horizon.png I. Čundrle Department of Anesthesiology and Intensive Care FNUSA HEAT, COLD, ELECTRICAL, CHEMICAL INJURIES horizon.png •Direct or indirect heat/electrical/radiation/chemical energy • •Exposure must be longer than treshold to cause damage • •Major pitfalls of burn injouries: •Pain •High morbidity •disability •Financial loss BURN INJURIES Výsledek obrázku pro burns contractures horizon.png PATHOPHYSIOLOGY •45°C --> direct tissue injury + indirect injury (ischemia) • •During the first 24 hrs – vasoactive mediators are released from damaged tissue --> capillary function loss --> loss of plasma into the intersticium --> edema --> loss of vascular filling --> hemoconcentrations --> hypovolemic shock --> centralization --> hypoperfusion and hypoxia --> metabolic acidosis --> organ damage. • •Kidney – oliguria, anuria, myoglobinuria, kidney failure •GIT – stress ulcus (Curling), gut dysfunction, paralytic ileus, solid organ necrosis (liver) •Lung – edema, ARDS •Metabolism – increased catabolism • Kidney damage is characterized by ... horizon.png CAUSES • •Thermal burns •hot fluid, steam •flame • •Chemical burns (acid, alkali) •Electrical burns •Radiation burns • horizon.png THERMAL BURNS •Contact – small extent, but deep •Scald – larger, but usually less deep ... especially common in kids (95%), coffee •Flame – all possible kinds of extent and depth •+ possible inhalation trauma, burning products, heat, high pressure exposure (explosion) •+ possible intoxication CO, NO a HCN • horizon.png ELECTRICAL BURNS •One of the most serious •Different tissues/organs have different electrical current resistance, therefore the same current could cause different damage to different organs •Bones have the highest electrical current resistance. Therefore, when electrical current is passing through the bone, it produces a lot of heat which may cause a collateral damage to tissues attached to the bones •Nerves and blood vessels present the lowes current resistance. • •Electrical damage – tissue necrosis usually just on the site of current entrance and exit from the body + damage to deeper tissues depending on current resistance •Electrical arch, lightning (several thousand of °C) - complete destruction of tissue on the entrance and exit site • Whit electrical current the most important thing is that horizon.png Výsledek obrázku pro electrical burns Výsledek obrázku pro lichtenbergovy obrazce horizon.png •Acids – coagulation necrosis, usually on the surface, self limiting (first aid – water) • CHEMICAL BURNS Výsledek obrázku pro acid burn horizon.png •Alkali – liquefactive necrosis (deep, continuous penetration into deeper structures, first aid – water) • CHEMICAL BURNS Výsledek obrázku pro alkali burn horizon.png •Other substances - fenol – antidote is ethylalkohol administered directly on the site, white phosphorus – antidote is copper sulfate – cuprite phosphate • CHEMICAL BURNS Výsledek obrázku pro white phosphorus burns horizon.png DAMAGE EXTENT ESTIMATION – RULE OF 9 Výsledek obrázku pro pravidlo deviti horizon.png DEPTH OF BURN INJURIES Související obrázek horizon.png •First degree – epidermis, erythema, painful, fully reversible within a few days, usually sunburn. • • FIRTS DEGREE Výsledek obrázku pro popáleniny 1. stupně horizon.png •Second degree – epidermis + part of dermis. Fluid filled blisters on the border of epidermis/dermis • •IIa more superficial, thin walled blisters, fully reversible (or change of skin pigmentation) •IIb deeper, healed by epithelization from the remaining parts of hair follicles, sweat glands, up to 6 weeks, may result in scars • SECOND DEGREE Výsledek obrázku pro popáleniny 2. stupně horizon.png •Third degree – necrosis of the whole skin. Unpainful. Small wounds are healed by epithelization from sides of the wound, larger need surgical care – skin grafting. • THIRD DEGREE horizon.png •Fourth degree – necrosis of the whole skin thickness + underlying tissues (muscles, bones, tendons). Complex reconstruction is needed. • FOURTH DEGREE horizon.png INHALATION INJURY Výsledek obrázku pro inhalation injury Výsledek obrázku pro inhalation injury horizon.png SEVERE BURN •Kids up to 2 years - 5 % body surface area •Kids up to 10 years - 10 % body surface area •Kids up to 15 