Brief Summary
This video provides a comprehensive overview of burn care for EMTs, covering various types of burns (thermal, chemical, electrical, radiation), initial management steps, and specific considerations for different burn scenarios. Key takeaways include stopping the burning process, removing contaminated clothing, cooling the burn (with caution), and being aware of potential complications like airway compromise, carbon monoxide/cyanide poisoning, and electrolyte imbalances. The video also details specific treatments for chemical burns (including hydrofluoric acid) and burns to the eyes.
- General burn management involves stopping the burning process and removing any contaminated clothing.
- Cooling the burn area should be done carefully to avoid hypothermia, especially in large burns.
- Inhalation injuries should be suspected in patients with burns to the face, singed eyebrows, or soot in the mouth.
- Chemical burns require specific management based on the type of chemical involved (acid vs. base).
- Eye burns should be flushed continuously, and both eyes should be covered to prevent further irritation.
General Burn Management
The initial management of any burn, regardless of the cause (chemical, electrical, thermal, or radiation), involves stopping the burning process. Remove any clothing that might still be smoldering, but if it's stuck to the burn, leave it be to avoid further damage. Take off any metal items or jewelry as they can retain heat and potentially act as tourniquets if swelling occurs. Cooling the burn area is important, but be careful not to overcool the patient, especially with large burns, as this can lead to hypothermia. Covering the patient with a clean or sterile sheet can help prevent heat loss.
Electrical Burns
Electrical burns, whether from household current or lightning, pose unique risks. Even household current can cause significant burns, especially in children. Lightning strikes, while brief, can cause widespread internal damage as electrons enter the body through orifices. For electrical injuries, the first step is to remove the patient from the source of electricity, ensuring your own safety by turning off the power first. Once the patient is safe, initiate standard BLS/CPR, including ventilation and defibrillation if necessary, as electrical injuries can cause cardiac arrhythmias.
Chemical Burns
Chemical burns can result from various household or industrial chemicals, which may contain acids or bases. Acid burns tend to coagulate the skin, limiting the depth of the burn, while base burns liquefy tissue, potentially causing deeper damage than initially apparent. For dry chemicals, brush off as much as possible before flushing with water, as some chemicals are activated by moisture. Remove any contaminated clothing and transport the patient to an appropriate medical facility.
Inhalation Injuries
Suspect inhalation injuries in patients with burns to the face, singed eyebrows, soot in the mouth or nose, or who were found in enclosed, smoky environments. These patients are at risk of airway compromise due to swelling and hypoxia from carbon monoxide and cyanide poisoning. Carbon monoxide displaces oxygen on hemoglobin, while cyanide prevents cells from using oxygen. Ask firefighters about the materials that were burning to assess the risk of cyanide exposure (e.g., rubber, plastics). These patients may require advanced care, including antidotes and possibly hyperbaric oxygen therapy.
Specific Chemical Burns and Other Considerations
Hydrofluoric acid, used in the glass and computer industries, can cause severe burns and deplete the body's calcium, leading to cardiac arrhythmias. While EMTs can't replace calcium in the field, advanced providers may apply calcium gluconate gel topically. For burns from asphalt or tar, cool the substance with water to stop the burning process, but be aware that the material underneath may still be burning the skin.
Eye Burns
Eye burns should be flushed continuously, both on scene and during transport. A practical method for continuous flushing involves using a nasal cannula connected to an IV bag of saline. Cut the nasal cannula tubing and connect it to the IV set, then position the prongs on either side of the nose to direct the saline flow into the eyes. Aim for 15-20 minutes of irrigation. After flushing, cover both eyes, even if only one is affected, to prevent movement and further irritation of the injured eye. Reassure and reorient the patient, as they will be effectively blindfolded and their other senses will be heightened.
