Chapter 26 Study Guide Burns

Agents and Sources of Burns Agent Light (typically involving the eyes)

Intense light sources; ultraviolet light can also be considered a source of radiation burns

Agents and Sources of Burns Agent Chemicals

Various acids, bases, and caustics

DEFINE full thickness burn

a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn.

Patients with respiratory ailments, heart disease, or diabetes will react ______ __________ to burn damage.

more severely

The rule of _____ may be easier to apply to smaller or localized burns, whereas the rule of _____ may be easier for larger or more widespread burns.

palm nines

Treating Specific Chemical Burns Sulfuric acid. Heat is produced when water is added to concentrated sulfuric acid, but it is still ____________ to wash rather than leave the contaminant on the skin.

preferable

The amount of skin surface involved can be calculated quickly by using:

the rule of nines.

The patient's age is a major factor in considering the severity of burns. Infants, children under age ___, and adults over age ____, because of their anatomy and physiology, have the most severe responses to burns and the greatest risk of death. They also have different healing patterns than other age groups.

5 55

rule of nines a method for estimating the extent of a burn. For an adult, each of the following areas represents ___ percent of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining ___ percent is assigned to the genital region. For an infant or child, the percentages are modified so 18 percent is assigned to the head, 14 percent to each lower extremity.

9 1

Agents and Sources of Burns Agent Electricity

Alternating current, direct current, and lightning

____ _____ approach a burn patient if there is a risk of electricity or a chemical/radiological threat.

DO NOT

PATIENT CARE for Burns to the eyes ___ _____ open the patient's eyelids if burned. Be certain the burn is thermal, not chemical. Apply sterile gauze pads to ______ eyes to prevent sympathetic movement. (Some local protocols recommend covering only the injured eye.) If the burn is chemical, flush the eyes for ___ minutes en route to the hospital.

Do not both 20

Agents and Sources of Burns Agent Thermal

Flame; radiation; excessive heat from fire, steam, hot liquids, and hot objects

Agents and Sources of Burns Agent Radiological

Usually from nuclear sources; ultraviolet light can also be considered a source of radiation burns

DEFINE partial thickness burn

a burn in which the epidermis (first layer of skin) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearance. Also called a second-degree burn.

DEFINE superficial burn

a burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling. A common example is a sunburn. Also called a first-degree burn.

DEFINE rule of nines

a method for estimating the extent of a burn. For an adult, each of the following areas represents 9 percent of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1 percent is assigned to the genital region. For an infant or child, the percentages are modified so 18 percent is assigned to the head, 14 percent to each lower extremity.

DEFINE rule of palm, also known as the palmar method or the rule of ones

a method for estimating the extent of a burn. The palm and fingers of the patient's own hand, which equals about 1 percent of the body's surface area, is compared with the patient's burn to estimate its size. For example, a burn the size of five palms and fingers equals approximately 5 percent of the body

Chapter Glossary - a scratch or scrape. - the surgical removal or traumatic severing of a body part, usually an extremity. - the tearing away or tearing off of a piece or flap of skin or other soft tissue. This term also may be used for an eye pulled from its socket or a tooth dislodged from its socket. - any material used to hold a dressing in place. - an internal injury with no open pathway from the outside. - a bruise. - an injury caused when force is transmitted from the body's exterior to its internal structures. Bones can be broken; muscles, nerves, and tissues damaged; and internal organs ruptured, causing internal bleeding. - the inner (second) layer of the skin found beneath the epidermis. It is rich in blood vessels and nerves. - any material (preferably sterile) used to cover a wound that will help control bleeding and prevent additional contamination. - the outer layer of the skin. - a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn. - a swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel. - a cut. - any dressing that forms an airtight seal. - an injury in which the skin is interrupted, exposing the tissue beneath. - burn a burn in which the epidermis (first layer of skin) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearance. Also called a second-degree burn. - a dressing applied tightly to control bleeding. - an open wound that tears through the skin and destroys underlying tissues. A penetrating puncture wound can be shallow or deep. A perforating puncture wound has both an entrance and an exit wound. - a method for estimating the extent of a burn. For an adult, each of the following areas represents 9 percent of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1 percent is assigned to the genital region. For an infant or child, the percentages are modified so 18 percent is assigned to the head, 14 percent to each lower extremity. - a method for estimating the extent of a burn. The palm and fingers of the patient's own hand, which equals about 1 percent of the body's surface area, is compared with the patient's burn to estimate its size. - layers the layers of fat and soft tissues found below the dermis. - a burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling. A common example is a sunburn. Also called a first-degree burn. - a bulky dressing.

