Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

depth of burn refers to how deep the damage goes. This can be difficult to estimate, particularly where different areas are burned to different depths. In superficial (first degree) burns, skin integ- rity is not disrupted. Capillaries and nerves are intact. Inflammation occurs with redness, pain, and warmth. An example of a superficial burn is typical sunburn. In partial-thickness (second degree) burns, the skin surface is damaged, but the injury is limited to outer layers. These are characterized by intact blisters and reddened or pink skin. Surface capil- laries are damaged, but deeper skin, blood vessels, and nerves are intact. There is fluid loss, redness, warmth, and pain. Full-thickness (third degree) burns penetrate the dermis to involve the subcutaneous soft tis- sues. Skin blood vessels and nerves are destroyed. The burned area may appear charred black or gray. The area may not be painful due to loss of nerve endings. Normal inflammation cannot occur, and as a result, blisters do not develop. Small full- thickness burns may appear to be less serious because of this. As with other injuries, look first for potentially life-threatening problems. These will usually come in the form of volume shock, respiratory distress, or toxic exposure to carbon monoxide. High-risk burns are those that include anticipated major problems with critical body systems, severe pain, infection, or scar formation. High-Risk Burns The following signs and symptoms should moti- vate careful monitoring and early evacuation to definitive medical care, preferably to a burn center: Any respiratory system involvement. Burned respiratory passages develop the same inflamma- tion, blisters, and fluid loss that are seen on the skin. Signs and symptoms include singed facial hair, burned lips, sooty sputum, and persistent cough. Respiratory distress may develop from pul- monary edema or from swelling and obstruction in the airways. It can develop quickly or slowly

over a period of hours. Respiratory burns carry a mortality rate of about 20%. Partial-thickness burns of the face, genitalia, hands, and feet. Any significant burns in these areas can cause problems with swelling and isch- emia in the short term, and mobility and scarring in the long-term. Circumferential burns. Burns that completely circle an extremity can cause distal ischemia as swelling develops. Burns > 10%BSA. Large burns carry the antic- ipated problem of volume shock and hypothermia. Any full-thickness burn. Any full-thickness burn is at high-risk for infection. Chemical burns. It can be difficult to fully arrest the burning process, because some chemi- cals react with the skin. Damage can continue for hours afterward. Electrical burns. Skin damage may be minor, but man-made electrical current can cause extensive injury to internal organs and tissues. Lightning tends to cause only superficial burns and internal electrical injuries are rare. Burns of very young or very old patients. Infants and the elderly have a more difficult time The initial treatment for burns is to remove the heat energy. The fastest way to do this is to immerse the patient, or injured part, in water. Fortunately, this is almost instinctive as it serves to relieve pain as well. If the burn is greater than about 10% BSA, limit your cooling to prevent hypothermia. For most chemical burns, continued irrigation with water will not only cool the area but help remove the chemical itself. Irrigation of chemical burns should continue for at least 30 minutes. If the burn is not a life-threatening emergency, clean and dress it with antibiotic dressings like you would for a minor abrasion or use a long- termwound care product. This can be done along compensating for injury. Treatment of Burns