Treatment
For major burns, notify your PIC and call Aircare Access. Until advanced medical care arrives, follow these steps:
• Make sure the patient is no longer in contact with smoldering materials or exposed to smoke or heat.
• Do not immerse severe, large burns in cold water. Doing so could cause the patient to go into shock.
• Evaluate airway and breathing. If the patient is not breathing, begin CPR and call for an AED.
• Do not remove burnt clothing.
• Cover the burn using a moist, sterile bandage or a clean, moist cloth.
The remaining treatment for third degree burns centers on infection control. Place sterile dressings over the burned area. If pain is an issue, cold, dry compresses may be used on top. The most critical aspects of full thickness burns are fluid loss, and the possibility of the patient going into shock. Professional medical care should be requested immediately.
A common type of burn you may see is called a “bulls- eye” burn. This burn appears much like concentric rings with third degree burning in the center, second degree burning farther out and first degree burns on the outside of the circle. As with any burn, never use ointments or creams because they will have to be cleaned off once the patient arrives at the hospital.
Emergency departments use many methods to treat burns. Surgery, tissue debridement, skin grafts, hydrotherapy, pain medications and antibiotics, to name a few. In the first aid setting, cold compresses and sterile dressings are your first mode of treatment followed by Water Jel® or BURNFREE®. These sterile, moist dressings are available in the Aircare Access Medical Kit and provide sanitary relief for burns. They are designed for single-patient use, but are extremely effective for pain control.
CHEMICAL BURNS
Chemical burns occur when a strong acid or base comes into contact with the skin. Immediate management of a chemical burn involves removing the chemical from the patient’s skin. This is an ideal time to practice scene safety, so you don’t become burned as well. Dry chemicals should be brushed off completely using a towel, brush or clothing and then flushed with copious amounts of water. Wet chemicals need to be flushed, again with copious amounts of water.
74 Trauma
If chemicals get into the patient’s eyes, flush them with water. The most effective way of doing this is to allow water to run from the bridge of the nose, across the eye and off the side of the face.
Acids usually dilute quickly to relatively harmless levels with water. That is not always true with alkalies, which may be oil- or alcohol-based. If possible, check the chemical container as it may have specific emergency instructions. Flushing with water should last at least 15 minutes. This is a time when Poison Control should be used. Aircare Access will be able to contact them for you. They will advise you of the most effective treatment.
ELECTRICAL BURNS
Electrical burns can be very deceiving, as they may produce devastating internal injuries with little external evidence. The degree of tissue damage from an electrical burn is related both to the intensity of the current and the duration of the exposure.
As electrical current passes from the contact point into the body, it is converted into heat. This heat continues to develop along the path of the current. In the case of low voltage (less than 1,000 volts) the current follows a path along the blood vessels and nerves, causing extensive damage to these tissues. When the voltage is high, the current takes the shortest path through the body to ground. Unfortunately, on the way through, it can cause violent muscle contractions and possibly broken bones.
Household current, or what is called alternating current (AC), can be more dangerous than direct current (DC) due to the pulsing nature of the current. This pulsing may cause muscle spasms in the body which can “freeze” the person until the source of the electricity is shut off. The direction of the current flow is also significant. When the flow is from one hand to another, the danger is particularly acute since it passes over and through the heart. As we know, the heart is very sensitive to any electrical current.
The most important step in managing a patient exposed to electrical current is to protect yourself. Turn off the power or make certain that someone else has turned it off. Once this is done, you can gain access to the patient. Look for entrance and exit wounds as well as any broken bones. Treat any visibly burned areas with dry, sterile dressings. Monitor the patient closely for respiratory or cardiac arrest. Remove any tight or smoldering clothing unless you feel resistance.
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