment: Thermal Burns

Irrigate the burn site with cool saline or water to stop the burning process Take care to prevent hypothermia when using cool saline or water Cover burned area with moist dressings, then cover moist dressings with dry dressings Initiate early load and go Monitor the patient's status closely

Rules of Nines

a method used in calculating body surface area affected by burns - One quick way to estimate the surface area that has been burned is to compare it to the size of the patient's palm, which is roughly equal to 1% of the patient's total body surface area.