Miscellaneous Flashcards
What should I know about burns and scalds
What should I know about burns and scalds?
Before you look at burns and scalds you should be aware of skin structure, as explained in the module Organisation of body systems. This will help you understand the associated injuries, recognise the organs or systems that lie underneath a burn and also explain certain signs and symptoms.
For example, some superficial (partial thickness) burns tend to be more painful than full thickness burns because of the depth of the nerve endings.
So do you know what a burn is? How does it differ from a scald? See if you’re right about burns and scalds in the Resource Centre.
In Britain some 143,000 injuries a year are caused by heat and around 11,000 are admitted to a burns unit. Approximately 700 people die every year from burns, most of which are the result of house fires. Some people are more likely to suffer certain kinds of burns than others - think about the predisposing factors in the Resource Centre.
Burns shock
Shock
Shock results from the escape of plasma from the burnt tissues and from the escape of blood or plasma into the tissues causing swelling.
The greater the area that is burnt the greater the extent of the shock will be.
Always be aware that SHOCK CAN KILL!
Managerment Treatment of burns
Treatment of burns
Safety
Ensure your own safety first and that of your colleagues and bystanders. If necessary remove the patient to a place of safety, making sure that burning clothes have been extinguished.
Airway
Ensure a clear airway and that the patient is breathing and has circulation.
Cool
Cool the burn with lots of cold water if possible. This will help to reduce the extent of the burn and help to ease the pain.
Cover
Cover the burn with a large sterile pad or dressing. If this is not available then use a clean non-fluffy towel or bed linen. This will prevent the spread of infection and will also stop the patient looking at the injury and becoming anxious. Keep the patient warm to prevent hypothermia setting in. Ordinary cling-film can be a good dressing for a burn but it is very important to make sure the burn is cooled before it is applied. It should only be applied in strips and NOT as a roller bandage.
Nil by mouth
You must not give anything by mouth, but you can moisten the lips.
Constricting items
Constricting items like rings should be removed as soon as possible because swelling will occur almost immediately.
Raise and immobilise
Burnt limbs should be raised if possible and charred limbs should be immobilised as for a fracture.
TLC
Your patient is extremely frightened and is looking to you to sort out their problems. A cool calm approach is of paramount importance. The patient’s psychological well-being is also very important, plenty of reassurance will go a long way to gaining the patient’s confidence.
Information
If the patient has a major burn the receiving hospital should be forewarned of the patient’s condition, level of consciousness and your estimated time of arrival.
Pain relief
Pain relief can be administered as per individual service protocol, either entonox or drug-induced analgesia .
In the case of undefined industrial or chemical burns, specialist advice should be obtained and the fire brigade requested to attend
Partial thickness
Partial thickness
Superficial
This involves the epidermis only. Redness and swelling of the skin occurs and can be very painful but usually heals within a week without scaring.
Deep
This involves both the epidermis and dermis layers of the skin. This type of burn has reddening and swelling of the skin but also has associated blistering and is extremely painful.
Full thickness burns
Full thickness
This type of burn involves not only the layers of skin but also underlying tissues and bones. These burns will have a whitish yellow appearance with a waxy texture.
There might be associated bleeding and some blood vessels may be visible. Charring of the surrounding tissues will also be apparent.
Although not always the case, this type of burn will seldom be very painful because the nerve endings in the skin have been destroyed
what is a burn
A burn is a breach in the continuity of tissue caused by the excessive transfer of heat energy:
- To the skin - flame burns and scalds
- From the skin - ice burns, frost bite
- Electricity - electrical current, lightening
- Chemical - strong acids or alkalis, other corrosives
- Radiation - from excess radiotherapy
Scalds
Scalds
Boiling water and fat will continue to damage the tissues until such time as they are cooled down. This may take quite some time, so cold running water must be applied if possible for at least 10 minutes, making sure that the patient does not become hypothermic in the process, then continue to treat as a burn
Predisposing factors burns
Predisposing factors
- Very young children, the elderly, epileptics and drug abusers are more at risk as are people under the influence of alcohol or who are confused.
- Scalds are particularly common in the under five range, as are burns to children playing with matches.
- Electrical power cables and railway lines also attract children.
- Suicides by burning are quite common, especially among Asian females and psychiatric patients.
- Industrial molten metal burns are usually full thickness and are quite serious.
