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Oh, I hope these cookies are done. Ow! Now let's talk about burns. Generally speaking, there are three degrees most prevalent: first, second, and third-degree burns, third-degree being the most severe and life-threatening. First-degree burns are characterized by a superficial burn that's normally red and painful. The second-degree burn then develops into a blister, while the third-degree burn is a full-thickness burn, sometimes noted even with charring all the way down to the bone. The way we treat the burns is exactly the same. Remove them from the source of the burn, A. B, cool the burn with water for 5-20 minutes. And C, cover the burn with dry sterile dressing whenever possible and get the patient or the victim to the hospital. The bigger the burn, obviously, the more the complication: This is a fairly large-size burn and we can see blisters, some popped and some not popped. The way we treat a second-degree burn in this case is by actually cooling the burn, which we're going to show in just a moment. The third-degree burn will be the same exact way, but we need to really need to expedite getting this person to the hospital. If they had a burning agent that caused that severe of a burn, we have to be thinking about what else might be going on. Was it involved in a house fire? Did they get scared and inhale an enormous amount of heat? The singeing of the nose, the mouth, there's soot on the tongue, means that they could have possibly inhaled that heat blast, and now we're going to be dealing with some swelling of the airways in a short amount of time. So will they actually be in respiratory distress within the next few minutes? These are all considerations we need to think about as we're looking at the overall management of a burn patient. We also need to be thinking about the fact that the larger the burn-- in fact, when it starts to cover percentages of the body-- this person is losing a lot of fluid, and they're also losing their heating and cooling system. So the fact that we've already cooled them down with water, and the fact that they are already wet, probably, if we had to put their clothing out with water, means that they're also going to be running into hypothermic events, and that's something we need to be mindful of the whole time while we're treating the patient, as well as looking for signs of shock-- pale, cool, sweaty, and they might be losing consciousness. Now let's cover the treatment of this specific burn, which is first and second degree. In this case, she's fine. She touched her hand to a hot item, and so it's isolated just to the top of her hand. First and second degree, big blisters but not super-duper big blisters, not the full arm, so though she's going to have some things to think about here, it's not something that I'm going to be thinking life-threatening. In this case we're dealing with pain management, really. The cold water's going to help anesthetize the skin. It's going to help bring some soothing to that area, but as soon as we take it out from the water it's going to start to hurt again. So we need to expedite getting this person to the med center, or even better yet, probably to the emergency room where they might have a burn center available to treat it appropriately, to reduce the chances of infection, and to help the patient with pain management. I'm going to cool this underwater regardless of the degree of the burn until the tissues are fully cooled and the burning has stopped. Now contrary to what might have been taught in the past, we're really simplifying this down to one treatment: cover after we've cooled it with a dry sterile dressing whenever possible and transport the patient to definitive care. I'm still going to be watching this patient for signs of decreased level of consciousness, signs of shock, and signs of complications with their breathing, but for the most part, this is what we're talking about, and keeping this clean, keeping it minimally agitated, not popping the blisters, and getting them to definitive care, is the idea when it comes to burns. Now, there's other forms of burns as well that we should be aware of. And that is chemical burns. If it was a dry chemical, it would be important to carefully, while keeping ourselves safe, brush off as much of the dry chemical first before we begin to rinse it off. And then rinsing off the remainder of the wet or dry chemical, we're going to do that for no less than fifteen minutes. The solution to pollution is dilution. So we just keep diluting that chemical down, helping stop the burn. And then we're gonna monitor the patient and watch them until EMS arrives and until the next level of care can take over. So we’ve covered thermal burns, we’ve covered chemical burns and the last one I want to talk about is electrical burns. Before we ever come in contact with the patient, we need to understand that the energy source must be removed from the patient. That means deenergizing the source, getting the professionals out to cut the power to that line that's fallen down. Whatever it is that needs to be done, but we cannot risk becoming a second patient by touching the primary patient and being electrocuted ourselves. Now some significant differences in electrical burns compared to the other two. Electrical burns tend to have an entry point and an exit point. The entry point, though it can be small, could have that small bullseye of the first, second and third degree burn. But the exit point could be explosive damage. That energy can literally show like a shotgun wound where it exits the ground of the body. And so on one end of the body we might actually have soft tissue and bleeding control, while at the entry point we have a burn to take care of. That burn will be managed the same way we described before with the removing of the burn source, the cooling, and the dressing. Now some other things to think about, though, is the fact that if that electric power was so much that it exploded as it exited, it might also have fractured long bones. So that's something to keep in mind. And then lastly, remember that the electricity as it travels through the body could also affect the conductivity of the heart and damage those conduction points in the heart. And in the next 24 to 72 hours, we can sometimes see the development of life threatening dysrhythmias develop as this person is pretty relatively stable from the burn or the wounds themselves, but then develops cardiac issues secondary to the electrocution.
Burns are a complex injury, as there are varying degrees of burns, different sizes, and different locations that can present unique challenges. And there are also different types of burns – thermal, chemical, and electrical.
In this lesson, when we talk overall about burns, then how to treat them, starting with thermal burns. Then, we'll discuss some information on chemical and electrical burns.
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and introduce yourself to the victim.
"Hi, my name's _____. I'm a paramedic. I'm going to help you."
The first thing you want to do is assess how bad the burn is. To determine the degree of burn, look for the following signs:
The concerning part about burns is that you may not see the full extent or concern of the injury until hours later. After the burning process has ended, the injured skin starts the healing process. This involves the moving of fluid to the injured area causing swelling, pain, dehydration/shock and other potentially life threatening conditions. Minor seeming injuries may be far more serious if not evaluated or treated by professionals.
Continue to assess for signs of something more serious. How are the pupils? Is the patient breathing normally? Is the patient still responsive and seemingly alert? And continue to monitor the patient for signs of shock.
You're likely going to encounter two types of chemical burns – those from dry chemicals and those from wet.
When you're dealing with dry chemicals, you first want to brush off as much of the loose, dry chemical as you safely can. Safety is key. You don't want to become the next victim. After brushing off the loose chemical, rinse the burn for a minimum of 15 minutes, again using cool clean water.
When dealing with wet chemicals, go right into rinsing them off using cool, clean water.
Electrical burn situations require an extra level of safety. Before anything, make sure the energy source has been removed before coming into contact with the patient. This could mean removing the patient from the energy source, cutting the power, or something else.
You cannot risk becoming another patient at the scene.
Manage the entry wound the same as you would a thermal burn. Manage the exit wound as the situation requires, which will likely include treatment options for tissue damage and excessive bleeding.
With electrical burns, monitoring for heart dysrhythmias for 24 to 72 hours in hospital might be necessary.
It's important to note that children have greater surface areas relative to their weights than adults. This can become a major factor when it comes to staying warm and hydrated.
Victims with severe burns tend to lose a lot of water through evaporation and leaking from the burned area. This increases our concerns as it can lead to hypothermia and shock. Monitor the victim for signs of dehyration, shock or hypothermia. Immediately seek advanced medical intervention if any of these are seen.
If the burn is minor, and the burning has been completely stopped, at-home treatment might be appropriate. The 2024 ECC Guidelines suggest petrolatum (with or without topical antibiotics such as polymyxin), honey, and aloe have been shown to improve healing time in certain burns. Over the counter pain medications may help with pain when used correctly. All treatment should be under the direction of your physician.