years - 15 % body surface area •Kids third degree always • •Adults - 20 % body surface area •Adults older than 70 years - 10 % body surface area • •+ always inhalation trauma, electrotrauma, chemical burns with intoxication, radiation trauma horizon.png SPECIALIZED BURN CLINICS •FN Brno Bohunice •FN Kralovské Vinohrady - Prague •FN Ostrava horizon.png FIRTS AID •Remove the source of burn – extinguish the fire, shut down electricity, transport the victim to a safe place •Check the vital signs and secure vital functions – airways, CPR, stop bleeding •Cooling of the wound – cold water (4 - 8 °C) + then sterile bandages. No more than 5% od body surface area. In very small kinds no cooling at all (risk of a fast and profound hypothermia). •Anti-shock precautions •Transport closest surgery or specialized clinic (depending on burn severity) • horizon.png HEATSTROKE •Usually a combination of hot and wet environment + physical work and lack of fluids. • •Symptoms are thirst, weakness, nausea, vomiting, hallucinations/desorientation, loss of consciousness. Hot, dry and red skin, fast and shallow pulse, fast breathing. horizon.png •Place the victim to a cooler environment, shadow. •Lower the body temperature – shower, bath (25 °C) •Cold fluids with salt/minerals •In case of unconsciousness – stabilized position •In case of cardiac arrest - CPR FIRST AID hwkb17_064.jpg horizon.png SUNSTROKE •Direct effect of sunlight on head (brain irritation) • •First to second degree burns, headache, tinnitus, nausea, vomiting, fewer 40 °C, seizures. Fast pulse + breathing. • horizon.png FIRST AID •Remove the victim from direct sunlight • •If fully conscious – cooling of the head + body, administer cool fluids • •If unconscious – same as heatstroke • horizon.png HYPOTHERMIA •Symptoms: weakness, desorientation, hallucinations (paradoxical behavior – clothes removal etc...), loss of consciousness. • •First aid •Bring the patient to a warm environment or at least prevent further heat loss •Moderate hypothermia – active + passive warming, exercise, warm baths (37 – 40 °C), warm fluids. No alcohol. •Severe hypothermia – secure vitals, prevent further heat loss, passive rewarming – no active rewarming or just in places with large blood vessels (neck, groins), fast transport. horizon.png FROSTBITES •Usually fingers, nose, ears ... • •Clasification similar to burns ... horizon.png •pale or purple skin, stinging pain • FIRST DEGREE horizon.png •pale – grey skin, very painful, blisters after rewarming • SECOND DEGREE horizon.png •waxy pale skin, not painful, risk of skin necrosis • THIRD DEGREE horizon.png FIRTS AID •Do not rub the injured places with show or ice •Bring the victim into warm environment (25 °C) •Sterile bandages on injured places, do not remove the blisters (risk of infection) •Injured places without blisters may be submerged in hot water •Anti shock precautions •Threat hypothermia •Transport • • horizon.png CHEMICAL BURNS •Cause not known • Remove the substance (on clothing etc...), rinse the injured place with continuous flow of water, sterile bandages, transport •Acids • Remove the substance (on clothing etc...), rinse the injured place with continuous flow of water, sterile bandages, transport) + You may try to neutralize the substance: alkali soap, soda on the bandage. •Alkali • Remove the substance (on clothing etc...), rinse the injured place with continuous flow of water, sterile bandages, transport) + You may try to neutralize the substance: diluted vinegar, lemon juice on the bandage. horizon.png INGESTION •Do not make the patient vomit •Do not use the neutralization substances, only water 250 – 500ml •Secure airways •Vital signs •Emergency • Výsledek obrázku pro alkali burn horizon.png ELECTRICAL BURNS •Low voltage1000 V • Try to break the contact of the victim ad source of electricity. Take and secure the vitals, treat burns, call emergency, transport. • •High voltage > 1000 V • Wait for someone (electritioner, firemen) to switch of the source of electricity. Until then wait at least 18 meters away. Then take and secure the vitals, treat burns, call emergency, transport. • •Lightning • Same process as in high voltage, except do not wait for the electritioner horizon.png THANK YOU FOR YOUR ATTENTION