food, fats and cooking oils; contact with hot fluids; and exposure to ignition of highly flammable material. Other less common causes of burn injury are from electric current, ionizing radiation, visible and ultraviolet light.
CASE STUDY At 5:20 AM, the fire department requests your assistance at the scene of a house fire where they have rescued a 39-year- old male from a burning building. While en route to the scene, the fire commander advises you that the patient is unconscious and has extensive burns. Your response time to the scene is approximately eight minutes. Upon arriving at the scene, you are
immediately escorted to the patient. Firefighters have placed a blanket on the patient and have applied 100% supplemental oxygen via a non- rebreathing mask. The fire commander advises you that the patient was unconscious at the time of his rescue. While your partner opens the trauma kit, you perform an initial and rapid trauma assessment, obtain baseline vital signs and SAMPLE history. The patient was trapped in a burning
building: Unconscious and unresponsive, severe burns and respiratory compromise noted
Respirations: rapid and labored, stridor 14
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on inhalation
Pulse is weak, rapid, and regular No gross bleeding noted Partial and full-thickness burns, singed nasal hair, carbonaceous sputum
Partial and full-thickness burns to rest of body present with weak pedal pulses
Unable to assess sensory and motor function (unconscious)
Radial pulses weak and unable to assess sensory and motor function (unconscious)
Superficial burns posterior back with no spinal deformities noted. Vitals: BP 88/60 mm Hg, P130 beats/
min, weak and regular, RR intubated, ventilated at 12 breaths/min, Saturation 95% (ventilated 100% O2) S&S: Severe burns to upper body, respiratory insufficiency, and unconscious. Allergies/ Medications/Pertinent Past History/Last Oral Intake: Unknown. Events leading to injury: Neighbours reported hearing a small explosion shortly before the house caught on fire. At this point patient identified as critical and immediate transport initiated to trauma centre, while initiating two large bore IV lines of normal saline.
«Burns are classified based on how much of the skin’s thickness is involved»
SYSTEMIC INFLAMMATORY RESPONSE OF THE BURNED PATIENT Systemic response occurs as a result of the release of cytokines and other inflammatory mediators at the site of injury. A systemic effect occurs once the burn has exceeded 30% of the total body surface area. Cytokines and other mediators are released into the systemic circulation, causing a systemic inflammatory response. Because vessels in burned tissue exhibit increased vascular permeability, an extravasation of fluids into the burned tissues occurs. Hypovolemia is the immediate consequence of this fluid loss and for decreased perfusion and oxygen delivery. The burn wound has been described as having three zones of local response: The zone of coagulation – usually the centre of the wound, comprising non-living tissue. The zone of stasis – tissue is viable, but with decreased perfusion the tissue is at risk of ischemic damage. The zone of hyperemia – the normal skin with increased blood flow as a response to injury sustained. A good understanding of the pathophysiology of burn injuries is vital for effective management and will assist paramedics in the initial stages of caring for a burn- injured patient.
TYPE OF BURNS Burns are classified based on how much of the skin’s thickness is involved: First-degree (or superficial) burns involve only the top layer of the skin and are the least serious burn injuries
Second-degree (or partial-thickness) burns injure deeper into the skin and cause blistering
Third-degree (or full-thickness) burns involve all the layers of the skin, including the nerves that supply the skin, and are extremely serious injuries
Fourth-degree burns extend into the muscle below the skin.
ASSESSMENT AND %TBSA The assessment of any burn patient must be deferred until the scene is secured and deemed safe. Assessment of the patient should begin before physical contact is made. As you approach the patient, be aware of their surroundings. What is the patient’s overall appearance? Are there any clues or signs to what happened on scene?
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