Division 3

Trauma Emergencies

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 21
Burns

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Topics
Introduction to Burn Injuries
Anatomy and Physiology of the Skin
Pathophysiology of Burns
Assessment of Thermal Burns
Management of Thermal Burns
Assessment and Management of
Electrical, Chemical, and Radiation
Burns
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Introduction to Burn Injuries

(1 of 2)

1.252 million Americans treated for

burns annually.

45,000 require hospitalization.

90% of burns can be prevented.
35% considered life threatening.
2nd leading cause of death for children
<12.
Half of all tap-water burns occur to
children <5.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Introduction to Burn Injuries

(2 of 2)

Greatest Risk

Very young and very old

Infirm
Firefighters
Metal smelters
Chemical workers
Drugs and alcohol play major role

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Reduction in Burn Injuries

Improved building codes
Safer construction techniques
Sprinkler systems
Use of smoke detectors
Educational campaigns aimed
primarily at school children

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Anatomy and Physiology

of the Skin (1 of 2)
Layers

Epidermis
Dermis
Subcutaneous
Underlying
structures
Fascia
Nerves
Tendons
Ligaments
Muscles
Organs

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Anatomy and Physiology

of the Skin (2 of 2)
Functions of the Skin
Protection from infection
Sensory organ
Temperature
Touch
Pain

Controls loss and movement of fluids

Temperature regulation
Insulation from trauma
Flexible to accommodate free body movement
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pathophysiology (1 of 4)
Emergent Phase (Stage 1)
Pain response
Catecholamine release
Tachycardia
Tachypnea
Mild hypertension
Mild anxiety

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pathophysiology (2 of 4)
Fluid Shift Phase (Stage 2)
Length 1824 hours
Begins after emergent phase
Reaches peak in 68 hours

Damaged cells initiate inflammatory response:

Vasodilation
Increased capillary permeability
Intravascular hypovolemia
Extravascular edema

Burns over 30% BSA present with

systemic immune response.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pathophysiology (3 of 4)
Hypermetabolic Phase (Stage 3)
Lasts for days to weeks.
Large increase in the bodys need for nutrients
as it repairs itself.
Fluid and electrolytes begin to move back into
the vasculature.
Influx of fluid within vascular space causes the
GFR to increase, leading to diuresis.
Fluid shifts may lead to hypernatremia and
hypokalemia.
Cardiac workload and O2 consumption increase.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pathophysiology (4 of 4)
Resolution Phase (Stage 4)
Scar formation
General rehabilitation and progression to
normal function

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pathophysiology of Burns
Types of Burns

Thermal
Electrical
Chemical
Radiation

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Thermal Burns (1 of 2)
Heat changes the molecular structure
of tissue.
Denatures proteins

Extent of burn damage depends on:

Temperature of agent
Concentration of heat
Duration of contact

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Thermal Burns (2 of 2)
Jacksons Theory of Thermal Wounds
Zone of Coagulation
Area in a burn nearest the heat source that
suffers the most damage as evidenced by
clotted blood and thrombosed blood vessels

Zone of Stasis
Area surrounding zone of coagulation
characterized by decreased blood flow

Zone of Hyperemia
Peripheral area around burn that has an
increased blood flow
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Jacksons Theory of
Thermal Wounds
Zone of Hyperemia

Zone of Stasis

Zone of Coagulation

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical Burns (1 of 5)
Terminology
Voltage
Difference of electrical potential between two
points
Different concentrations of electrons

Amperes
Strength of electrical current

Resistance (Ohms)
Opposition to electrical flow
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical Burns (2 of 5)
Ohms Law

V=IR
V: Voltage
R: Resistance
I: Current

I=V
R

Based on electron flow through tungsten

Emit more light the more current passed through
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical Burns (3 of 5)
Joules Law
P: Power
R: Resistance
I: Current

P=I R

Skin is resistant to electrical flow:

Greater the current the greater the flow through
the body and the greater the release of heat

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical Burns (4 of 5)
Greatest heat occurs at the points of
resistance:
Entrance and exit wounds
Dry skin = greater resistance
Wet Skin = less resistance

Longer the contact, the greater the potential

of injury
Increased damage inside body

Smaller the point of contact, the more

concentrated the energy, the greater the
injury
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Electrical Burns (5 of 5)
Electrical Current Flow
Tissue of less resistance
Blood vessels
Nerve