- Fireworks injuries can be fairly horrific but are thankfully on the decline.
- Fires as a result of road traffic accidents are not all that common.
- Non-accidental injuries occur in child abuse or physical abuse between adults. These are usually caused by either hot irons or cigarettes.
burns area adult
Burn area
Burns in the region of 10% of the body’s area are considered to be major burns and can produce very severe shock.
The size of the area burnt is more important than the depth of the burn and the patient’s age is an important consideration. On average:
A person less than 20 years old will usually survive a burn of 20% area
A person of 60 years has a 40% chance of surviving 20% burns
A person of 70 years has a 1% chance of surviving 20% burns
A person of 75 years or more will usually die from a burn greater than 18-20%
A person less than 20 years old has a 40% chance of surviving a 50% burn area
A person of 50 years or more will usually die from a burn area of 50%
Children with burns become shocked much more easily than adults because they have less body fluid but they are more resilient and can withstand the effect better.
Estimating burn area: the rule of nines
A patient’s hand as a rule, is equal to approximately 1% of a person’s body area. Bearing this in mind a system has been developed where:
Head and neck = 9%
Front of trunk = 18%
Back of trunk = 18%
Leg = 18%
Arm = 9%
Genitalia = 1%
There is a slight change in this method when using it to assess small children and infants:
Head and neck = 18%
Front of trunk = 18%
Back of trunk = 18%
Leg = 14%
Arm = 9%
Genitalia = 1%
burns area child infant
There is a slight change in this method when using it to assess small children and infants:
Head and neck = 18%
Front of trunk = 18%
Back of trunk = 18%
Leg = 14%
Arm = 9%
Genitalia = 1%
Chemical burns
Chemical burns
These occur when the skin comes in contact with strong acids, alkalis or other corrosives. The burn progresses as long as the chemical is in touch with the skin.
The area should be flushed with copious amounts of water to neutralise the chemical. Contaminated clothing should be removed with care, ensuring that you do not become contaminated yourself. Then treat as for any other burn.
Anxiety
Anxiety
Anxiety can result from many things, the accident itself, pain or fear. It is often incorrectly called shock.
Shock is a clear medical condition with specific signs and symptoms. A better way to describe anxiety would be to say that the patient was distressed or anxious.
Respiratory problems
Respiratory problems
Respiratory problems can occur following the inhalation of flames or hot gases. This may make the patient unconscious or even kill them before the fire consumes them. The airway becomes obstructed by swelling or pulmonary oedema.
Airway obstruction should be suspected in fires in enclosed areas, fires involving toxic chemicals or plastics, facial burns, if the patient’s voice is hoarse, if there is coughing, or if redness can be seen in the upper airway.
Airway obstruction should be treated by the administration of oxygen but in the absence of this, cold compresses can be administered to the outside of the neck and throat.
Patients who die a few days after being admitted to a burns unit do so usually as a result of airway problems or infection.
Sometimes the complex changes to the body as a result of shock can also be the cause of death
Electrocution
Electrocution
Electrical burns may produce very severe internal damage with only slight external injury. Electricity takes the route of least resistance and tends to follow the path of nerves and blood vessels. It will always have an entrance and exit wound.
The entrance wound would be at the point of the body that touched the electricity. The exit wound could be anywhere on the body, but as a rule if the patient were standing up at the time of the incident the exit wound would most likely be at the feet.
About 40 people die each year from electrocution and another 2000 are injured.
Lightening bolts contain over a million volts of electrical current and may cause cardiac arrest as the electrical current passes through the chest, cause massive entrance and exit wounds and set clothing alight
control mechanisms for maintaining body temperature
How is body temperature maintained?
Normal body temperature is in the range of 36-37ºC. In order to maintain this temperature the body has several mechanisms to accommodate any fluctuation in the norm.
These control mechanisms are:
- Constriction of the blood vessels on the periphery of the body to prevent blood from cooling on the surface. This keeps the inner temperature higher.
- Voluntary or involuntary muscle movement causing the production of heat, eg shivering.
- Erection of body hairs to trap a layer of warm air near the body surface. This process can also be reversed to lose heat from the body.
- To lose heat the body will produce sweat, which then evaporates from the skin’s surface causing heat loss.
- Breathing rates can also change. To lose heat breathing rates increase, drawing cooler air into the inner body. To gain heat breathing rates slow down to minimise the amount of cool air entering the body.
