First Aid Course PHMU 702 Lecture 4 Burns PDF

First Aid Course PHMU 702 Lecture 4 Burns Prof. Dr. Nabila Hamdi MD, PhD  ILOs a. Knowledge & Understanding a.1. Recognize the principles for basic life support measures a.2.Describe the types and degrees of burns...

First Aid Course PHMU 702 Lecture 4 Burns Prof. Dr. Nabila Hamdi MD, PhD  ILOs a. Knowledge & Understanding a.1. Recognize the principles for basic life support measures a.2.Describe the types and degrees of burns b. Professional and practical skills b.3. Perform the appropriate first aid measures in case of burns. c. Intellectual skills c.1. Demonstrate the rapid and correct assessment of the situation and casualty at the scene of an incident c.5. Compare the different types of burns and choose the appropriate first aid measures accordingly. d. General and transferable skills d.1. Work effectively in a team d.2. Communicate effectively with emergency care providers d.3. Act in a reliable and responsible manner 2  The skin The skin is composed of two main layers:  The epidermis, made of closely packed epithelial cells.  The dermis, made of dense, irregular connective tissue that houses blood vessels, hair follicles, sweat glands, and other structures. The hypodermis (subcutaneous layer) lies beneath the dermis and it is composed mainly of well-vascularized, loose connective tissue and fatty tissue. The hypodermis connects the skin to the underlying fascia (fibrous tissue) of the bones and muscles. 3  The skin https://opentextbc.ca/anatomyandphysiology/chapter/5-1-layers-of-the-skin/ 4  Definition Burns are a type of soft tissue injury. Burns commonly occur by direct or indirect contact with heat, electric current, radiation, or chemical agents. Burns can lead to cell death, which can require hospitalization and can be fatal. 5 Levels of Burns 6 http://www.urgentcarefl.com/differenttypes-of-burns-and-treatment/  Levels of Burns  First-degree burn: This is the shallowest burn. Damage only penetrates through the top outer layer of the epidermis. Indicated by:  Redness  Mild swelling  Tenderness  Pain Usually heals within a week without permanent scarring Caused by:  Sun  Brief contact with hot object or liquid 7  Levels of Burns  Second-degree burn (partial thickness burns) goes through and damages the epidermis and the dermis. Indicated by:  Blisters  Swelling  Weeping of fluid  Severe pain Usually heals in 3 to 4 weeks and may scar.  Caused by:  Severe sunburns  Contact with hot object or liquid 8  Levels of Burns  Third-degree burn (full thickness burns) The most severe type of burn. All layers of skin are burned, and so are tissues beneath the skin. The skin appears  dry  leathery  gray colored  Charred (blackened) The skin may be numb Healing requires medical assistance (skin grafting). Scarring is likely. Caused by:  Electricity  Contact with fire/clothes catch on fire  Sustained contact with hot object or liquid 9  Severity of Burns  Determinants of severity: Size Depth Location: Burns on the face, hands, feet, and genitals can be particularly serious. Age: Children under age 4 and adults over age 60 have a higher chance of complications and death from severe burns because their skin tends to be thinner than in other age groups. Absent breathing/pulse OR deterioration in consciousness Severe burns need urgent medical care. This can help prevent scarring, disability, and deformity. 10  Severity of Burns  Minor burns: First degree burns anywhere on the body Second degree burns less than 20% BSA Rule of Hand  Major burns: The person’s hand including palm, closed fingers and thumb equals 1% of his or her body surface Second-degree burns more than area (BSA) 20% BSA Second-degree burns on the hands, feet, face, groin, buttocks. Third-degree burns 11  Thermal Burns 1. Check the scene for safety! 2. Stop the burning! If clothing is on fire, have the person roll on the ground. Smoother the flames with a blanket, or douse the person with water. Remove clothing and all jewelry, especially rings, from the burn area. 3. Check and monitor breathing if the person inhaled heated air or was in an explosion. 4. Determine depth of the burn. 5. Determine the size of the burn using the Rule of Hand. 6. Determine which parts of the body are burned. 12  Thermal Burns 7. Seek medical care or call local emergency number if:  Burns on the face, neck, hands, feet or genitals  Breathing difficulties  Blistering or broken skin  Large area burned  All third and large second degree burns  burned airways  Circumferential burns  Others (coughing, wheezing, hoarse voice, carbon monoxide exposure) 13  Thermal Burns  First-Degree Burn 1. Immerse burned area in cool cold water, place it under running cool water, or apply a wet cool compress for at least 10 min asap. 2. Do NOT apply ice, ice water or salt water. 