thermal trauma
TRANSCRIPT
-
7/27/2019 Thermal Trauma
1/27
11
Lesson
Prehospital Trauma Life Support
Thermal Trauma
Injuries
-
7/27/2019 Thermal Trauma
2/27
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
-
7/27/2019 Thermal Trauma
3/27
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
-
7/27/2019 Thermal Trauma
4/27
Anatomy & Physiology
11-3
Subcutaneous(elastic & fibroustissues; fattydeposits)
Dermis(nerveendings,blood vessels)
Epidermis(outermostlayer)
-
7/27/2019 Thermal Trauma
5/27
Depth of Burns
11-4
Partialthickness
Fullthickness
1st 2nd 3rd
-
7/27/2019 Thermal Trauma
6/27
Rule of Nines
Adult
11-5
Child
Why does the Rule of Nines change for children?
-
7/27/2019 Thermal Trauma
7/27
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?
-
7/27/2019 Thermal Trauma
8/27
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
-
7/27/2019 Thermal Trauma
9/27
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
-
7/27/2019 Thermal Trauma
10/27
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...
-
7/27/2019 Thermal Trauma
11/27
Treatment
11-10
Full thickness (third degree).
Dry dressings.
Fluid therapy as indicated.
contd.
-
7/27/2019 Thermal Trauma
12/27
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?
-
7/27/2019 Thermal Trauma
13/27
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?
-
7/27/2019 Thermal Trauma
14/27
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?
-
7/27/2019 Thermal Trauma
15/27
Special Burn Situations
Chemical burns
What is different about these burns?
How would you treat chemical burns?
11-14
-
7/27/2019 Thermal Trauma
16/27
Electrical Burns
11-15
Direct contact.
Arc injuries.
Flash burns.
How do you manage these injuries?
-
7/27/2019 Thermal Trauma
17/27
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
-
7/27/2019 Thermal Trauma
18/27
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.
-
7/27/2019 Thermal Trauma
19/27
Thermal Trauma Injuries
Environment Injuries
11-18
-
7/27/2019 Thermal Trauma
20/27
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?
-
7/27/2019 Thermal Trauma
21/27
What are your
concerns?
What places this patient
at high risk for a heat
emergency?
How would you treat
him?
11-20
-
7/27/2019 Thermal Trauma
22/27
Other Heat Injuries
List the signs, symptoms and likelyinvolvement of each of the following:
Heat cramps
Heat exhaustion
Heat stroke
11-21
-
7/27/2019 Thermal Trauma
23/27
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
-
7/27/2019 Thermal Trauma
24/27
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
-
7/27/2019 Thermal Trauma
25/27
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?
-
7/27/2019 Thermal Trauma
26/27
Rough handling.
External warming vs. corerewarming.
They are not dead until they arewarmand dead!
Pitfalls
11-25
-
7/27/2019 Thermal Trauma
27/27
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