abrasion - a scratch or scrape. amputation - the surgical removal or traumatic severing of a body part, usually an extremity. avulsion - the tearing away or tearing off of a piece or flap of skin or other soft tissue. This term also may be used for an eye pulled from its socket or a tooth dislodged from its socket. bandage - any material used to hold a dressing in place. closed wound - an internal injury with no open pathway from the outside. contusion - a bruise. crush injury - an injury caused when force is transmitted from the body's exterior to its internal structures. Bones can be broken; muscles, nerves, and tissues damaged; and internal organs ruptured, causing internal bleeding. dermis - the inner (second) layer of the skin found beneath the epidermis. It is rich in blood vessels and nerves. dressing - any material (preferably sterile) used to cover a wound that will help control bleeding and prevent additional contamination. epidermis - the outer layer of the skin. full thickness burn - a burn in which all the layers of the skin are damaged. There are usually areas that are charred black or areas that are dry and white. Also called a third-degree burn. hematoma - a swelling caused by the collection of blood under the skin or in damaged tissues as a result of an injured or broken blood vessel. laceration - a cut. occlusive dressing - any dressing that forms an airtight seal. open wound - an injury in which the skin is interrupted, exposing the tissue beneath. partial thickness - burn a burn in which the epidermis (first layer of skin) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearance. Also called a second-degree burn. pressure dressing - a dressing applied tightly to control bleeding. puncture wound - an open wound that tears through the skin and destroys underlying tissues. A penetrating puncture wound can be shallow or deep. A perforating puncture wound has both an entrance and an exit wound. rule of nines - a method for estimating the extent of a burn. For an adult, each of the following areas represents 9 percent of the body surface: the head and neck, each upper extremity, the chest, the abdomen, the upper back, the lower back and buttocks, the front of each lower extremity, and the back of each lower extremity. The remaining 1 percent is assigned to the genital region. For an infant or child, the percentages are modified so 18 percent is assigned to the head, 14 percent to each lower extremity. rule of palm - a method for estimating the extent of a burn. The palm and fingers of the patient's own hand, which equals about 1 percent of the body's surface area, is compared with the patient's burn to estimate its size. subcutaneous - layers the layers of fat and soft tissues found below the dermis. superficial burn - a burn that involves only the epidermis, the outer layer of the skin. It is characterized by reddening of the skin and perhaps some swelling. A common example is a sunburn. Also called a first-degree burn. universal dressing - a bulky dressing.

Remember also that some thermal burns, especially immersion burns and liquid scald burns, can be indicators of _______. Always have a high index of suspicion when evaluating such burns, especially in children.

abuse

Findings such as burns to the mouth and nose, soot in sputum or mucus, hoarse voice, singed eyebrows or nose hairs, and difficulty speaking are all dangerous findings due to complications with the _________ when dealing with burns.

airway

Although part of the treatment for both acid and alkali burns is irrigation, ________ burns should be irrigated longer because of the different ways in which these chemicals react with the human body.

alkali

When the groin, genitalia, buttocks, or medial thighs are burned, potential _________ ______________ can be far more serious than the initial damage to the tissues.

bacterial contamination

Treating Specific Chemical Burns Carbolic acid (phenol). Carbolic acid does ______ mix with water. When available, use __________ for the initial wash of unbroken skin, followed by a long steady wash with _______.

not alcohol water.

•In a ____________________ burn the epidermis is burned through and the dermis (the second layer of the skin) is damaged, but the burn does not pass through to underlying tissues. There will be deep, intense pain; noticeable reddening; blisters; and a mottled (spotted) appearance to the skin. Burns of this type cause swelling and blistering for 48 hours after the injury, as plasma and tissue fluids are released and rise to the top layer of skin. When treated with reasonable care, partial thickness burns will heal themselves, producing very little or no scarring. Partial thickness burns are also called second-degree burns.

partial thickness burn

What type of burn is this? and what degree? There will be deep, intense pain; noticeable reddening; blisters; and a mottled (spotted) appearance to the skin. Burns of this type cause swelling and blistering for 48 hours after the injury, as plasma and tissue fluids are released and rise to the top layer of skin. When treated with reasonable care this type of burn will heal themselves, producing very little or no scarring.