Tissue of greater
resistance
Muscle
Bone

Results in:
Serious vascular and
nervous injury
Immobilization of
muscles
Flash burns
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Chemical Burns
Chemicals destroy tissue:
Acids
Form a thick, insoluble mass where they
contact tissue
Coagulation necrosis
Limits burn damage

Alkalis
Destroy cell membrane through liquefaction
necrosis
Deeper tissue penetration and deeper burns
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Radiation
Transmission of energy
Nuclear energy
Ultraviolet light
Visible light
Heat
Sound
X-rays

Radioactive Substance
Emits ionizing radiation
Radionuclide or radioisotope
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Basic Physics (1 of 2)
Protons
Positive charged particles

Neutrons
Equal in mass to protons
No electrical charge

Electrons
Minute electrically charged particles
When emitted from radioactive
substances are termed beta particles
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Basic Physics (2 of 2)
Isotopes
Atoms with unstable nuclear composition
Ionizing radiation

Half-life
Time required for half the nuclei to lose
activity through decay

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Types of Radiation

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Radioactive Substances (1 of 2)
Alpha Particles
Slow moving
Low energy
Stopped by clothing
and paper
Penetrate a few cell
layers on skin
Minor external
hazard
HARMFUL if
ingested

Beta Particles
Smaller than alpha
Higher energy than
alpha
Stopped by
aluminum or similar
materials
Less local damage
than alpha
HARMFUL if
inhaled or ingested
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Radioactive Substances (2 of 2)
Gamma Rays
Highly energized
Penetrate deeper than
alpha or beta
EXTREMELY
DANGEROUS
Penetrate thick
shielding
Pass entirely through
clothing and body
Extensive cell damage

Indirect damage
Cause internal tissue
to emit alpha and beta
particles

Neutrons
More penetrating than
other radiation
310 times greater
penetration than
gamma

Less internal hazard

when ingested than
alpha or beta
Direct tissue damage
Only present in nuclear
reactor core

LEAD SHIELDING
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury Effects

on Body
Geiger counter needed
to detect
R/hr: Milliroentgens per
hour
1,000 mR = 1R

RAD
Radiation absorbed
dose of local tissue

REM
Roentgen equivalent in
man
Injury to irradiated part
of organism
RAD=REM for all
purposes

Alters bodys cell DNA

Cumulative damage
over lifetime exposure
Decreased WBCs
Acute
Effects in minutes to
weeks

Long-term effects
Years or decades later

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Safety
TIME

DISTANCE

Clean Accident
Exposed to radiation
Not contaminated by
products
Properly decontaminated
Little danger to
personnel

Dirty Accident

SHIELDING

Associated with fire at

scene of radiation
accident
Trained decontamination
personnel
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury
Management
Park upwind.
Notify radiation response or hazmat
response team.
Look for radioactive placards.
Measure radioactivity.
Decontaminate patients before care.
Routine medical care (ABCs, etc.).
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Inhalation Injury
Toxic Inhalation
Synthetic resin combustion
Cyanide and hydrogen sulfide
Systemic poisoning
More frequent than thermal inhalation burn

Carbon Monoxide Poisoning

Colorless, odorless, tasteless gas
Byproduct of incomplete combustion of
carbon products
Suspect with faulty heating unit
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Pulse Oximetry
Clinical assessment of hypoxia is very
difficult in the prehospital setting.
Cyanosis typically occurs with O2 saturation
<70%.

May be falsely positive in the patient with

significant blood loss or CO poisoning.
200x greater affinity for hemoglobin than oxygen
Hypoxemia and hypercarbia

Measures hemoglobin saturation, NOT oxygenation

Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Inhalation Injury (1 of 2)

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Inhalation Injury (2 of 2)
Airway Thermal Burn
Supraglottic structures absorb heat and prevent
lower airway burns.
Moist mucosa lining the upper airway

Injury is common from superheated steam.

