© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE11 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Burns chapter © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning,atat a glancegla LLCnce NearlyNOT 2 million FOR SALEburn injuries OR DISTRIBUTION occur each year in the United States,NOT FOR SALE OR DISTRIBUTION resulting in 75,000 hospitalizations and more than 3,000 deaths. Burns occur in every age group, across all socioeconomic levels, at home and 3 Burns in the workplace, and in urban, suburban, and rural settings. It has been estimated that about 80% of all burn injuries occur in the home, 3 Types of Burns © Jones &with Bartlett house firesLearning, responsible LLC for the majority of fire deaths.© Jones Most &burn Bartlett Learning, LLC NOT FORvictims SALE are OR injured DISTRIBUTION as a result of their own actions. NOT FOR SALE OR DISTRIBUTION The highest-risk age groups for burn injuries are children younger than 5 years and adults older than 55 years. Both groups may have limited ability to recognize and escape from a fire or burn incident. In addition, their relatively© Jones thinner & skin Bartlett predisposes Learning, them to LLC more seri- © Jones & Bartlett Learning, LLC ous injuries. Death andNOT complications FOR SALE increase OR DISTRIBUTION dramatically for burn NOT FOR SALE OR DISTRIBUTION victims older than 55 years owing to the likelihood of preexisting health problems and their immune systems’ decreased ability to fight infection. Skin death and injury occur as the applied heat exceeds the body’s ability to disperse the heat; that point starts at about 113° F. The amount and ©depth Jones of skin & Bartlettdamage depend Learning, on the LLCheat’s intensity, the duration© Jones & Bartlett Learning, LLC of contact,NOT FOR and the SALE skin’s OR thickness. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Types of Burns © Jones &Burn Bartlett injuries Learning, can be classified LLC as thermal (heat), chemical,© Jones or electrical. & Bartlett Learning, LLC NOT FOR SALE Not OR all DISTRIBUTIONthermal (heat) burns are caused by flames.NOT ContactFOR SALE OR DISTRIBUTION with hot objects, flammable vapor that ignites and causes a © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 09467_CH11_143_160.indd 143 2/15/11 3:41 PM 144 Advanced First Aid, CPR, and AED © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEflash OR or DISTRIBUTIONan explosion, and steam and hot liq- NOT FOR SALE OR DISTRIBUTION uid are other common causes of burns. Just 3 seconds of exposure to water at 140° F can cause a full-thickness (third-degree) burn in an adult. At 156° F, the same burn occurs in 1 second. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chemical burnsNOT. A wide FOR range SALE of chemical OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION agents can cause tissue damage and death on contact with the skin. As with thermal burns, the amount of tissue damage depends on the ©duration Jones of& contact, Bartlett the Learning, skin thickness LLC in the © Jones & Bartlett Learning, LLC NOTarea ofFOR exposure, SALE and OR the DISTRIBUTION strength of the chem- NOT FOR SALE OR DISTRIBUTION ical agent. Chemicals will continue to cause tis- sue destruction until the chemical agent is removed. Three types of chemicals—acids, alkalis, and organic compounds—are responsi- © Jones & Bartlettble for Learning,most chemical LLC burns. Alkalis produce © Jones & Bartlett Learning, LLC NOT FOR SALEdeeper, OR moreDISTRIBUTION extensive burns than acids. NOT FOR SALE OR DISTRIBUTION Electrical burns. The injury severity from contact with electric current depends on the type of current (direct or alternating), the volt- age, the area of© the Jones body exposed, & Bartlett and the Learning, LLC © Jones & Bartlett Learning, LLC duration of contact.NOT Electricity FOR SALE can induce OR DISTRIBUTION ven- NOT FOR SALE OR DISTRIBUTION tricular fibrillation (a type of cardiac arrest), cause respiratory arrest, or “freeze” the victim Figure 11-1 to the electrical contact point with powerful First-degree burn. muscle spasms that increase the length of © exposure.Jones & Victims Bartlett of low-voltage Learning, electrical LLC © Jones & Bartlett Learning, LLC NOTinjuries FOR may SALE have no OR skin DISTRIBUTION burns at all but NOT FOR SALE OR DISTRIBUTION might still have cardiac or respiratory arrest. Thermal Burns © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOREvaluate SALE aOR thermal DISTRIBUTION burn using the following steps. NOT FOR SALE OR DISTRIBUTION These steps form the basis for treatment of thermal burns. 