BURNS

1. 1 BURNS NOTES The topic for our lesson today is � BURNS� State the reason on the need for the lesson, i.e. As Medical Orderlies there is a need for them to understand and know the topic, enabling them to effectively render first aid treatment. NOTES The topic for our lesson today is � BURNS� State the reason on the need for the lesson, i.e. As Medical Orderlies there is a need for them to understand and know the topic, enabling them to effectively render first aid treatment.

2. 2 LEARNING OBJECTIVES 1 List and describe the three types of burns 2 Assess the severity, depth and extent of injury 3 Assess and administer management treatment steps to the victim NOTES Inform the trainees that at the end of this lesson, they are expected to achieve the three learning objectives as set out as follows:- - List and describe the three types of burns. - Assess the severity, depth and extent of injury. - Assess and administrate management treatment steps to the victim. NOTES Inform the trainees that at the end of this lesson, they are expected to achieve the three learning objectives as set out as follows:- - List and describe the three types of burns. - Assess the severity, depth and extent of injury. - Assess and administrate management treatment steps to the victim.

3. 3 SCOPE 1. Introduction 2. Types of Burns 3. Assessment & Complications of Burns 4. Signs and symptoms of Burns 5. Management of Burns 6. Conclusion NOTES The scope for today�s lesson is: - Introduction - Types of Burns - Assessment & Complications of Burns - Signs and symptoms of Burns - Management of Burns - Conclusion NOTES The scope for today�s lesson is: - Introduction - Types of Burns - Assessment & Complications of Burns - Signs and symptoms of Burns - Management of Burns - Conclusion

4. 4 INTRODUCTION Definition Injury to the skin or mucous membrane from excessive heat or cold, chemical substances and electrical current Burns causes most painful injuries Accurate assessment is vital Management and rapid transport is critical NOTES Explain the definition of burns i.e., injury to the skin or mucous membrane from excessive heat or cold, chemical substances and electrical current. Explain to the trainees that Burns cause some of the most painful and catastrophic injuries you will encounter in the field. Your accurate assessment, management and rapid transport of burn victims- particularly those with inhalation injuries - is often critical to their survival. NOTES Explain the definition of burns i.e., injury to the skin or mucous membrane from excessive heat or cold, chemical substances and electrical current. Explain to the trainees that Burns cause some of the most painful and catastrophic injuries you will encounter in the field. Your accurate assessment, management and rapid transport of burn victims- particularly those with inhalation injuries - is often critical to their survival.

5. 5 TYPES OF BURNS Thermal Burns Chemical Burns Electrical Burns NOTES State that there are three types of burns: - Thermal burns - Chemical burns - Electrical burns NOTES State that there are three types of burns: - Thermal burns - Chemical burns - Electrical burns

6. 6 TYPES OF BURNS Thermal Burns: - Destroys tissue through heat. - Burning in the tissues continues for about 10 minutes following the critical burn injury - Smoke inhalation and carbon monoxide poisoning NOTES State that thermal burn destroys tissue through heat. Burning in the tissues continues for about 10 minutes following the critical burn injury. Thermal burns are often accompanied by serious complications like smoke inhalation and carbon monoxide poisoning. NOTES State that thermal burn destroys tissue through heat. Burning in the tissues continues for about 10 minutes following the critical burn injury. Thermal burns are often accompanied by serious complications like smoke inhalation and carbon monoxide poisoning.

7. 7 Thermal Burns Casualty burnt by overheated tool

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10. 10 Tug of war

11. 11 TYPES OF BURNS NOTES State that a chemical burn results when a chemical comes in contact with the skin. Chemicals usually destroy tissue through protein coagulation rather than heat. The extent of tissue destruction in chemical burns depends primarily on three factors: - duration of contact - concentration or strength of chemical - amount of tissue exposed to the chemicalNOTES State that a chemical burn results when a chemical comes in contact with the skin. Chemicals usually destroy tissue through protein coagulation rather than heat. The extent of tissue destruction in chemical burns depends primarily on three factors: - duration of contact - concentration or strength of chemical - amount of tissue exposed to the chemical

