Prehospital Trauma Life Support

Lesson

11

Thermal Trauma Injuries

Developed by the

National Association of Emergency Medical Technicians

In cooperation with

The Committee on Trauma, American College of Surgeons

This slide presentation is intended for use only in approved PHTLS courses.

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Lesson 11 Objectives

Identify, manage and differentiate critical and non-critical burns. Identify priorities for managing chemical burns.

Discuss assessment and care of CO inhalation.

Address the priorities for assessing and managing heat-related illness. Discuss the priorities for assessing and managing hypothermia.
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Anatomy & Physiology

Epidermis
Dermis
(outermost layer) (nerve endings, blood vessels)

Subcutaneous
(elastic & fibrous tissues; fatty deposits)

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Depth of Burns
Partial Full thickness thickness 1st 2nd 3rd

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Rule of Nines
Adult Child

Why does the Rule of Nines change for children?

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Scenario
You are called to care for a patient who has been burned while fueling his lawn mower. As you approach, you see a 32-year-old male with a smoldering right arm. He appears to be in intense pain.

What are you going to do first?

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Findings
A - Clear. B - Normal. Clear BS.

C - Normal pulse; no external bleeding.

D - Alert, oriented x 3. EBright red skin with blisters on entire upper and lower right arm.

Vitals: Normal.

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Discussion
What thickness is this burn?

What percentage of BSA is burned?

How are you going to treat this patient? Why do second degree burns hurt the most?
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Treatment

continued...

First priority is to stop the burning. Superficial (first degree).

Generally no field treatment needed.

Partial thickness (second degree).

Burns < 10% can be treated with moist dressings.

If > 10%, wet dressings can cause hypothermia.

If indicated, administer IV analgesics.

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Treatment
Full thickness (third degree).

contd.

Dry dressings.

Fluid therapy as indicated.

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Scenario
You respond to a structure fire. On your arrival you see a victim who has just been removed from the house and appears unresponsive.

What are your first priorities?

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Findings
A B C DStridor noted. Oral mucosa appear red. Rapid. BS = rhonchi in all fields. Weak, rapid pulse; no external bleeding. Unresponsive.

E-

Partial-thickness burns of upper chest (9% BSA).

What problems does this patient have? How does CO poisoning present?
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Possible Injuries
Burns.
Upper airway swelling secondary to inhalation of superheated gases. Carbon monoxide (CO) poisoning. Trauma related to falls or building collapse.
Why is he showing signs & symptoms of shock?
How are you going to treat him?
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Special Burn Situations

Chemical burns

What is different about these burns? How would you treat chemical burns?

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Electrical Burns
Direct contact. Arc injuries. Flash burns.

How do you manage these injuries?

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Patients Requiring Burn Centers

Burns complicated by respiratory injuries.

Partial-thickness burns > 30% BSA.

Full-thickness burns > 10% BSA. The young and the old. Pre-existing medical conditions. Burns of specialty areas.
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General Treatment
DO NOT become a victim yourself.

Airway management & oxygenation are critical.

Early shock after burns points to other injuries.

Avoid hypothermia.
Fluid therapy as indicated by BSA involved (Parkland Formula). Transport to an appropriate facility.
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Thermal Trauma Injuries

Environment Injuries

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Scenario
You respond to a construction site for a

male with an unspecified illness. It is a

90-degree day with 90% humidity. Your patient has been working in an enclosed area. Workers report that they found the patient collapsed and confused.

What are you going to do now?

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What are your concerns? What places this patient at high risk for a heat emergency?
How would you treat him?

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Other Heat Injuries

List the signs, symptoms and likely involvement of each of the following:

Heat cramps Heat exhaustion Heat stroke

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Hypothermia
Hypothermia begins when body temperature reaches 95o F (35o C):

Shivering begins. Heart rate, respirations and BP begin to decrease.

Below 90o F (32o C):

CNS impairment.
Ventricular fibrillation.
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Below 82o F (28o C):

Scenario
You respond to a scene

where a 34-year-old
male has fallen into a sewer. You are on scene, when after 10 minutes, the rescue team brings up a limp body.

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Findings
A - Water in airway. B - Not breathing.

C - Very slow, weak carotid pulse.

D - Unresponsive. EWet clothes removed. Vitals: Pulse 28, RR 0. No obtainable BP.
How are you going to resuscitate this patient?
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Pitfalls
Rough handling. External warming vs. core rewarming. They are not dead until they are warm and dead!
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Thermal Trauma Summary

The key to caring for thermal injuries is observing safety, protecting damaged tissue, and preserving normal body temperature without ignoring other life-threatening conditions.

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