Symptoms:
Stridor or crowing inspiratory sounds
Singed facial and nasal hair
Black sputum or facial burns
Progressive respiratory obstruction and arrest due to
swelling
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Burn Depth (1 of 4)
Superficial Burn
Partial-Thickness Burn
Full-Thickness Burn

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Burn Depth (2 of 4)
Superficial Burn:
1st Degree Burn
Red
Painful
Dry (no blisters)

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Burn Depth (3 of 4)
Partial-Thickness
Burn: 2nd Degree
Burn
Red or White
Painful
Blisters (wet)
Ultraviolet keratitis
should be suspected in
welders.

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Burn Depth (4 of 4)
Full-Thickness
Burn: 3rd Degree
Burn
Leathery skin
White
Dark brown
Charred

Minimally painful
Dry

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Body Surface Area

Rule of Nines
Best used for large surface areas
Expedient tool to measure extent of burn

Rule of Palms
Irregular or splash burns
Best used for burns <10% BSA

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Rule of Nines

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Rule of Palms
A burn equivalent to the size of the
patients hand is equal to 1% body
surface area (BSA).

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Systemic Complications (1 of 2)
Hypothermia
Disruption of skin and its ability to
thermoregulate

Hypovolemia
Shift in proteins, fluids, and electrolytes to the
burned tissue
General electrolyte imbalance

Eschar
Hard, leathery product of a deep full-thickness
burn
Dead and denatured skin
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Systemic Complications (2 of 2)
Infection
Greatest risk of burn is infection

Organ Failure
Release of myoglobin

Special Factors
Age and health

Physical Abuse
Elderly, infirm, or young
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment of Thermal Burns

(1 of 5)

Scene Size-up
Fire department
SCBA and protective clothing

Initial Assessment
ABCs MUST be intact
Consider ET or RSI

Rapid evacuation of patient if scene is

unstable

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment of Thermal Burns

(2 of 5)

Focused and Rapid Trauma

Assessment
Accurately approximate extent of burn
injury:
Rule of Nines or Rule of Palms
Depth of burn
Area of body affected
Any burn to the face, hands, feet, joints, or genitalia
considered a serious burn

Ringing burns
Age of patient affected
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment of Thermal Burns

(3 of 5)

General Signs and Symptoms

Pain
Changes in skin
condition at affected
site
Adventitious sounds
Blisters
Sloughing of skin
Hoarseness
Dysphagia
Dysphasia

Burnt hair
Edema
Paresthesia
Hemorrhage
Other soft-tissue injury
Musculoskeletal injury
Dyspnea
Chest pain

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment of Thermal Burns

(4 of 5)

Burn Severity
Minor
Superficial
Partial Thickness
Full Thickness

<50% BSA
<15% BSA
<2% BSA

Moderate
Superficial
Partial Thickness
Full Thickness

>50% BSA
>15% BSA
>2% BSA

Critical
Partial Thickness
Full Thickness
Inhalation Injury

>30% BSA

>10% BSA

Any partial- or full-thickness burn involving hands, feet, joints, face, or genitalia

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment of Thermal Burns

(5 of 5)

Ongoing Assessment
Non-critical: Reassess Q 15 min.
Critical: Reassess Q 5 min.

Burn Center Care

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2006 by Pearson Education, Inc. Upper Saddle River, NJ

Management of Thermal Burns

(1 of 5)

Local and Minor Burns

Local cooling.
Partial thickness: <15% of BSA
Full thickness: <2% BSA

Remove clothing.
Cool or cold water immersion.
Consider analgesics.
Morphine sulfate
Fentanyl (Sublimaze)
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Management of Thermal Burns

(2 of 5)

Moderate to Severe Burns

Dry sterile dressings:
Partial thickness: >15% BSA
Full thickness: >5% BSA

Maintain warmth.
Prevent hypothermia.

Consider aggressive fluid therapy.

Moderate to severe burns.

Burns over IV sites:

Place IV in partial-thickness burn site.

Consider analgesics.
Morphine sulfate
Fentanyl (Sublimaze)
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Management of Thermal Burns

(3 of 5)

Parkland Formula
4 mL X weight X % burn
volume in first 8 hours
Second over last 16 hours

Consider 1 hour dose

0.5 mL x Pt wt in kg x % BSA = Amt of fluid

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Management of Thermal Burns

(4 of 5)

Moderate to Severe Burns

Caution for fluid overload.
Frequent auscultation of breath sounds

Consider analgesic for pain.

Morphine
Fentanyl

Prevent infection.

