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Thermal & Chemical Burns, Electrical & Lightning Injuries

Thermal & Chemical Burns, Electrical & Lightning Injuries. Chapters 199, 200, 201, & 202. Burn Size Ch.199. Fact: the area of the back of a patient’s hand is approximately 1% BSA. Burn Depth. Burn pictures. superficial. Superficial Partial thickness. Full thickness.

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Thermal & Chemical Burns, Electrical & Lightning Injuries

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  1. Thermal & Chemical Burns, Electrical & Lightning Injuries Chapters 199, 200, 201, & 202

  2. Burn Size Ch.199 Fact: the area of the back of a patient’s hand is approximately 1% BSA

  3. Burn Depth

  4. Burn pictures superficial Superficial Partial thickness Full thickness Deep partial thickness

  5. American Burn Association Burn Unit Referral Criteria • Advances in burn care and increased admissions to specialized burn centers have improved outcomes in burn injury care. The American Burn Association recommends transfer to a burn center if any of the following criteria are met: • Chemical or electrical burns • Partial thickness burns covering more than 10 percent of the total body surface area (TBSA) • Burns covering substantial portions of the face, hands, feet, genitalia, perineum or major joints • Smoke inhalation injury • Third degree or full-thickness burns • Patients with certain pre-existing medical conditions • Children in the hospital for a burn injury without the appropriate facilities to care for them • Patients who will need social, emotional and/or rehabilitative interventions

  6. Inhalation Injury • Cause of ½ of fire related deaths • Consider toxic inhalants: • CO and cyanide • Intubate if: • Singed hair, carbonaceous sputum, wheezing, hoarseness, or soot in mouth • ARDS is common complication

  7. Treatment • Establish airway • Start fluid resuscitation • Parkland formula • Monitor urine output • Pain control • IV morphine and anxiolytics • Wound care • Moist saline-soaked dressings • Escharotomy of chest if ventilation restriction • Evaluate limbs with doppler (fasciotomy)

  8. Care of Minor Burns in ED • Analgesia • Clean with mild soap & water • Leave small blisters intact • Debride broken, large, or blisters over joints • Tetanus • Topical antimicrobials (silvadine or bacitracin) • Adherent dressing to act as second skin • Leave in place until spontaneous separation occurs • Arrange follow-up prior to discharge

  9. Acid Burns Ch.200 • Coagulation necrosis from the desiccation action of acid on tissue proteins (board ?) • Acetic acid • Carbolic acid (phenol) • Chromic acid • Formic acid • Methacrylic acid • Nitric acid • Oxalic acid • Hydrochloric and sulfuric acids • Hydrofluoric acid • The acid that acts like an alkali!!! (board ?)

  10. Alkali Burns • Penetrate deeper and longer than acids, causing liquification necrosis • Lyes • Lime • Portland cement • (picture at right)

  11. Air bag burns • Occurs in 8% of airbag deployment • Results in friction, thermal, & chemical burns • Airbags deploy by ignition of sodium azide • Exothermic reaction • Creates many corrosive gases • Evaluate for chemical keratitis • Treat as alkali burns with copious irrigation

  12. Ocular Burns • Check pH if type of irritant is unknown • Acid will be limited to area of contact • Alkali penetrate much deeper & are devastating • Irrigate immediately with 1-2L NS for acids and continuous until pH is 7.4 for alkali • Treat with pain control, cycloplegics, mydriatics, and antibiotics • Get an ophtho consult ASAP

  13. Electrical Injuries Ch. 201Fun Facts • Bone: greatest resistance to electricity • DC: continuous in one direction • AC: alternates direction of current (worst) • High voltage considered >1000V but serious injury can occur >600V • Current can induce sudden forceful contraction (appear to be thrown) and results in dislocations of joints esp. posterior shoulders (board ?) • Also may induce cardiac dysrhythmia, pulmonary arrest and seizures

  14. ED treatment • ABC and immobilize • Test for rhabdo, EKG, and assoc injury/burns • Fluid resuscitation usually 40cc/kg in1st hr • Cardiac arrest is primary cause of death • Low voltage AC: V fib • High AC & DC: Asystole

  15. Lightning Injuries Ch. 202 • Extremely high voltage direct current (DC) • Flashover: when lightning travels over body surface • Direct strike: results in most serious injury • Side flash • Contact strike • Ground current • Upward streamer

  16. Clinical • Ocular: cataracts from flash • Cardiac: dysrhythmia, ST elev, prolonged QT • Respiratory: will be continue even after the heart starts beating; cont. to assist breathing • Neuro: unconscious; lower ext paralysis; seizure; heat induced cerebral coagulation • Vasoconstriction and transient loss of pulses • Auditory: blast from expansion of surrounding air • Spinal cord and skeletal injury

  17. Clinical cont/ Disposition • Lichtneberg figures: ferning • Admit for observation due to delayed sequelae

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