12. 12 Chemical Burns Burned by Petrol

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14. 14 NOTES State that an electrical burn occurs some parts of the body complete the circuit between two conductors. Electrical burns can be extremely deceiving. A small surface wound may cover widespread underlying tissue damage. As the current passes through the body, destruction of muscle, nerve, and blood vessels can occur. Tetanic muscle contractions can be strong enough to fracture long bones and the vertebrae. Further,disruption of cardiac contraction or damage to myocardium can induce cardiac arrest. Frequently, the electrical current interferes with the body�s own electrical activity, resulting in cardiac and neurogenic complications. Arrhythmia, respiratory arrest, muscle spasm and seizures are all common conditions. In cases of cardiac arrest, defibrillation and CPR have proven to be effective. CPR must be continued until the patient is provided with ACLS. NOTES State that an electrical burn occurs some parts of the body complete the circuit between two conductors. Electrical burns can be extremely deceiving. A small surface wound may cover widespread underlying tissue damage. As the current passes through the body, destruction of muscle, nerve, and blood vessels can occur. Tetanic muscle contractions can be strong enough to fracture long bones and the vertebrae. Further,disruption of cardiac contraction or damage to myocardium can induce cardiac arrest. Frequently, the electrical current interferes with the body�s own electrical activity, resulting in cardiac and neurogenic complications. Arrhythmia, respiratory arrest, muscle spasm and seizures are all common conditions. In cases of cardiac arrest, defibrillation and CPR have proven to be effective. CPR must be continued until the patient is provided with ACLS.

15. 15 Electrical Burns Lineman burnt while attending to electrical cable

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18. 18 Burns & Scalds How to recognise severity? Types of burns electrical, chemical, explosion Depth of burn

19. 19 Burns & Scalds

20. 20 Burned tissue Increased capillary permeability Shift of water, plasma proteins & electrolytes into tissues Decreased circulating blood volume Increased blood viscosity Hypovolaemia NOTES State that burns causes vascular changes in the body. A major burn injury alters the normal fluid and electrolyte balance in the body. Generalized vascular changes occur. Immediately following the burn, fluids leak from the capillaries into the tissues in the burn area. The burned tissue is less capable of retaining fluid. It allows the passage of plasma, plasma proteins, and electrolytes into the wound. As fluids shift into the injured tissues, the total circulating blood volume in the body decreases which causes hypovolaemia. The plasma leak usually continues for 24 to 48 hours after the injury.NOTES State that burns causes vascular changes in the body. A major burn injury alters the normal fluid and electrolyte balance in the body. Generalized vascular changes occur. Immediately following the burn, fluids leak from the capillaries into the tissues in the burn area. The burned tissue is less capable of retaining fluid. It allows the passage of plasma, plasma proteins, and electrolytes into the wound. As fluids shift into the injured tissues, the total circulating blood volume in the body decreases which causes hypovolaemia. The plasma leak usually continues for 24 to 48 hours after the injury.

21. 21 Vascular Changes Body attempt to compensate loss Maintain B/P by releasing fluid from unburned areas Other changes: - decreased life span of RBC�c - Loss of sodium and chloride and elevated potassium NOTES State that the body attempts to compensate for this loss of circulating fluid and to maintain blood pressure by releasing fluid from unburned areas into the circulation. Other changes that occur with a major burn injury include: - a decreased life span of red blood cells (this results in less nutrients and oxygen being carried to the cells). - loss of sodium and chloride and elevated potassium in the blood. Almost all patients sustaining greater than 20% of total body surface burns require IV fluid resuscitation.NOTES State that the body attempts to compensate for this loss of circulating fluid and to maintain blood pressure by releasing fluid from unburned areas into the circulation. Other changes that occur with a major burn injury include: - a decreased life span of red blood cells (this results in less nutrients and oxygen being carried to the cells). - loss of sodium and chloride and elevated potassium in the blood. Almost all patients sustaining greater than 20% of total body surface burns require IV fluid resuscitation.

22. 22 Assessment of Burns  NOTES State that you will learn how to do a general assessment of burns. This includes assessing the severity, depth and extent of the burn. NOTES State that you will learn how to do a general assessment of burns. This includes assessing the severity, depth and extent of the burn.