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Management of Thermal Burns

(5 of 5)

Inhalation Injury

Provide high-flow O2 by NRB.

Consider intubation if swelling.
Consider hyperbaric oxygen therapy.
Cyanide exposure:
Sodium nitrite, amyl nitrite, sodium thiosulfate
Forms methemoglobin which binds cyanide
Non-toxic substance secreted in urine
Inhale 1 ampule of amyl nitrite
300 mg sodium nitrite over 24 minutes
12.5 gm of sodium thiosulfate
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (1 of 7)
Electrical Injuries
Safety
Turn off power.
Energized lines act as whips.
Establish a safety zone.

Lightning strikes
High voltage, high current, high energy.
Lasts fraction of a second.
No danger of electrical shock to EMS.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (2 of 7)
Entrance and exit wounds.
Remove clothing, jewelry, and leather items.
Treat any visible injuries.
Thermal burns

ECG monitoring:
Bradycardia, tachycardia, VF or asystole:
ACLS protocols

Treat cardiac and respiratory arrest.

Aggressive airway, ventilation, and circulatory
management.

Consider fluid bolus for serious burns.

20 mL/kg

Consider sodium bicarbonate: 1 mEq/kg.

Consider mannitol: 10 g.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (3 of 7)
Chemical Burns
Scene size-up
Hazardous materials team.
Establish hot, warm, and cold zones.
Prevent personnel exposure from chemical.

Specific Chemicals
Phenol
Dry lime
Sodium
Riot control agents
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (4 of 7)
Specific Chemicals
Phenol
Industrial cleaner.
Alcohol dissolves phenol.
Irrigate with copious amounts of water.

Dry Lime
Strong corrosive that reacts with water.
Brush off dry substance.
Irrigate with copious amounts of cool water.
Prevents reaction with patient tissues.

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (5 of 7)
Sodium
Unstable metal.
Reacts vigorously with water.
Releases
Extreme heat
Hydrogen gas
Ignition

Decontaminate: Brush off dry chemical.

Cover the wound with oil substance.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (6 of 7)
Riot Control Agents
Agents
CS, CN (Mace), Oleoresin, Capsicum (OC, pepper
spray)

Irritation of the eyes, mucous membranes, and

respiratory tract
No permanent damage
General signs and symptoms
Coughing, gagging, and vomiting
Eye pain, tearing, temporary blindness

Management
Irrigate eyes with normal saline.
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns (7 of 7)
Radiation Burns
Notify hazardous materials team.
Establish safety zones.
Hot, warm, and cold

Personnel positioned upwind and uphill.

Use older rescuers for recovery.
Decontaminate ALL rescuers, equipment, and
patients.

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury Whole Body Exposure

RAD vs. Body Effects
Effect

(RAD)
525

Asymptomatic

5075

Asymptomatic, WBC changes

75125

Anorexia, N/V, and fatigue in 2 days

125200 N/V, diarrhea, anxiety, tachycardia

N/V, diarrhea, weakness and fatigue in hours

200600 50% fatal within 6 weeks without medical care
600
1,000

N/V, diarrhea in hours

100% fatal within two weeks with medical care

1,000+

Burning sensation in minutes, N/V in 10 min

Confusion, ataxia, watery diarrhea in 2 hrs
100% fatal in short time
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ

Radiation Injury Local Exposure

(RAD) vs. Local Effects
(RAD)

Effect

50

Asymptomatic

500

Asymptomatic (usually), altered function of exposed

area

2,500

Atrophy, vascular lesion, altered pigment

5,000

Chronic ulcer, risk of cancer

50,000

Permanent destruction of exposed tissue

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Assessment and Management

of Electrical, Chemical, and
Radiation Burns
Ongoing Assessment
Re-evaluate initial assessment.
Re-evaluate all interventions.

Bledsoe et al., Essentials of Paramedic Care: Division 1II

2006 by Pearson Education, Inc. Upper Saddle River, NJ

Summary
Introduction to Burn Injuries
Anatomy and Physiology of the Skin
Pathophysiology of Burns
Assessment of Thermal Burns
Management of Thermal Burns
Assessment and Management of
Electrical, Chemical, and Radiation
Burns
Bledsoe et al., Essentials of Paramedic Care: Division 1II
2006 by Pearson Education, Inc. Upper Saddle River, NJ