Burns Burns Burn injuries are extremely painful Risk

Burns

Burns • Burn injuries are extremely painful. • Risk of infection is high because the outer layer of skin is damaged.

Burns Although they do not bleed, burn injuries result in: • fluid loss • loss of temperature control • can damage underlying layers of tissue and nerves.

Burns If it occurs in a confined space, burns may damage the respiratory system and eyes.

Burns The patient may go into shock as result of fluid loss.

Burns Even after the source of heat has been removed, further damage occurs because soft tissue retains heat for minutes afterwards.

The major objectives is to cool the burnt area and prevent infection!

Monitoring the casualty is essential! You may need to treat for respiratory distress, cardiac arrest or shock!

Burns Children under 5 are more at risk due to their smaller fluid resolve.

Burns Also the elderly due to associated illnesses.

Severity of burns The extent and depth of burns can be influenced by the temperature of the object, liquid or gas and the length of time the patient was exposed to burning.

Severity of burns

Severity of burns Superficial Thickness Burn Partial Thickness Burn Full Thickness Burn

Severity of burns

How do burns effect the body? • Infection – the deeper the burn the higher the risk • Shock – caused by loss of blood or blood plasma • Respiratory problems – caused from burns to the face/throat or inhaled smoke gas or fumes. 19 December 2021 Burns and Scalds 15

General Management of Burns • Follow DRSABCD • Cool burnt area, running cold water or cold Compresses • Remove clothing unless stuck • Remove jewellery

General Management of Burns • Apply Burnaid • Cover burnt area with glad wrap or a nonadherent dressing and a roller bandage (not firm). • Advise patient to seek medical advice • Administer oxygen if appropriate

General Management of Burns Ring 000 if: • The burn involves airway, face, hands, groin or genitals, or is deep • If it is severe or you are unsure of the severity • It is larger than a twenty cent piece

Burnaid Gel consists of in excess of 90% water trapped in a proprietary gel, containing a small percentage of Melaleuca Oil – a naturally occurring substance.

Types of burns • • Thermal Chemical Hot liquids Electrical

Thermal Causes • heat • contact with open flame or a hot object • scalding by steam or hot liquids • burning by friction

Heat

Scalding

Scalding

Scalding

Friction Burns • A friction burn is a form of abrasion caused by friction when a person's skin rubs against a surface. • As friction also generates heat, extreme cases may result in genuine burning of the outer layers of skin.

Friction Burns • More commonly, friction with abrasive surfaces, including clothing, carpet, or rope, can lead to a friction burn. • The major risk in assessing friction burns is misdiagnosis. • Another risk is infection.

Friction Burns 19 December 2021 Coffs Harbour Divisional Training 32

Management • Follow DRSABCD • Extinguish any burning clothing • Immediately flood burnt area with gentle running cold water for up to 20 minutes • Remove jewellery

Management • If casualty feels cold or starts to shiver, stop cooling • Cover burn with a non-adherent dressing or glad wrap. • Seek medical aid urgently

Radiation burns (sunburn) Caused by: • Radiant energy (energy that radiates from its source) – – – Sunburn Therapeutic treatment X-rays Welding equipment Radioactive material sunburn

Management of sunburn • Rest the casualty in a cool place • Place under a cold shower, in a cold bath, or sponge with cold water • Apply cool gauze padding to the burnt area • Give cool drinks • Seek medical aid for young babies and casualties with blisters

Management of sunburn Sunburn to eyes • Cover eyes with thick, cool moist dressings to cool and keep light out • Reassure casualty and seek medical aid

Chemical burns Caused by: All chemicals used in • Industry • home sulfuric acid Caustic chemicals will continue to burn while in contact with the skin! Chemical burns to the eyes can cause permanent damage and loss of sight!

Management • Follow DRSABCD If Chemical is on skin • Wash chemical off immediately—use large quantity of water for at least 20 minutes • Remove contaminated clothing and footwear—avoid contaminating yourself • DO NOT pick off contaminants that stick to skin

Management of chemical burns If chemical is in eye • Tilt head back and turn to side • Protect uninjured eye • Gently flush the injured eye with cool water for at least 20 minutes. • Keep eye open with fingers if necessary— eyelid spasm may make this difficult • Cover the area of eye with sterile or clean non-adherent dressing • Call 000 for an ambulance

Hydrofluoric acid burn • It comes in gaseous and liquid form • Is strongly corrosive • Burn may not be immediately painful or visible Hydrofluoric acid burn

Hydrofluoric acid burn • Commence treatment immediately, not when symptoms appear • Speed of treatment is essential • Must be seen by a doctor Hydrofluoric acid burn

Case study A 45 -year-old healthy man was involved in demolishing an industrial plant in which glass had been etched. He was exposed to a reservoir of 70% hydrofluoric acid while repairing a pipeline. He was admitted to the intensive care unit for second-degree and thirddegree burns from hydrofluoric acid affecting 30% of his body-surface area, including both hands, both forearms, the chest, back, scalp, and neck.

