A medical assistant is assisting in the treatment of a patient who experienced a chemical burn

A burn is tissue damage from contact with:

Inhaltsverzeichnis Show

Things not to do
I. Airway
II. Breathing
III. Circulation
IV. Immediate Therapy
VI. Transfer Procedure
VII. Final Note
Burn Injury Criteria for Burn Center
What is the first action the medical assistant should take when he she determines there is a fire?
Which dressing should a medical assistant use on a partial thickness burn?
When treating a second degree burn a medical assistant should?
Which one of the following instructions should a medical assistant provide to a patient regarding transdermal patch use and care?

flames
very hot water (scalding)
corrosive chemicals
electricity
radiation (including sunburn)

The first step in treating a burn injury is determining whether the burn is a minor or major one. That determination will direct action and treatment. Read on to learn the difference and how to treat both types.

Major burns can be recognized by four primary characteristics:

deep
result in dry, leathery skin
larger than 3 inches in diameter or cover the face, hands, feet, buttocks, groin, or a major joint
have a charred appearance or patches of black, brown, or white

Minor burns are recognized by the following characteristics:

less than 3 inches in diameter
surface redness (like a sunburn)
skin blistering
pain

The first step in treating a major burn is to call 911 or seek emergency medical care.

Steps to take until emergency arrives include:

Make sure you and the person who’s burned are safe and out of harm’s way. Move them away from the source of the burn. If it’s an electrical burn, turn off the power source before touching them.
Check to see if they’re breathing. If needed, start rescue breathing if you’ve been trained.
Remove restrictive items from their body, such as belts and jewelry in or near the burned areas. Burned areas typically swell quickly.
Cover the burned area. Use a clean cloth or bandage that’s moistened with cool, clean water.
Separate fingers and toes. If hands and feet are burned, separate the fingers and toes with dry and sterile, nonadhesive bandages.
Remove clothing from burned areas, but don’t try to remove clothing that’s stuck to the skin.
Avoid immersing the person or burned body parts in water. Hypothermia (severe loss of body heat) can occur if you immerse large, severe burns in water.
Raise the burned area. If possible, elevate the burned area above their heart.
Watch for shock. Signs and symptoms of shock include shallow breathing, pale complexion, and fainting.

Things not to do

Don’t contaminate the burn with potential germs by breathing or coughing on it.
Don’t apply any medical or home remedy, including ointment, butter, ice, spray, or cream.
Don’t give the burned person anything to ingest.
Don’t put a pillow under their head if you think they have an airway burn.

Cool down the burn. After holding the burn under cool, running water, apply cool, wet compresses until the pain subsides.
Remove tight items, such as rings, from the burned area. Be gentle, but move quickly before swelling starts.
Avoid breaking blisters. Blisters with fluid protect the area from infection. If a blister breaks, clean the area and gently apply an antibiotic ointment.
Apply a moisturizing lotion, such as one with aloe vera. After the burned area has been cooled, apply a lotion to provide relief and to keep the area from drying out.
Loosely bandage the burn. Use sterile gauze. Avoid fluffy cotton that could shed and get stuck to the healing area. Also avoid putting too much pressure on the burned skin.
Take an over-the-counter pain reliever if necessary. Consider acetaminophen (Tylenol), ibuprofen (Advil), or naproxen (Aleve).

Airway
Breathing
Circulation
Immediate Therapy
History
Transfer Procedure
Final Note
Burn Injury Criteria for Burn Center

I. Airway

A. Assess for signs of inhalation injury:

Singed hairs, beard, eyelids, eyelashes, or nasal hairs;
Peri-oral charcoal;
Intra-oral charcoal, especially on teeth and gums.

B. Inhalation injury is diagnosed by bronchoscope.
C. Patients with facial and neck burns often develop massive swelling and airway obstruction. Evaluate for respiratory distress and intubate early, before massive swelling impairs ventilation.

II. Breathing

A. If patient is a suspected inhalation injury or is in respiratory distress, he is a candidate for prompt intubation.
B. Nasotracheal tube with a soft, low-pressure cuff is preferred, but oral intubation should be performed in patients with nasal deformation.
C. Emergency surgical airway is rarely indicated. If a surgical airway is necessary, perform a cricothyrotomy.
D. Special Note:

Patient's level of consciousness is NOT a criterion for intubation. Most severely burned patients are quite awake on presentation to the Emergency Department and, yet, may need to be intubated. Post-burn edema of facial and/or inhalation burns manifests itself early. Establishing an adequate airway is essential.
An awake patient may be intubated with relative ease if the nose and throat are well anesthetized with Cetacaine and the patient is given sedation as soon as the ET tube is in proper position.

III. Circulation

A. IV

Two large bore IV's (14-16 gauge angiocath or medicut) are adequate for even the largest body surface burns. IV sites are precious - do not waste them with unnecessary line placement.
Cutdowns in non-burned areas are permissible but only if absolutely necessary.

