BURN EMERGENCIES

2018
 The Skin
THE LARGEST ORGAN OF
THE BODY IS
 The Function of the Skin
Unlike most organs, the skin has many functions.
The Three Major Functions:
1. Protect the body from the environment
Keeps out harmful bacteria
2. Regulate body temperature
Helps to cool down or heat up body
3. Transmit information from the environment
to the brain
AAOS 11th Ed P. 213
 Anatomy of the Skin
Our skin is broken down into 2 Layers

• Epidermis

• Dermis

• Subcutaneous
Tissue
 Anatomy of the Skin
• Epidermis:
– Most superficial layer
– Varies in thickness
• Thick areas: scalp, back, soles of feet
• Thin areas: forearm
– Germinal Layer at the base of the Epidermis
 Anatomy of the Skin
• Epidermis Continued:
– Germinal Layer
• Blood supply found here
• Skin cells produced here & then cells move to surface
– Journey takes 4 weeks
– Outermost cells are constantly rubbed away
• Enroute to the surface the cells die
– Stratum Corneum layer: dead layer of skin (see next slide)
» No blood supply
• Contains pigment granules (help produce skin color)
AAOS 11th Ed P. 212
Anatomy of the Skin

https://phamix.com/2016/11/structure-of-the-skin/
 Anatomy of the Skin
• Dermis:
– Sweat glands
• Cooling of the body
– Sebaceous (oil) glands
• Waterproofing and softening of skin
– Hair follicles
– Blood vessels
• Provide nutrients and oxygen to skin
– Specialized nerve endings
• Sensitive to environmental stimuli
AAOS 11th Ed. P212-213
 Burns
Generally, Burns themselves don’t kill, however,
complications resulting from burns do kill.

When large amounts of skin are damaged by a

burn, body processes are upset.

The care you provide as a first responder can make

a big difference in the patients recovery and in
some cases life or death.
 Three Burn Depth Classifications
• Superficial (first-degree)

• Partial-Thickness (second-degree)

• Full-Thickness (third-degree)
 Three Burn Depth Classifications
• Superficial ( first-degree) Burns
– These involves the top layer of skin.
 Three Burn Depth Classifications
• Partial-Thickness (second-degree) burns
– Involve the epidermis and dermis
 Three Burn Depth Classifications
• Full-Thickness (third-degree) burn
– Extends through all layers of the skin
Classifications of Minor Burns in Adults
• First-degree involving less than 50%

• Second-degree involving less than 15%

• Third-degree involve less than 2%

AAOS page 925 Table 26-1

Classifications of Moderate Burns in Adults

• First Degree that involves more than 50% of

the body’s total surface area.
• Second Degree that involve 15% - 30% of the
body’s total surface area.
• Third Degree involving 2%-10% of the body’s
total surface area (excluding the hands, feet,
groin or major joints)

AAOS page 925 Table 26-1

Classification of Severe Burns in Adults
• Moderate Burns on patients younger than 5
and older than 55.
• Burns associated with respiratory injury
(smoke inhalation or inhalation injury)
• Burns complicated by fractures

AAOS page 925 Table 26-1

Classification of Severe Burns in Adults
• Second Degree involving more than 30% of
body’s total surface area.
• Third Degree involving more than 10% of
body’s total surface area.
• Third Degree burn involving the face, hands,
feet, upper airway, groin, circumferential or
major joint.
AAOS page 925 Table 26-1
 Type of Burns
• Thermal Burns
• Inhalation Burns
• Inhalation of Toxic Gases
• Chemical Burns
• Electrical Burns
• Taser Injures
• Radiation Burns
AAOS page 931 and 937
 Thermal Burns
• Scalds – hot liquids
– Most common along with Open Flame
– Mostly seen in children and handicapped
• Steam burn
– Type of Scald burn
• Open Flame burn
– Most common along with Scalds

AAOS page 932 and 933

 Thermal Burns
• Contact burn
– Touching a hot object
– Rarely deep due to reflexes
• Flash burn
– Explosion: brief exposure to intense heat
– Lightning

AAOS page 932 and 933

 Inhalation Burns
• Upper airway damage usually caused by
superheated gases
• Lower airway damage usually caused by
chemicals or particulate matter

AAOS page 933 and 934

 Inhalation of Toxic Gases
• Incomplete combustion
• Carbon Monoxide
• Carbon Dioxide
• Hydrogen Cyanide
• Other Gases

AAOS page 933 and 934

 Chemical Burns
• Toxic substance contacts the body
• Usually a strong acid or strong alkalis (base)
• Fumes from chemicals can cause burns, especially
to the respiratory tract
• Severity of burns are related to:
– Type of chemical
– Concentration of the chemical
– Duration of exposure
• Consider requesting Haz Mat
AAOS page 934
 Electrical Burns
Possible Sources
• AC: Alternating Current