Case study

Signs & Symptoms • Throbbing, burning pain • Localised death of skin, deep tissues & blood vessels which may penetrate to the bone • Infection around nails may cause amputation of the finger • Slow healing

Management of Hydrofluoric acid burn • • Remove casualty from contamination Remove contaminated clothing Shower immediately Wash with copious amount of water for at least 10 minutes, if shower unavailable • Wear gloves, or wash own hands and dry

Management of Hydrofluoric acid burn • Apply Calcium Gluconate Gel, continuing until medical aid available • Continue to apply Calcium Gluconate Gel until 15 minutes after pain subsides • Cover with a light dressing soaked in Calcium Gluconate Gel and bandage lightly

Management of Hydrofluoric acid burn • Give Oxygen • Seek medical aid DO NOT allow Calcium Gluconate Gel to enter eyes!

Hot liquids burns Bitumen Burns Caused by: • Glue • Plastic • Tar (bitumen) Bitumen should not be removed from the skin unless it is obstructing the airway or further damage may result!

Management of Bitumen burn • Follow DRSABCD • DO NOT attempt to remove bitumen from skin or eyes • Drench burnt area immediately with cold running water • Apply cold, wet towels frequently • Continue the cooling for 20 minutes but not longer • If burn is to eye, flush eye with water for 20 minutes then cover the eye • Call 000 for an ambulance

Electrical burns • High voltage electrical burns may be more serious than they appear • It can be quite deep even when the surface skin shows no evidence of burning Electric burns

Electrical burns • There may be entry and exit wounds where the current density is highest, but most of the damage is to the deep tissues which can be severely damaged by heat • Electrical current especially AC may cause cardiac arrest Electric burns

Management of Electrical burns • Check for danger to yourself and bystanders • Switch off power if possible • Remove the casualty from electrical supply without directly touching the casualty, using nonconductive, dry materials WARNING: casualty may be LIVE!

Management of Electrical burns • Follow DRSABCD • Wash and cool the burnt area under running water • Apply a non-adherent/burns dressing (or aluminum foil, plastic wrap or clean dressing) • Call 000 for an ambulance

Important The early management of burns has the potential to reduce the effect of the burn and to hasten recovery! Severe burns can be life threatening so medical aid should be sought as soon as possible!

Ring 000 if • The burn involves airway, face, hands, groin or genitals, or is deep • Your unsure of the severity • It is larger than a twenty cent piece

Questions 19 December 2021 Coffs Harbour Divisional Training 65

BREAK 19 December 2021 Coffs Harbour Divisional Training 66

Scenario You are on duty at a school athletics carnival. It is a hot, humid day with the temperature around 30ºC. You have been kept busy with minor soft tissue injuries when you are approached by a parent. They advise you they have been sitting in the sun watching their children run and have not been using any sun block.

Scenario Although their upper body was in the shade, their thighs were in the sun and have been badly sun burnt. You see the fronts of the casualty’s thighs are very red and the casualty complains of the pain they are feeling.

Scenario 1. Put on gloves 2. Sits casualty down and have them rest in a cool place 3. Obtain history

Casualty information You are at your children’s school athletics carnival and have been watching the races. As the day it hot, you took precautions to ensure the top half of your body was in shade, however, you did notice your thighs were being exposed to the sun. After a while you realise your thighs are badly sunburnt and very painful.

Casualty information You seek out assistance from the St John First Aid Post. You forgot to bring sun screen with you. You do not have any pre‐existing medical conditions, do not take any medications and have an allergy to latex products.

Scenario 4. 5. 6. 7. 8. Cool the sunburn with cool water Provide cool water to drink Provide medical advice Provide reassurance to the casualty Remove gloves and dispose of correctly 9. Complete a Casualty Report (OB 12)

Questions 19 December 2021 Coffs Harbour Divisional Training 73