3. If needed, take pain reliever: Ibuprofen (acetaminophen for children) 4. Keep burned arm or leg raised. 5. After burn has been cooled, apply aloe Vera gel or a skin moisturizer. 6. No need to cover. 14  Thermal Burns  Small Second-Degree Burn (Less than 20% BSA) 1. Immerse burned area in cool water, place it under running cool water, or apply a wet cool compress for at least 10 min asap. 2. Pain reliever: Ibuprofen (acetaminophen for children) 3. Keep burned arm or leg raised. 4. After burn has been cooled, apply thin layer of antibacterial ointment on it. 5. Cover with a loose, dry, nonstick, sterile or clean dressing. 6. Do NOT break any blisters 15  Thermal Burns  Large Second-Degree Burn (More than 20% BSA) 1. Apply cold but monitor, as it may cause hypothermia (shivering, breathing, pulse, mental status…). 2. Pain reliever: Ibuprofen (acetaminophen for children) 3. Keep burned arm or leg raised. 4. Call local emergency number 16  Thermal Burns  Third-Degree Burn 1. Cover burn with a dry, nonstick, sterile or clean dressing. 2. Cool water can be applied to the surrounding areas, but not more than 20% of the body or 10% for child (avoid hypothermia) 3. Elevate the affected body parts. 4. Call local emergency number. 17  Thermal Burns  The don’ts: DO NOT 1. Apply ice or ice water to any burn 2. Touch a burn with anything except a clean covering. 3. Remove pieces of clothing that stick to the burned area. 4. Try to clean a severe burn 5. Break blisters 6. Use any kind of ointment on a severe burn 7. Immerse large severe burns in cold water (Hypothermia) 18  Inhalation Burns If a fire is associated with the burn, there is a risk of inhaling smoke or steam and burning the airways. The injury is basically a chemical burn from which resulting edema of the small airways creates a clinical picture identical to acute respiratory distress syndrome. Symptoms include:  Ash and smoke around the mouth and nose  Charred lips  Grey or black saliva/spiting up dark mucus  Change in voice  Inability to properly breath, wheezing  Chest pain or tightness  Blurred vision  Dizziness and confusion 19  Inhalation Burns  What to do?  Call emergency.  Check safety  Get the person into fresh air if it is safe for you to do so.  If conscious: sit the person down or lay them on their side.  If alert ask the person whether they have any medical conditions.  If they are not breathing perform CPR.  Medical care is essential  If left untreated, severe smoke inhalation can be fatal due to complications.  Significant injuries may require endotracheal intubation and mechanical ventilation. 20  Electrical Burns Every person who has been electrocuted needs medical care. Emergency must be called. The major damage occurs inside the body; the outside burn might appear small. If the person is inside a building and still in contact with electricity (power cord, electrical device, bare wire), turn off the electricity or unplug the appliance. Don't move a person with an electrical injury unless there is immediate danger. If the electrocuted person is in contact with high-tension power line:  Call emergency to have the electricity turned off or wires cut.  DO NOT touch or move the power lines or person.  DO NOT try to move electrical wire or devices with a wooden pole, rope or any other item (stay at least 6 m away).  Keep people away from the area. 21  Electrical Burns What to look for? Burn wound, which might appear small. Entrance and exit wounds (often hand or foot) Multiple burns (most electrical burns are third- degree burns) Tingling/Fatigue/headache/muscle pain/ spasms Loss of consciousness Absent breathing/pulse (risk of cardiac arrest) What to do? Perform CPR whenever needed. Call emergency number immediately. If the person fell, check for broken bones and a spinal injury. Cover all burn wounds with sterile dressings. 22  Chemical Burns Avoid chemical contact; wear gloves, goggles if available. If the burn occurs at a work place, send someone to check the safety data sheets (SDSs) for the hazardous materials used at the worksite. SDSs include first aid procedures. 23 Chemical Burns 24  Chemical Burns What to look for? Pain Burning Breathing difficulties Eye pain or vision changes What to do? Once area is safe: Brush a dry or powder chemical off the skin with a gloved hand or piece of cloth before flushing with water. Flash the burn immediately with large amount of cool running water for at least 20 min or until EMS arrives. Clothing can be removed while flushing. DO NOT try to neutralize the chemical 25  Chemical Burns For a chemical in an eye: Tip the head so that the affected eye is below the nose. Wash the eye with warm water (better tolerated in the eye than cold water) from nose out to side of face for at least 20 min. 26  References ECSI Emergency Care & Safety Institute. First Aid seventh edition, 2017. American College of Emergency Physicians. 27