1. Determine the depth (degree) of the burn. Historically, burns have been described as first-degree, second-degree,© Jones & Bartlettand third-degree Learning, LLC © Jones & Bartlett Learning, LLC injuries. The termsNOT superficial,FOR SALE partial OR thick- DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ness, and full thickness are often used by burn- Figure 11-2 care professionals because they are more descriptive of the tissue damage. Second-degree burn blisters. © Jones First-degree & Bartlett (superficial) Learning, burns LLC affect the © Jones & Bartlett Learning, LLC NOTskin’s FOR outer SALE layer OR (epidermis) DISTRIBUTION Figure 11-1 . NOT FOR SALE OR DISTRIBUTION Signs and symptoms include: redness, mild Second-degree (partial-thickness) burns swelling, tenderness, and pain. Healing oc- extend through the entire outer layer and curs without scarring, usually within a into the inner skin layer Figure 11-2 . Signs week. The outer edges of deeper burns of- and symptoms include: blisters, swelling, © Jones & Bartlettten Learning, are first-degree LLC burns. © Jones & weepingBartlett of Learning,fluids, and severe LLC pain. The NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 09467_CH11_143_160.indd 144 2/15/11 3:41 PM Chapter 11 Burns 145 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 9 Back: 18 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR99 SALE OR DISTRIBUTION 18 12 Back: 18 18 1 18 18 © Jones & Bartlett Learning, LLC © 9Jones & Bartlett18 Learning, LLC 9 9 NOT FOR SALE OR DISTRIBUTION 18NOT FOR 9SALE OR DISTRIBUTION Figure 11-3 1 1 16.5 16.5 13.5 13.5 Third-degree burn. © Jones & Bartlett Learning,signs occur becauseLLC the capillary blood ves-© Jones & Bartlett Learning, LLC NOT FOR SALE OR selsDISTRIBUTION in the dermis are damaged and give upNOT FOR FigureSALE 11-4 OR DISTRIBUTION fluid into surrounding tissues. Intact blisters provide a sterile, waterproof covering. Once Rule of nines. a blister breaks, a weeping wound results, and the© risk Jones of infection & Bartlett increases. Learning, LLC © Jones & Bartlett Learning, LLC Third-degreeNOT FOR (full-thickness) SALE OR burns DISTRIBUTION are NOT FOR SALE OR DISTRIBUTION severe burns that penetrate all the skin lay- ers into the underlying fat and muscle Figure 11-3 . Signs and symptoms include: leathery, waxy, or pearly gray skin that is © Jonessometimes & Bartlett charred. Learning, It has a dryLLC appearance © Jones & Bartlett Learning, LLC NOT FORbecause SALE capillary OR DISTRIBUTION blood vessels have been NOT FOR SALE OR DISTRIBUTION destroyed and no more fluid is brought to the area. The skin does not blanch after be- ing pressed because the area is dead. The © Jones & Bartlett Learning,victim feels LLCno pain from a third-degree © Jones & Bartlett Learning, LLC NOT FOR SALE OR burnDISTRIBUTION because the nerve endings have beenNOT FOR SALE OR DISTRIBUTION damaged or destroyed. Any pain felt is from surrounding burns of lesser degrees. A third-degree burn requires medical care Figure 11-5 and the removal of dead tissue and often a skin graft© Jonesto heal properly. & Bartlett Learning, LLCRule of the hand. © Jones & Bartlett Learning, LLC 2. DetermineNOT the extent FOR ofSALE the burn. OR Skin DISTRIBUTION will NOT FOR SALE OR DISTRIBUTION not ignite unless heated to thousands of degrees. However, if clothing ignites or skin is 9%, one complete arm is 9%, the front torso is kept in contact with a heat source, such as 18%, the complete back is 18%, and each leg is © Jonesscalding & Bartlett water, large Learning, areas of the LLC skin will be 18%.© Jones The rule & of Bartlett nines must Learning, be modified LLC to NOT FORinjured. SALE Determining OR DISTRIBUTION the extent of a burn takeNOT into FOR account SALE the different OR DISTRIBUTION proportions of a means estimating how much body surface area small child. In small children and infants, the the burn covers. A rough guide known as the head accounts for 18% and each leg is 14%. For rule of nines assigns a percentage value of total small or scattered burns, use the rule of the hand body surface area (BSA) to each part of an Figure 11-5 . The victim’s hand, including the © Jones & Bartlettadult’s Learning, body Figure LLC 11-4 . The entire head is © Jones & Bartlettfingers and Learning, the thumb heldLLC together, represents NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 09467_CH11_143_160.indd 145 2/15/11 3:41 PM 146 Advanced First Aid, CPR, and AED © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORmedical SALE problems. OR DISTRIBUTION Concurrent injuries such as fractures, internal injuries, and open wounds What is the rule of the palm? increase the severity of a burn.