partial thickness burn second degree

Note that circumferential burns (burns that encircle the body or a body part) can be very serious because they constrict the ____. When they occur to an extremity, they can interrupt ___________ to the distal tissues. When they occur around the chest, they can _______ breathing by limiting chest wall movement.

skin circulation restrict

•A ____________________ burn involves only the epidermis (the outer layer of the skin). It is characterized by reddening of the skin and perhaps some swelling. An example is a sunburn. The patient will usually complain about pain (sometimes severe) at the site. Typically the burn will heal of its own accord, without scarring. Superficial burns are also called first-degree burns.

superficial burn

What type of burn is this? and what degree? The patient will usually complain about pain (sometimes severe) at the site. Typically the burn will heal of its own accord, without scarring.

superficial burn first degree

Burns involving the skin are classified as ______________, ____________ ___________, and _______ _____________ _______. These classifications are also sometimes called first-degree, second-degree, and third-degree burns

superficial, partial thickness, and full thickness burns

PATIENT CARE for Chemical Burns Emergency care for a patient with chemical burns includes the following: 1.The primary care procedure is to ______ ______ the chemical with flowing water. If a dry chemical is involved, ______ _____ as much of the chemical as possible; then ______ the skin. Simply wetting the burn site is not enough. Continuous flooding of the affected area is required, using a copious but gentle flow of water. Avoid hard sprays that may damage badly burned tissues. Continue to wash the area for at least ___ minutes, and _________ the process en route to the hospital. Take steps as needed to avoid contaminating yourself with the chemical agent. Remove the patient's contaminated clothing, shoes, socks, and jewelry as you apply the wash. Do not contaminate skin that has not been in contact with the chemical. 2.Apply a sterile dressing or burn sheet. 3.Treat for shock. 4.Transport.

1. wash away brush away flush 20 continue

PATIENT ASSESSMENT for Burns When your patient has been burned, patient assessment involves classifying, then evaluating, the burns. Burns can be classified and evaluated in three ways:

1.By agent and source 2.By depth 3.By severity

CLASSIFICATIONS BY THICKNESS AND PERCENT OF BODY SURFACE AREA - Children Less than Five Years of Age Minor Burns •Partial thickness burns of less than ___ percent of the body surface

10

CLASSIFICATIONS BY THICKNESS, PERCENT OF BODY SURFACE AREA, AND COMPLICATING FACTORS Burns that are moderate should be considered critical in a person less than five or greater than fifty-five years of age. Critical Burns •All burns complicated by injuries of the respiratory tract, other soft-tissue injuries, and injuries of the bones •Partial thickness or full thickness burns involving the face, hands, feet, genitalia, or respiratory tract •Full thickness burns of more than ___ percent •Partial thickness burns of more than ___ percent •Burns complicated by musculoskeletal injuries •Circumferential burns

10 30

CLASSIFICATIONS BY THICKNESS AND PERCENT OF BODY SURFACE AREA - Children Less than Five Years of Age Moderate Burns •Partial thickness burns of ___ to ___ percent of the body surface

10 to 20

In the rule of nines, the percentages are modified for infants and young children, whose heads are much larger in relationship to the rest of the body. An infant's or young child's head and neck are counted as___ percent; each upper extremity as ___ percent; chest and abdomen as ___ percent; the entire back as ___ percent; each lower extremity as ___ percent; and the genital region as ___ percent. This adds up to ___ percent, but it is used to give only a rough determination. Some systems count each lower limb as 13.5 percent to achieve an even 100 percent.

18 9 18 18 14 1 101

Some Do/Don'ts for providing care for burn patients. Fill in the blank. its either Do Not or Do 1. apply ointments, sprays, or butter. 2. keep the patient warm 3. break blisters. 4. apply ice to any burn. 5. keep the burn site clean to prevent infection.