B. Fluid Resuscitation

Pre-hospital
     a. Over age 15: 500 ml/hour Ringers Lactate
     b. Age 5-15: 250 ml/hour Ringers Lactate
     c. Under age 5: no fluids
Emergency Department
a. Calculate fluid requirements using the Parkland formula (4 cc/kg body weight/% burned). One-half (1/2) of total should be given in first 8 hours. The remaining amount is divided equally over the next 16 hours. Do not over resuscitate.
b. Use Ringers Lactate. Avoid solutions with glucose in them, except in children less than 1 year old. Infants should receive D5LR.

IV. Immediate Therapy

A. Remove all clothing and jewelry.
B. Stop the burning process by cooling the burned area with liberal amounts of normal saline. Then warm the patient.
C. Chemical Burns (personnel must wear appropriate protective clothing during chemical neutralization)

Remove saturated clothing.
Brush powdered chemicals off the skin.
Irrigate with copious amount of water. (Irrigation is generally continued until the patient identifies a decrease in pain or burning.) 4. Hydrofluoric acid burns require definitive management. Please consult as soon as possible.

D. Do not cover patients with wet cloths or ice.
E. Nasogastric tube may be indicated if:

Burns greater than 25%
Patient intubated
If nausea or vomiting present:
a. Keep patient NPO
b. Aspirate contents of stomach

F. An indwelling urinary catheter may be indicated if:

Burns greater than 20% BSA.
Perineal burns.
a. Check the patency of the indwelling urinary catheter with irrigation after insertion.
b. If urine is red or black (hemochromogens), consult with Burn Center.

G. Pain medications:

Use narcotics intravenously. Never intramuscularly.
Morphine Sulfate is the drug of choice (0.1 mg/kg for children). Monitor respiratory rate after administration.
Administer only if necessary and document sensorium prior to administration.

H. Give tetanus prophylaxis.
I. Do not use prophylactic antibiotics.
J. Burn wound care:

Cover minor burns with dressings dampened with sterile normal saline. Keep the patient warm.
Patients with a major burn injury should have their wounds covered with a dry clean or sterile sheet. Keep the patient warm.
Emergency Department escharotomies are rarely indicated. If distal blood flow to the extremities is compromised, consult the burn center physician before attempting escharotomies.

V. History

A. Patient's name, age, and time of burn injury.
B. Etiology of burn injury:

Scald - nature of scalding agent, i.e., water, grease, etc.
Flame
Electrical - determine voltage and mechanism of injury.
Chemical:
     a. Name, kind, nature of chemical
     b. Amount of time flooded with water/saline
     c. Do not attempt to neutralize the chemical substance
Time of burn (date and hour)
Where burn occurred:
a. Open space (field, etc.)
b. Closed space (car, house, etc.)
Pertinent medical history
Known allergies
Present medications
Related injuries

VI. Transfer Procedure

A. Call the John A. Gannon Comprehensive Burn Care Center at MetroHealth Medical Center at (216) 778-4095 and ask for the burn resident. He/she will provide information necessary to transfer and prepare the patient for arrival at the Emergency Department. If emergent transfer is needed, please call Metro Life Flight at (216) 778-5433 or 1-800-233-5433.
B. Patients who are unstable, have inhalation injury, or transferred by ground vehicle should be accompanied by a physician and/or nurse.
C. If possible, someone who knows the patient personally should accompany them to the Comprehensive Burn Care Center. Nearest of kin should be informed of the transfer.
D. Complete Transfer Form and send it with patient, after calling report to nurse in the Comprehensive Burn Care Center.

VII. Final Note

Even though you may wish to transfer a patient immediately, it is important that the patient be medically stable, airway maintained, and shock, if present managed prior to transfer. The Comprehensive Burn Care Center physicians and nursing staff are available to assist you, through consultation, in preparing the patient for a safe transfer. Please call us as early as possible.
________________________________________

Burn Injury Criteria for Burn Center

Partial-thickness burns of greater than 10% of the total body surface area
Burns that involve the face, hands, feet, genitalia, perineum, or major joint
Third degree burns in any age group
Electrical burns, including lightning injury
Chemical burns
Inhalation injury
Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality
Any patients with burns and concomitant trauma (such as fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient's condition may be stabilized initially in a trauma center before transfer to a burn center. Physician judgment will be necessary in such situations and should be in concert with the regional medical control plan and triage protocols.
Burned children in hospitals without qualified personnel or equipment for the care of children
Burn injury in patients who will require special social, emotional, or rehabilitative intervention

Questions concerning specific patients can be resolved by consultation with the burn center physician.

What is the first action the medical assistant should take when he she determines there is a fire?

"Evacuate the area, following the fire safety plan."

Which dressing should a medical assistant use on a partial thickness burn?

The assistant should use a non adherent dressing on a partial-thickness burn. This type of dressing allows the wound to be exposed to air and heal.

When treating a second degree burn a medical assistant should?

A second-degree burn causes redness, blistering, pain, and swelling. Immerse the area in cool water for at least 10 minutes. Do not use cold water or ice.

Which one of the following instructions should a medical assistant provide to a patient regarding transdermal patch use and care?

Which of the following instructions should a medical assistant provide to a patient regarding transdermal patch use and care? Make sure to rotate patch placement to avoid skin irritation.