• DC: Direct Current

• Lightning
 Electrical Burns
• Damage will consist of:
– An entrance wound
– An exit wound
– Unseen damage along the internal path
– The burn might be larger under the skin
– Electrical burns are ALWAYS more severe than they
appear
• Electricity causes thermal burns and chemical
changes.
AAOS page 936
 Electrical Burns
• Chemical Changes occur to the following
systems:
– Nervous
– Cardiovascular
– Muscular
• Chemical changes cause:
– Disruption of normal body functions
– May cause system failure
AAOS page 936
 Electrical Burns
• Your safety is paramount
• Always assume that power lines are energized
• Never touch electrical lines
• Do not step over electrical lines
• Never touch a patient who is in contact with
an electrical source

AAOS page 937

 Taser Injuries
• Two prongs 13 mm long
• Generally treated as impaled objects
• Deaths associated with tasers have been
associated with ‘excited delirium.’
• Excited delirium is commonly associated with
illegal drugs like cocaine & meth
• Can cause dysrhythmias and sudden cardiac
arrest
AAOS page 937
 Taser Injuries
• Excited Delirium is characterized by:
– Extreme aggression
– Shouting
– Delusions
– Paranoia
– Strength
– Hyperthermia
• Excited Delirium is a true emergency requiring
ALS
AAOS page 937 and Mecklenburg County Protocols Page 97
 Radiation Burns
Possible Sources
• Nuclear sources
• Ultraviolet light is also considered a source of
radiation burns, as in sunburn.
 Three Types of Ionizing Radiation
• Alpha :
– Low energy. Stopped by clothing.
• Beta :
– Not stop by clothing.
– Dust particles can be inhaled.
– Can cause cell damage.
• Gamma : X Rays
– Can cause death
– Can be protected by lead.
AAOS page 937 and 938
 Determining the Severity of a Burn
• The severity of a burn is gauged by both the:
– DEPTH and the
– AMOUNT (TBSA)
• Use the Rule of Nines to estimate the % of
Total Body Surface Area (TBSA) burned
• TBSA only used for thermal burns
• TBSA only used for 2nd and 3rd Degree burns
• TBSA does NOT apply to electrical burns
Mecklenburg County Protocol Page 118
 Rule of 9s for Adults
Estimation of % total body surface area – Adult
Head = 9% (face 4.5%, scalp 4.5%)
Anterior torso = 18%
Posterior torso = 18%
R Arm = 9% (anterior 4.5%, posterior 4.5%)
L Arm = 9% (anterior 4.5%, posterior 4.5%)
R Leg = 18% (anterior 9%, posterior 9%)
L Leg = 18% (anterior 9%, posterior 9%)
Genitalia = 1%
Mecklenburg County Burn Protocol Page 118
Rule of 9s for Adults

http://helid.digicollection.org/en/d/Jh0218e/20.2.html
 Rule of 9s for Pediatrics
Estimation of % total body surface area – Pediatric
Head = 18% (face 9%, scalp 9%)
Chest = 13%
Back = 13%
R Arm = 9%
L Arm = 9%
R Leg = 18%
L Leg = 18%
Genitalia = 1%
Mecklenburg County Burn Protocol Page 118
Rule of 9s for Pediatrics
 Care and Treatment of Burns
• Scene Safety
• Move the patient away from the burning area.
– STOP THE BURNING PROCESS
• Follow proper BSI techniques
– Medical Gloves at a Minimum
– Face Protection
– Gown
 Care and Treatment of Burns
• Maintain ABCs
– Airway - Open
– Breathing – Ensure Adequate, Provide Oxygen
– Circulation – Check for a Pulse
• Remove clothing check for additional burning
• Cool burn with saline ONLY if within the first 1
to 2 minutes of exposure
• Dress burns with clean, DRY dressing
Mecklenburg County Protocols Page 119
 Care and Treatment of Burns
• Do NOT apply ice
• Consider:
– Carbon Monoxide Poisoning
– Cyanide Poisoning
– Toxic Gases

• Consider abuse, particularly in pediatrics

Mecklenburg County Protocols Page 119

 Examine the Airway Carefully
• Look for burns around face & in the mouth
• Stridor, dyspnea
• Soot around nose and mouth.
• Carbonaceous (Sooty) sputum
• Singed nasal hair

Mecklenburg County Protocols Page 119

 Gasses
• CO Carbon Monoxide colorless tasteless`
Causing saturation the red blood cells
• Hydrogen Chloride Found in upholstery & PVS
Causing pulmonary edema
• Hydrogen Cyanide Found in nylons, wool's
and plastics.
Interferes with cellular respiration.
 Gasses
• Formaldehyde Found in Lacquered woods
Depression of the central nervous system

• Formic Acid