Burns and Environmental

Emergencies
Burns
Is an injury involving the skin,
including muscles, bones,
nerves, and blood vessels. This
results from heat, chemical or
radiation.

Seriousness of Thermal Burns
Factors that determine the Seriousness of
Burns
1. The depth
2. The amount of surface area
3. Involvement of Critical Areas
4. The patients age
5. Patients general health
The Rule of Nines
Critical Burns
1. All burns complicated by fractures
2. Any degree of Respiratory injury
3. Third degree burn with more than
10% of the body surface area
4. Second burns with 25% of the body
5. Moderate burn in an elderly or
critically ill patient
6. For children: any third degree burn
and second degree burn of the body
Moderate Burns
1. Third degree burns with 2 to 10 % of
the body
2. Second degree burns that involve 15
to 25 % of the body
3. First degree burns with body 50 % or
more of the body
4. For children: second degree burn of
10 to 20 % of the body
Minor Burns
1. Third degree burns with less than
2 % of the body
2. Second degree burn of less than
15 % of the body
3. For children: a second degree
burn less than 10 %
Thermal Burns
Signs and Symptoms
Red Skin (1
st
degree burns)
Swelling (1
st
degree burns)
Blisters ( 2
nd
degree burns)
Peeling skin ( 3
rd
degree burns)
Pain
Shock
For Airway Burns:
> Charred mouth
> Singed nose hairs or eyebrows
> Burns on the head, face and
neck
> Difficulty in breathing; coughing
First Aid
1. Stop the burning process and
prevent injury
2. Cover the burned area with dry,
sterile and non-adhesive dressing
3. Support the patients vital
functions
4. Transport the patient promptly to
the hospital that has necessary
capabilities to care a burn patient
5. If fingers or toes have been burned,
separate them with dry, sterile, non-
adhesive dressing
6. For airway burns
a. Maintain open airway
b. For conscious victim, place him in a
position easiest for him to breathe
c. For unconscious victim, place him in
a recovery position
Chemical Burns
Causes
Strong acids
Strong alkali
Strong chemical fumes
First Aid
1. Basically the same with Thermal Burns
2. Do not neutralize but flood the area
with water immediately
3. Do not direct a forceful stream of
water from a hose to the affected area
4. Continue flooding the burn area for 10
minutes after burning pain stop.
Electrical Burns
Causes
Faulty electrical equipment
Careless use of appliances
First Aid
1. Institute Rescue Breathing or CPR
if needed
2. Place a dry sterile dressing on the
affected area
3. Apply splint if there is suspected
fracture
Environmental Emergencies
1.Heat Exhaustion
2.Heat Stroke
3.Frostbite
Heat Exhaustion
Heat exhaustion is the inadequacy or the
collapse of peripheral circulation due to
volume and electrolyte depletion.
Untreated heat exhaustion may progress
to heat stroke.
Nursing Interventions
1. Move the patient to a cool
environment, and remove all the
clothing.
2. Position the patient supine with the
feet slightly elevated.
3. If the patient complains of nausea and
vomiting, do not give fluids by mouth
4. Monitor the patient for changes in
cardiac rhythm and vital sign. Vital
signs should be taken at least every 15
minutes until the patient is stable.
5. Provide fans and cool sponge baths as
cooling methods.
6. Provide patient education
a. Emphasize the importance of
maintaining an adequate fluid intake,
wearing loose clothing, and reducing
activity in hot weather.
Heat Stroke
Heat stroke is a medical emergency that
can result in significant morbidity and
mortality. It is defined as the
combination of hyperpyrexia (40.6 C [
105 F ]) and neurologic symptoms. It is
caused by a shut down or failure of the
heat-regulating mechanisms of the
body.
Nursing Interventions
1. Provide cooling measures
a. Reduce the core (internal)
temperature to 39 C ( 102 F ) as
rapidly as possible.
b. Evaporative cooling is the most
efficient. Spray tepid water on skin
while electric fans are used to blow
continuously over the patient to
augment heat dissipation.
c. Apply ice packs to neck, groin,
axillae, and scalp ( areas of maximal
heat transfer )
d. Soak sheets/towels in ice water and
place on patient, using fans to
accelerate evaporation/cooling rate

e. Monitor condition
> Monitor and record core
temperature continually during the
cooling process to avoid
hypothermia.
> Monitor vital signs continually.
> Perform frequent ( every 30
minutes ) neurologic assessments
Frostbite
Frostbite is trauma due to exposure to
freezing temperatures that cause actual
freezing of the tissue fluids in the cell
and intracellular spaces, resulting in
vascular damage. The areas most likely
to develop frostbite are the earlobes,
cheeks, nose, hands and feet. Frostbite
maybe classified as frostnip (initial
response to cold, reversible), superficial
frostbite, and deep frostbite.
Signs and Symptoms of Frostbite
For frostnip: White patches of skin that
are numb.
For frostbite (superficial or deep): Skin
that is white or grayish-yellow and feels
hard or waxy; numbness; blistering.
Other symptoms include swelling,
itching, burning, and deep pain when
the area is warmed.

Nursing Interventions
1. Frostnip may be treated by placing a warm
hand over the chilled area.
2. Leave the frostbitten area alone until
definitive rewarming is undertaken. Pad
extremity to prevent damage from trauma.
3. Handle the part gently to avoid further
mechanical injury.
4. Remove all constricting clothes that can
impair circulation, including watchbands and
rings.
5. Rewarming
a. Rewarm extremity by controlled and
rapid rewarming. Rewarm with a
temperature of 37 C 40 C (98.6 F
104 F) in a fairly large tepid water bath
where the part can be fully immersed
without touching the side or bottom.
b. More warm water may be added to
the container by removing some cooled
water and adding warm water.
c. Slow rewarming is less effective and may
increase tissue damage.
d. Dry heat is not recommended for
rewarming.
e. The rewarming procedure may take 20
30 minutes.
f. Rewarming is complete when the area is
warm to touch and pink or flushed.
g. Do not rub or massage a frostbitten
extremity . The ice crystals in the tissue will
lacerate delicate tissue.
h. Elevate the part to control swelling.
i. Use foot cradle to contact with
bedding if the feet are involve
prevents further tissue injury.
j. Encourage hourly active motion of the
affected digit to promote maximum
restoration of function and to prevent
contractures.