1Do not 2Do 3Do not 4Do not 5Do

CLASSIFICATIONS BY THICKNESS, PERCENT OF BODY SURFACE AREA, AND COMPLICATING FACTORS Burns that are moderate should be considered critical in a person less than five or greater than fifty-five years of age. Minor Burns •Full thickness burns of less than ___ percent of the body surface, excluding the face, hands, feet, genitalia, or respiratory tract •Partial thickness burns of less than ___ percent of the body surface •Superficial burns of ___ percent of the body surface or less

2 15 50

CLASSIFICATIONS BY THICKNESS, PERCENT OF BODY SURFACE AREA, AND COMPLICATING FACTORS Burns that are moderate should be considered critical in a person less than five or greater than fifty-five years of age. Moderate Burns •Full thickness burns of ___ to ___ percent of the body surface, excluding the face, hands, feet, genitalia, or respiratory tract •Partial thickness burns of ___ to ___ percent of the body surface •Superficial burns that involve more than ___ percent of the body surface

2 to 10 15 to 30 50

CLASSIFICATIONS BY THICKNESS AND PERCENT OF BODY SURFACE AREA - Children Less than Five Years of Age Critical Burns •Full thickness burns of any extent or partial thickness burns of more than ___ percent of the body surface

20

PATIENT CARE for Chemical Burns to the Eyes A corrosive chemical can burn the globe of a person's eye before he can react and close the eyelid. Even with the lid shut, chemicals can seep through onto the globe. To care for chemical burns to the eye, you should take the following steps: 1.Immediately flood the eyes with water. Often the burn will involve areas of the face as well as the eye. When this is the case, flood the entire area. Avoid washing chemicals back into the eye or into an unaffected eye. 2.Keep running water from a faucet, low-pressure hose, bucket, cup, bottle, rubber bulb syringe, IV setup, or other such source flowing into the burned eye. The flow should be from the medial (nasal) corner of the eye to the lateral corner. Since the patient's natural reaction will be to keep the eyes tightly shut, you may have to hold the eyelids open. 3.Start transport and continue washing the eye for at least ___ minutes or until the patient's arrival at the medical facility. 4.After washing the eye: 5.Wash the patient's eyes for ___ more minutes if he begins to complain about renewed burning sensations or irritation. NOTE. Do not use ___________ such as vinegar or baking soda in a patient's eyes.

3. 20 4. cover both eyes with moistened pads. 5. 5 NOTE. neutralizers

•In a __________________ burn all the layers of the skin are damaged. Some full thickness burns are difficult to tell apart from partial thickness burns; however, there are usually areas that are charred black or brown or areas that are dry and white. The patient may complain of severe pain or, if enough nerves have been damaged, may not feel any pain at all (except at the periphery of the burn, where adjoining partial thickness burns may be causing pain). This type of burn may require skin grafting. As these burns heal, dense scars form. Full thickness burns damage all layers of the skin and may damage subcutaneous tissue, muscle, bone, and underlying organs. These burns are sometimes called third-degree burns.

Full thickness burn

PATIENT CARE for Thermal Burns As an EMT, you will have to care for thermal burns caused by scalding liquids, steam, contact with hot objects, flames, flaming liquids, and gases. Sunburn can also be severe in infants and young children, who may have other heat-related injuries. 1.Stop the burning process!/Cool the burned area. •Flame—Wet down, smother, then remove any affected clothing. •Semi-solid (grease, tar, wax)—Cool with water. Do not remove the substance. 2.Ensure an open airway. Assess breathing. 3.Look for signs of airway injury: hoarse voice, stridor, soot deposits, burned nasal hair, facial burns. 4.Complete the primary assessment. 5.Treat for shock. Provide high-concentration oxygen. Treat serious injuries. 6.Evaluate burns by depth, extent (rule of nines or rule of palm), and severity. .Do not clear debris. Remove clothing and jewelry. 8.Wrap with dry sterile dressing. 9.Burns to hands or feet—Remove the patient's rings or jewelry that may constrict blood flow with swelling. Separate fingers or toes with sterile gauze pads.

Just keep reading it.

Burns pose greater risks to infants and children than to adults. This is because their ______ ___________ area is greater in relation to their total body size. This results in greater _____ and _____ loss than would occur in an adult patient. Infants have a higher risk of shock, airway problems, and hypothermia from burns. When a child has been burned, consider the possibility of ________ __________.

body surface fluid and heat child abuse

Airway-related burns can also expose patients to potentially harmful chemicals such as ___________ ____________ and ___________ ___________. In general, any patient who has a potential airway burn or exposure to inhaled by-products of combustion should be monitored for the possibility of __________ _____________ and ___________ poisoning. At a minimum, these patients should be moved to fresh air and treated with high-concentration oxygen via nonre-breather mask. If your protocols allow, the application of _________ _________ may slow down the swelling process.