23. 23 SEVERITY OF BURNS NOTES State that the severity of a burn depends on the following: -depth of the burn -extent of the burn -location of the burn -accompanying complication -age of the patientNOTES State that the severity of a burn depends on the following: -depth of the burn -extent of the burn -location of the burn -accompanying complication -age of the patient

24. 24 Severity of Burns NOTES State that the depth of a thermal burn can range from a very superficial to very deep. The classifications of the depth are first, second and third degree. NOTES State that the depth of a thermal burn can range from a very superficial to very deep. The classifications of the depth are first, second and third degree.

25. 25 Severity of Burns First Degree: - Superficial partial thickness burn involving only the epidermal area. - Redness, tenderness and peeling. - Heals within one or two weeks without scarring. NOTES Explain that a first degree burn is a superficial partial thickness burn involving only the epidermal area. Signs and symptoms includes redness, tenderness and peeling. First degree burns heal within one or two weeks without scarring. NOTES Explain that a first degree burn is a superficial partial thickness burn involving only the epidermal area. Signs and symptoms includes redness, tenderness and peeling. First degree burns heal within one or two weeks without scarring.

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27. 27 Severity of Burns Second degree - Deep, partial thickness burn involving the dermis and epidermis - Characterized by red or mottled skin, often with blisters NOTES State that second degree burn is a deep, partial thickness burn involving the dermis and epidermis. The epidermal cells, which line the hair follicles and sweat glands, are usually preserved. A second degree burn is characterized by red or mottled skin, pain, blisters or open weeping areas and swelling. This burn heals within two or three weeks without scarring. NOTES State that second degree burn is a deep, partial thickness burn involving the dermis and epidermis. The epidermal cells, which line the hair follicles and sweat glands, are usually preserved. A second degree burn is characterized by red or mottled skin, pain, blisters or open weeping areas and swelling. This burn heals within two or three weeks without scarring.

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29. 29 Third degree:- Full thickness burn- All sensation is lost- Characterized by charred skin NOTES State that third degree burn is a full thickness burn which destroys the epidermis, dermis, sub-cutaneous layer, and deeper layers. All sensation is lost because the sensory organs are destroyed. The third degree burn is characterized by white or charred skin, a loss of skin, and an absence of pain except around the burn margins. Healing is paralyzed with scar tissue formation.NOTES State that third degree burn is a full thickness burn which destroys the epidermis, dermis, sub-cutaneous layer, and deeper layers. All sensation is lost because the sensory organs are destroyed. The third degree burn is characterized by white or charred skin, a loss of skin, and an absence of pain except around the burn margins. Healing is paralyzed with scar tissue formation.

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32. 32 SIGNS OF INHALATION INJURY NOTES State the signs of burn injury as follows: -Burns over face and neck, especially around the lips. -Singed eyebrows, eyelashes and nasal hairs. -Hoarseness. -Noisy, crowing respiration. -Redness and deposits in the mouth and pharynx. NOTES State the signs of burn injury as follows: -Burns over face and neck, especially around the lips. -Singed eyebrows, eyelashes and nasal hairs. -Hoarseness. -Noisy, crowing respiration. -Redness and deposits in the mouth and pharynx.

33. 33 SYMPTOMS OF INHALATION INJURY Pain in the throat or chest A strong tendency to cough, and coughing up black sputum containing particles of soot Complaints of headache, dizziness and confusion NOTES State that the symptoms of burn injury are: - Pain in the throat or chest. - A strong tendency to cough, and coughing up black sputum containing particles of soot. - Complaints of headache, dizziness and confusion.NOTES State that the symptoms of burn injury are: - Pain in the throat or chest. - A strong tendency to cough, and coughing up black sputum containing particles of soot. - Complaints of headache, dizziness and confusion.

