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EMS/Nursing

This PowerPoint file is a supplement to the video presentation.  Some of the educational content of this program is not available solely through the PowerPoint file.  Participants should use all materials to enhance the value of this continuing education program. EMS/Nursing. 80912/ 37212.

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EMS/Nursing

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  1. This PowerPoint file is a supplement to the video presentation.  Some of the educational content of this program is not available solely through the PowerPoint file.  Participants should use all materials to enhance the value of this continuing education program.

  2. EMS/Nursing 80912/ 37212 Burns: Part 1 Toni Galvan, MSN, RN, CCRN, CEN Charge Nurse II Medical Intensive Care Unit Covenant Health System Lubbock, Texas

  3. EMS/Nursing 80912/ 37212 Objectives Identify incidence and measures for prevention of burns.

  4. EMS/Nursing 80912/ 37212 Objectives Indicate types of burns and physiological responses.

  5. EMS/Nursing 80912/ 37212 Objectives Identify fluid replacement measures used in the treatment of burns.

  6. Annual Incidence • 450,000 requiring medical treatment • 3,500 fire and burn deaths • 45,000 hospitalizations

  7. Annual Incidence • Cost: millions to billions in dollars, immeasurable in emotional distress to victims and families

  8. Where Burns Happen • Majority in home: 86% • #1: careless cigarettes • also water >140° F, cooking surfaces, combustibles, space heaters, chemicals, unsafe electrical wiring, etc.

  9. Where Burns Happen • Industry: 10% • Street/highway: 8% • Farm and other/unknown: 16%

  10. Financial/Community Impact • Care is specialized, expensive [$3,000-5,000 per day in burn intensive care unit (BICU)]

  11. Financial/Community Impact • Victim off work, non-productive for weeks to months • Family roles are disturbed for weeks to years

  12. Financial/Community Impact • Prevention is cheaper and easier!

  13. Mortality/Morbidity in BICUs • Survival rate: 94.8% • Gender: 70% male, 30% female • Ethnicity: 63% Caucasian, 17% African-American, 14% Hispanic, 6% other

  14. Mortality/Morbidity in BICUs • Admission cause: 42% fire/flame, 31% scald, 9% contact, 4% electrical, 3% chemical, 11% other

  15. Prevention of Burns • Hot water heaters: <120° F • Bath water: about 100° F • Anti-scald devices on bath and shower heads • Supervision of small children and elders

  16. Prevention of Burns • Grab bars in showers for impaired mobility • NO children in cooking area • While cooking, all pot handles and electric cords out of reach

  17. Prevention of Burns • Safety handles/knobs on stoves • Do not use open flame heaters • Meals: hot items in center of table

  18. Prevention of Burns • Meals: non-slip placemats with toddlers • Meals: no tablecloths with toddlers or when anyone using crutches or wheelchairs

  19. Prevention of Burns • Hot liquids • don’t carry while carrying child • not on low tables • Wheelchair: use a tray to carry hot foods/drinks

  20. Prevention of Burns • Microwave • use extreme caution with plastic wrap and hot containers • stir all food before serving • Fires: no gasoline, aerosols, or plastic

  21. Prevention of Burns • Carburetors: don’t prime with gasoline • Open flames: don’t combine with gasoline/kerosene

  22. Prevention of Burns • Electrical • use extreme care • if in doubt, don’t touch • don’t use questionable outlets

  23. Prevention of Burns • Chemical • use protective gear with all • never combine bleach and ammonia or products containing them

  24. Prevention of Burns • Christmas trees • never leave lights unattended • use mini-lights only • Smoke alarms: check battery monthly

  25. Prevention of Burns • Children playing with fire: NO • Don’t refuel a hot lawn mower engine

  26. Prevention of Burns • Sunscreen, hats, long sleeves for prolonged exposure • Routinely check fireplaces, heaters/furnaces

  27. Prevention of Burns • Use cool mist vaporizers with children/disabled/elders • Flameproof/retardant clothes for sleep, Halloween, etc. • Supervise kids carefully around open flames

  28. Mortality Estimates • Mortality estimate: %TBSA + age • Inhalation injury: 2(%TBSA + age) • TBSA: total body surface area (burned)

  29. Estimate Severity • Size (%TBSA) • Depth • Location (hands, feet, genitalia, face more severe) • Age [<2 years (yrs) and >65 yrs more severe]

  30. Estimate Severity • Past medical history (chronic disease) • Concomitant injuries

  31. Minor vs. Major • Minor: treat at home • Moderate: community hospital • Major: burn unit

  32. Minor vs. Major • Minor: 2nd degree <15% or 3rd degree <3% with no other concerns • Moderate: 2nd degree 25-35% or 3rd degree <10% on trunk only

  33. Minor vs. Major • Major: 2nd degree >35% or 3rd degree >10% or face/hands/feet/genitalia or inhalation injury or concomitant injuries or electrical or most chemical burns

  34. Anatomy and Functions of Skin

  35. Anatomy and Functions of Skin • First barrier to infection • Prevent loss of body fluid • Control body temperature

  36. Anatomy and Functions of Skin • Excretory organ • Sensory organ • Vitamin D production • Identity (cosmetic, etc.)

  37. Body Response to Burns • Local • evaporation • loss of heat • actual fluid loss • loss of first defense against infection

  38. Body Response to Burns • Cardiovascular • release epinephrine • response to shock • myocardial depressant factor from inflammation

  39. Body Response to Burns • Blood • damaged red blood cells (RBCs)

  40. Body Response to Burns • Blood • 3rd spacing, platelet, and white blood cell (WBC) clumping •  coagulation factors

  41. Body Response to Burns • Respiratory system if inhalation injury • burn upper airway • decreased chest and neck expansion

  42. Body Response to Burns • Respiratory system if inhalation injury • CO poisoning • smoke inhalation • acquired respiratory distress syndrome (ARDS)

  43. Body Response to Burns • Renal • potential acute renal failure from dehydration

  44. Body Response to Burns • Renal • in chemical, electrical, and large muscle burns: myoglobinuria and risk for rhabdomyolysis

  45. Body Response to Burns • Gastrointestinal • gastric dilation • paralytic ileus • Curling’s ulcer

  46. Body Response to Burns • Neuro: alert, active 1st 1-2 hours (hrs), then diminished level of consciousness (LOC) from hypoxia

  47. Body Response to Burns • Pain: prescribe intravenous (IV) morphine

  48. Body Response to Burns • Emotional and social • diminished coping, body image • familial and work stress • long and costly healing

  49. Fluid shift in burns • Inflammation opens capillary pores causing leak of water, albumin, fibrin, electrolytes to 4-15x normal

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