carbon monoxide and hydrogen cyanide carbon monoxide and cyanide humidified oxygen

When acids encounter tissue, they break down proteins. This results in __________ tissue that limits further progression of the acid. Alkalis, on the other hand, break down proteins, but they also _________ the damaged tissue. This process is called ____________. Because a strong alkali liquefies dead tissue, the alkali is able to eat into the tissue much farther than an acid can. Continued irrigation is the best method of diluting and removing the alkali and limiting the damage it causes. There is a well-known exception to the principle of acids causing limited damage and that acid is __________ acid

coagulated liquefy saponification Hydrofluoric

Treating Specific Chemical Burns Mixed or strong acids or unidentified substances. Many of the chemicals used in industrial processes are mixed acids, whose combined action can be immediate and severe. The pain produced from the initial chemical burn may mask any pain being caused by renewed burning due to small concentrations left on the skin. When the chemical is a strong acid (e.g., hydrochloric acid or sulfuric acid), a combination of acids, or an unknown, play it safe and _________ __________ even after the patient claims he is no longer experiencing pain.

continue washing

Treating Specific Chemical Burns Hydrofluoric acid. This acid is used for etching glass as well as many other manufacturing processes. Burns from it may be _________, so treat all patients who may have come into contact with the chemical, even if burns are not in evidence. Flood the affected area with _________. Do not delay care and transport to find neutralizing agents.

delayed water.

Treating Specific Chemical Burns Dry lime. If dry lime is the burn agent, ___ _____ wash the burn site with water. To do so will create a corrosive liquid. ________ the dry lime from the patient's skin, hair, and clothing. Make certain that you do not contaminate the patient's eyes or airway. Use _____ only after the lime has been brushed from the body, contaminated clothing and jewelry have been removed, and the process of washing can be done quickly and continuously with running water.

do not Brush water

The hands and feet also are areas of concern because scarring may cause loss of movement of _______ or ____________.

fingers or toes

What type of burn is this? and what degree? The patient may complain of severe pain or, if enough nerves have been damaged, may not feel any pain at all (except at the periphery of the burn, where adjoining partial thickness burns may be causing pain). This type of burn may require skin grafting. As these burns heal, dense scars form. This type of burn damages all layers of the skin and may damage subcutaneous tissue, muscle, bone, and underlying organs.

full thickness burn third degree

Treating Specific Chemical Burns Inhaled vapors. Whenever a patient is exposed to a caustic chemical and may have inhaled the vapors, provide ______-___________ ___________ (___________, if available) and transport as soon as possible. This is very important when the chemical is an acid that is known to vaporize at standard environmental temperatures. (Examples include hydrochloric acid and sulfuric acid.)

high-concentration oxygen humidified

If you encounter a patient with a __________ __________ exposure, you must irrigate copiously and for as long as you can or until medical direction tells you to stop. Hydrofluoric acid burns can cause great tissue damage with _____ external signs, so do your best to persuade a reluctant patient to go to the emergency department for further treatment.

hydrofluoric acid few

A burn caused by electrical current may cause only small areas of skin injury but pose a great risk of severe _______ injuries.

internal

Circumferential burns (burns that encircle the body or a body part) healing process can be very complicated. This is particularly true when circumferential burns occur to _______, the ________, and the _____________ where the encircling scarring tends to limit normal functions.

joints, the chest, and the abdomen

Burn severity is determined by considering the source of the burn, body regions burned, depth of the burn (superficial, partial thickness, and full thickness), extent of the burn (by rule of nines or rule of palm), age of the patient (children under five and adults over fifty-five react most severely), and other patient illnesses or injuries.

just read it

Care for burns includes stopping the burning process (using water for a thermal burn, brushing away dry chemicals), covering a thermal burn with a dry sterile dressing, flushing a chemical burn with sterile water, protecting the airway, administering oxygen, treating for shock, and transporting the patient to a medical facility

just read it

You should not approach a radiological injury without the proper protective equipment and specialized training. You may be called, however, to treat a patient with radiological injuries after that patient had been decontaminated. In the immediate setting, most radiological injuries will present like _________ _________ with damage to the various layers of the soft tissue. Care would be similar in these cases and consist of covering the burns and transport to an appropriate facility.

thermal injuries

When determining the severity of a burn, consider the following factors:

•Agent or source of the burn •Body regions burned •Depth of the burn •Extent of the burn •Age of the patient •Other illnesses and injuries