prehospital burns
TRANSCRIPT
Prehospital and Emergency Room Care for Burns
Teodoro J. Herbosa MD FPCS!Department of Emergency Medicine!Division of Trauma Dept of Surgery!
Philippine General Hospital!University of the Philippines, Manila!
Former Undersecretary DoH
BURN INJURIES:A SERIOUS PUBLIC HEALTH PROBLEM
• Globally a serious public health problem • Devastating injury - 4th most common
injury • >195,000 deaths yearly from fires alone • More deaths from scald, electrical
burns, & other forms of burns • Global data are not available
• Fire-related deaths rank among the 15 leading causes of death - children & young adults 5-29 yrs !
• > 95% of fatal burns occur in low/middle-income countries !
• < 5 yrs and elderly (> 70 yrs) - highest mortality rates
• millions left with disabilities & disfigurement resulting in stigma
• more tragic as burns are so eminently preventable
BURN TREATMENT The nature and complexity of severe burn injury requires a collaborative approach to patient care. This is provided by a multi-disciplinary team with expertise in the management of severe burns with supporting services such as: prehospital, emergency room, critical care, surgery, reconstruction and rehabilitation.
• Bringing together the expertise required to coordinate clinical services across the continuum of care - from first responder, prehospital, initial hospital admission through to hospital discharge, rehabilitation and ongoing care.
• Sharing clinical expertise • Developing standardized clinical practice
guidelines for patient care • Increasing the focus on prevention, improving
links to community outreach services for patients and undertaking research to improve patient care
A great number of patients who had burn injuries were alive upon reaching the hospital
Most patients with burn injuries are treated and sent home while some are being admitted
Most burn patients improved after treatment.
PATHOGENESIS OF BURN INJURY (INITIAL AND DELAYED)
KEY INSULTS Heat Induced Injury !Inflammatory Mediator Injury !Ischemia Induced Injury
Burns : results from dry heat, corrosive substances/friction!
!
!! Scalds: caused by wet heat!!General Principles:! first address your own safety! stop burning! cover injury! obtain medical aid
Classification of burns!
! ! ! thermal! !chemical! !electrical
Burn Patient
First Degree BurnInvolves the epidermis!Redness, mild swelling!
Tenderness, pain!E.g. mild sunburn!
First aid! relieve pain! dec pain/infl! moisturizer
Second Degree BurnDermis and epidermis!
Blister formation, looks raw!
Swelling ,severe pain!First aid!
analgesic! hospital!
cover!Topical antibiotic
Third Degree BurnSkin, fats, muscles!
Leathery,waxy charred!No pain!Hospital!
Cover !Treat for shock
Extent of BurnsEstimating the body surface !
Rule of palm! victims hand,it
represents 1% ! for small of scattered
burn!Large burn, unburned
subtract to 100%
Thermal Burn
Pointers: seek medical attention !Burns of face, hands, feet and genital
are more severe!Circumferential burn!Age( < 5 y/o,>55 y/o)!
Electrical injury!Child abuse is suspected!
Surface of 2 degree >15% of BSA!3rd burn
Chemical Burn
Chemical burns:
!
caustic or corrosive substance! alkalis ( drain cleaners)!
acids (battery acids)! organic compounds(petroleum
products)!First Aid:!
flood flush with water > 20 min
remove contaminated clothing! sterile dressing!
hospital! chemical burn to eye flush with
water
Electrocution Current of 1,000 volts or > high
voltage!Entrance and exit wound!
Disrupt normal heart rhythm!First Aid:!
safety first! check ABC!Treat for shock!
hospital
Electrical Injuries
Approaching the Victim
ABC’s of Life Support
Call an ambulance
Summary of First Aid for Burns
Stop the burning and cool area!Check ABC!
Depth and extent!Determine other injuries!
Burn severity!Seek medical attention
Inhalational Injuries
CARBON MONOXIDE TOXICITYCarbon monoxide toxicity - leading
cause of death in fires While oxygen is being used during
combustion, carbon monoxide is being released -
it is a basic by-product of combustion. Carbon monoxide is rapidly
transported across the alveolar membrane (lungs)
and preferentially binds with the hemoglobin molecule (RBC) in place
of oxygen.
CARBON MONOXIDE TOXICITY shifts the Hb-O2 curve to the left, impairing oxygen unloading at the
tissues a major impairment in oxygen delivery, since 98% of oxygen is carried to the
tissues on Hb prolonged exposure, CO can saturate
the cell, binding to cytochrome oxidase,
thereby further impairing mitochondrial function and
adenosine triphosphate (ATP) production.
CARBON MONOXIDE TOXICITYSYMPTOMS:
usually not present until carboxyhemoglobin > 15%.
those of decreased tissue oxygenation, initial manifestations being neurologic
due to the impairment in cerebral oxygenation.
myocardial dysfunction can also develop,
with evidence of myocardial ischemia or even infarction,
especially with preexisting coronary artery disease.
CARBON MONOXIDE TOXICITYSYMPTOMS:
neurologic dysfunction can lead to a progressive/permanent cerebral
dysfunction. patient will awaken transiently after severe inhalation injury only to have
progressive neurologic deterioration 24 to 48 hrs later.
Cyanide toxicity - very similar to carbon monoxide, with severe metabolic
acidosis and obtundation in severe cases.
Diagnosis - more difficult because cyanide levels not readily available
EFFECTS OF CARBON MONOXIDE POISONING
ALTERED JUDGMENTCONFUSION
DISORIENTATION LETHARGY,
STUPOR RESPIRATORY
ARRESTDEATH
Thank you very muchTeodoro J. Herbosa M.D. Dept. of Emergency Medical Services Philippine General Hospital University of the Philippines,
Manila !twitter Teddybird fb Ted Herbosa