Thermal Trauma

7/27/2019 Thermal Trauma

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11

Lesson

Prehospital Trauma Life Support

Thermal Trauma

Injuries


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Developed by the

National Association ofEmergency Medical Technicians

In cooperation with

The Committee on Trauma,American College of Surgeons

This slide presentation is intended for use only

in approved PHTLS courses. 11-1B


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Lesson 11 Objectives

Identify, manage and differentiate critical andnon-critical burns.

Identify priorities for managing chemical

burns.

Discuss assessment and care of CO inhalation.

Address the priorities for assessing andmanaging heat-related illness.

Discuss the priorities for assessing andmanaging hypothermia.

11-2


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Anatomy & Physiology

11-3

Subcutaneous(elastic & fibroustissues; fattydeposits)

Dermis(nerveendings,blood vessels)

Epidermis(outermostlayer)


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Depth of Burns

11-4

Partialthickness

Fullthickness

1st 2nd 3rd


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Rule of Nines

Adult

11-5

Child

Why does the Rule of Nines change for children?


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Scenario

You are called to care for a patient whohas been burned while fueling his lawn

mower.

As you approach, you see a 32-year-old

male with a smoldering right arm. He

appears to be in intense pain.

11-6

What are you going to do first?


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Findings

A

- Clear. B- Normal. Clear BS.

C- Normal pulse; no external bleeding.

D- Alert, oriented x 3.

E- Bright red skin with blisters onentire upper and lower right arm.

Vitals: Normal.

11-7


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What thickness is this burn?

What percentage of BSA is burned?

How are you going to treat this patient?

Why do second degree burns hurt themost?

Discussion

11-8


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Treatment

11-9

First priority is to stop the burning.

Superficial (first degree).

Generally no field treatment needed.

Partial thickness (second degree).

Burns < 10% can be treated with moist dressings.

If > 10%, wet dressings can cause hypothermia.

If indicated, administer IV analgesics.

continued...


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Treatment

11-10

Full thickness (third degree).

Dry dressings.

Fluid therapy as indicated.

contd.


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Scenario

You respond to a structure fire. On your

arrival you see a victim who has just been

removed from the house and appears

unresponsive.

11-11

What are

your first

priorities?


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Findings

A- Stridor noted. Oral mucosa appear red.

B- Rapid. BS = rhonchi in all fields.

C- Weak, rapid pulse; no external

bleeding. D- Unresponsive.

E- Partial-thickness burns of upper chest

(9% BSA).

11-12

What problems does this patient have?

How does CO poisoning present?


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Burns.

Upper airway swelling secondary to

inhalation of superheated gases. Carbon monoxide (CO) poisoning.

Trauma related to falls or building collapse.

Possible Injuries

11-13

Why is he showing signs & symptoms of shock?

How are you going to treat him?


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Special Burn Situations

Chemical burns

What is different about these burns?

How would you treat chemical burns?

11-14


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Electrical Burns

11-15

Direct contact.

Arc injuries.

Flash burns.

How do you manage these injuries?


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Burns complicated by respiratory injuries.

Partial-thickness burns > 30% BSA.

Full-thickness burns > 10% BSA.

The young and the old.

Pre-existing medical conditions.

Burns of specialty areas.

Patients Requiring Burn Centers

11-16


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General Treatment

11-17

DO NOT become a victim yourself.

Airway management & oxygenation are

critical. Early shock after burns points to other injuries.

Avoid hypothermia.

Fluid therapy as indicated by BSA involved(Parkland Formula).

Transport to an appropriate facility.


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Thermal Trauma Injuries

Environment Injuries

11-18


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Scenario

You respond to a construction site for a

male with an unspecified illness. It is a

90-degree day with 90% humidity. Your

patient has been working in an enclosed

area. Workers report that they found the

patient collapsed and confused.

11-19

What are you going to do now?


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What are your

concerns?

What places this patient

at high risk for a heat

emergency?

How would you treat

him?

11-20


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Other Heat Injuries

List the signs, symptoms and likelyinvolvement of each of the following:

Heat cramps

Heat exhaustion

Heat stroke

11-21


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Hypothermia

Hypothermia begins when bodytemperature reaches 95o F (35o C):

Shivering begins.

Heart rate, respirations and BP beginto decrease.

Below 90o F (32o C):

CNS impairment.

Below 82o F (28o C):

Ventricular fibrillation.

11-22


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Scenario

You respond to a scenewhere a 34-year-old

male has fallen into a

sewer. You are on

scene, when after 10minutes, the rescue

team brings up a limp

body.

11-23


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Findings

A- Water in airway.

B- Not breathing.

C- Very slow, weak carotid pulse.

D- Unresponsive.

E- Wet clothes removed.

Vitals:

Pulse 28, RR 0. No obtainable BP.

11-24

How are you going to resuscitate this patient?


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Rough handling.

External warming vs. corerewarming.

They are not dead until they arewarmand dead!

Pitfalls

11-25


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Thermal Trauma Summary

The key to caring for thermal injuries is

observing safety, protecting damaged

tissue, and preserving normal body

temperaturewithout ignoring other

life-threatening conditions.

11-26

Documents

Thermal Trauma