34. 34 MANAGEMENT OF BURNS Removal from danger Primary Survey: Open airway Ensure circulation arrest haemorrhage Fluid resuscitation NOTES The instructor explains the treatment and management of a burn victim should follow the patient assessment method Removal of casualty from danger area: The medic must remove the casualty from any immediate danger. Primary survey: - Ensure an open airway and adequate breathing. If unconscious, airway obstruction must be removed by head-tilt- chin-lift method. Give artificial ventilation if necessary. - Ensure adequate circulation. In case of severe haemorrhage, arrest it immediately. Check carotid pulse and note shock signs. - Fluid resuscitation in a burn casualty. Intravenous infusion is important. Lost fluids should be replenished immediately to prevent further dehydration. NOTES The instructor explains the treatment and management of a burn victim should follow the patient assessment method Removal of casualty from danger area: The medic must remove the casualty from any immediate danger. Primary survey: - Ensure an open airway and adequate breathing. If unconscious, airway obstruction must be removed by head-tilt- chin-lift method. Give artificial ventilation if necessary. - Ensure adequate circulation. In case of severe haemorrhage, arrest it immediately. Check carotid pulse and note shock signs. - Fluid resuscitation in a burn casualty. Intravenous infusion is important. Lost fluids should be replenished immediately to prevent further dehydration.

35. 35 Management of Burns Secondary Survey: Expose injured area Rapid full body examination Check vital signs Physical examination Sterile dressing Keep casualty warm NOTES Explain to the trainees that a secondary survey must be done as follows: - Remove any clothing covering the injured area. - A rapid full body examination must be done. - Vital signs like pulse and respiration must be noted. - A thorough physical examination from head to toe must be done concentrating on the head, neck, abdomen and limbs. - Sterile dressing should be used to cover the entire surface area of the burn. Do not clean the wound, rupture any blisters and smear any ointment. - Cover the casualty with a blanket or towel to conserve body heat. - Pain relief medications should be administered only by a Medical Officer. NOTES Explain to the trainees that a secondary survey must be done as follows: - Remove any clothing covering the injured area. - A rapid full body examination must be done. - Vital signs like pulse and respiration must be noted. - A thorough physical examination from head to toe must be done concentrating on the head, neck, abdomen and limbs. - Sterile dressing should be used to cover the entire surface area of the burn. Do not clean the wound, rupture any blisters and smear any ointment. - Cover the casualty with a blanket or towel to conserve body heat. - Pain relief medications should be administered only by a Medical Officer.

36. 36 Treating Burns and Scalds Reduce the spread of heat, pain and swelling by placing the burnt area under cold running water or immersing it in cold water for at least 10 minutes. Gently remove any rings, watches, belts or constricting clothing from the injured area before it starts to swell. Cover the injured area with clean, preferably sterile, non-fluffy material. A burnt face may be covered with a gauze mask, with holes cut into it to assist the victim in breathing. NOTES The instructor explains the treatment and management of a burn victim should follow the patient assessment method Removal of casualty from danger area: The medic must remove the casualty from any immediate danger. Primary survey: - Ensure an open airway and adequate breathing. If unconscious, airway obstruction must be removed by head-tilt- chin-lift method. Give artificial ventilation if necessary. - Ensure adequate circulation. In case of severe haemorrhage, arrest it immediately. Check carotid pulse and note shock signs. - Fluid resuscitation in a burn casualty. Intravenous infusion is important. Lost fluids should be replenished immediately to prevent further dehydration. NOTES The instructor explains the treatment and management of a burn victim should follow the patient assessment method Removal of casualty from danger area: The medic must remove the casualty from any immediate danger. Primary survey: - Ensure an open airway and adequate breathing. If unconscious, airway obstruction must be removed by head-tilt- chin-lift method. Give artificial ventilation if necessary. - Ensure adequate circulation. In case of severe haemorrhage, arrest it immediately. Check carotid pulse and note shock signs. - Fluid resuscitation in a burn casualty. Intravenous infusion is important. Lost fluids should be replenished immediately to prevent further dehydration.

37. 37 Do not break blisters or remove anything that is sticking to a burn. Do not apply lotions, ointments or fat to the injured area. NOTE:For severe burns, call 995 for an emergency ambulance.

38. 38 CONCLUSION Revision Any Questions ? NOTES The instructor will revise the main sections of the topic: - Definition - Types of burns - Assessment of burns - Management of burns The instructor will clarify any questions from the trainees. NOTES The instructor will revise the main sections of the topic: - Definition - Types of burns - Assessment of burns - Management of burns The instructor will clarify any questions from the trainees.