| As CMO of a Starship or Starbase your medical teams will respond involving burns be it chemical or phaser. You must be able to classify, evaluate, and care for burn injuries. Most cases involving burns, we tend to think only of injury to the skin, but burns can do much more than injure the skin. Injuries from burns often involve structures below the skin, including muscles, bones, nerves, and blood vessels. The eyes can be injured beyond repair when burned. Respiratory systems structures can be damaged, with possible airway obstruction, respiratory failure, and respiratory arrest. In addition physical damage caused by burns, patients also may suffer emotional and psychological problems that begin at the scene and could last a life time. Classification of Burns: Burns can be classified according to the agent causing the burn. The score of the burn also can be used to make the classification more specific. Always report the agent causing the burn and when practical the source of the agent. The agent of the burn can be as follows: Thermal: Including flame, radiation or excessive heat from fire, steam, and hot liquids and hot objects. Chemical: Including various acids, bases, and caustics. Electricity: Including AC current, DC current and lighting. Light: typically involving the eyes, with burns caused by intense light sources or ultraviolet light including sunlight. Radiation: Usually from nuclear sources. Ultraviolet light also is considered to be a source of radiation burn. Never assume the source of the burn. What may appear thermal may be in fact radiation. Degrees of Burns: First Degree- A superficial injury, that involves only the epidermis. It is characterized by pain, reddening of the skin, and perhaps some swelling. The burn will heal of its own accord without scarring. Since the skin is not burned through, this type of burn is evaluated as a mild partial thickness burn. Second Degree- The first layer of the skin is burned through and the second layer is damaged, but the burn does not pass through to the underlying tissues. There will be deep intense pain, intense reddening, blisters, and a mottle (spotted) appearance to the skin. Burns of this type have swelling and blistering for 48 hours after the injury as plasma and tissue rise to the top layer of skin. A second degree burn is called a partial thickness burn. When treated with reasonable care, second degree burns will heal themselves and produce very little scarring. Third Degree- This is a full thickness burn, with all the layers of the skin damaged. Some third degree burns are difficult to tell from second degree; However, there usually are areas charred black or areas that are dry and white. The patient may complain of severe pain, or, if enough nerves have been damaged, he may feel no pain at all (except at the periphery of the burn where adjoining second degree burns may be causing pain.) This type of burn may require skin grafting. Third degree burns will cause dense scars to form. Severity of Burns: -Source of the burn -Body regions burned -degree of burn -Extent of the burned area -Age of your patient -Other patient illnesses and injuries Classifying the Severity of the Burn: Once you have determined from your assessment by the criteria from above the following classification can be used: Critical Burns: -All burns complicated by injuries of the respiratory tract, soft tissues, and bones. Third degree burns involving the face, hands, feet, groin, or major joints. -Third degree burns involving more than 10% of the body surface. -Second degree burns involving more than 30% of the body surface. Moderate Burns: -Third degree burns that involve less than 10% of the body surface, excluding face, hands, feet, groin, or major joints. -Second degree burns that involve 15 - 75% of the body surface. Minor Burns: -Third degree burns involving less than 2% of the body surface, excluding face, hands, feet, groin, or major joints. -Second degree burns that involve less than 15% of the body surface. -First degree burns that involve less than 20% of the body surface. Tx. Modalities: Thermal Burns: First & Second Degree -Immerse in cold water 2 - 5 minutes -Cover entire burn with a dry sterile dressing -Transport and continue cold water application. -Gel packs* Extensive First, Second & Third Degrees: -Gel Packs* -Wrap area with dry sterile dressing -Treat for shock -Establish IV -Transport If Hands or Toes are burned: -Separate digits with a sterile gauze by placing the gauze in-between toes and or fingers. -Moisten pads with sterile water. Burns to the Eyes: -Do not open eyelids if burned -Be certain Burn is Thermal not Chemical -Apply moist sterile gauze Pads to both eyes. Chemical Burns: Evaluate the scene in and around your patient for dangerous chemical. A phaser blast could have erupted a container of acid and toxic fumes may be present. Immediate action get your patient away from the location. Wash away the chemical with water with a continuous flooding of the affected areas. Remove any contaminated clothing, shoes, socks, and jewelry. Once you have washed away the chemical apply sterile dressing, treat for shock and transport. Find out the chemical or the mixture of chemicals involved in the accident and be on the alert for delayed reactions that may caused renewed pain, or interfere with the patient's ability to breathe. Dry Lime: -If the chemical burn is caused by Dry Lime, DO NOT wash the burn site with water. To do so will create a corrosive liquid. Brush the dry lime off the patient's skin, hair, and clothing. Make certain you do not contaminate his eyes or airway. Use water only after you have brushed the dry lime away from the patient and all articles of contamination have been removed. Carbolic Acid (phenol): -Does not mix with water, When available use alcohol for the initial wash, followed by a long steady was with water. Sulfuric Acid: -Concentrated sulfuric acid produces heat when water is added. An initial wash with mild soapy water is added. An initial wash with soapy water if the burns are not classified as sever. Proceed to treat for shock and transport. Hydrofluoric Acid: -Burns may be delayed. Begin treatment with a Bicarbonate of soda solution and then flood with water. If burning sensations are severe Immediately begin the water wash. Do not delay care and transport to find any neutralizing agents. Anytime a patient is exposed to a caustic chemical and may have inhaled the vapors, provide humidified O2 and transport. Very important when the chemical is an acid known to vaporize at standard environmental temperatures e.g., hydrochloric acid or sulfuric acid. Chemical Burns to the eyes: 1. Immediately flood the eyes with water. 2. Keep running water from a faucet, low pressure hose, bucket, cup, bottle, rubber bulb syringe, or other such source flowing into the burned eye. The flow should be medial corner of the eye to the lateral corner. (Nasal area then flow outward) Gentle hold the eyes open. 3. Continue washing the eye for the following time periods: -Acid burns = At least 5 min. -Alkali Burns = At least 15 min. -Unknown caustic = at least 20 min. 4. After washing, cover both eyes with moistened pads, and transport. 5. If Patient complains of renewed pain wash for an additional 5 mins. WARNING!! DO NOT use neutralizers such as vinegar or baking soda in your patients eyes. *Note With the exception of the Gel packs this is the general treatment modality used by EMS. This is to enhance the role-players experience and not intended for actual care for burn injuries. Contact your local EMS Office for training within your area. Refer: Emergency Care; Grant, Murray and Bergeron. Anne E. Erickson. MD. Commander SFEF Stardate 55301.76 4/20/02 |
| Burns & Treatment (TX) Modalities (Sequences and Types) |
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