United States
Department of Transportation
National Highway
Traffic Safety Administration
Paramedic: National Standard Curriculum
(Reprinted with
permission)
http://www.nhtsa.dot.gov/people/injury/ems/
Burns: 4
UNIT TERMINAL
OBJECTIVE
4-4 At the completion of this unit, the
paramedic student will be able to integrate pathophysiological principles and
the assessment findings to formulate a field impression and implement the
management plan for the patient with a burn injury.
COGNITIVE
OBJECTIVES
At the completion
of this unit, the paramedic student will be able to:
4-4.1 Describe the anatomy and physiology
pertinent to burn injuries. (C-1)
4-4.2 Describe the epidemiology, including incidence,
mortality/ morbidity, risk factors, and prevention strategies for the patient
with a burn injury. (C-1)
4-4.3 Describe the pathophysiologic complications
and systemic complications of a burn injury. (C-1)
4-4.4 Identify and describe types of burn
injuries, including a thermal burn, an inhalation burn, a chemical burn, an
electrical burn, and a radiation exposure. (C-1)
4-4.5 Identify and describe the depth
classifications of burn injuries, including a superficial burn, a
partial-thickness burn, a full-thickness burn, and other depth classifications
described by local protocol. (C-1)
4-4.6 Identify and describe methods for
determining body surface area percentage of a burn injury including the
"rules of nines," the "rules of palms," and other methods
described by local protocol. (C-1)
4-4.7 Identify and describe the severity of a
burn including a minor burn, a moderate burn, a severe burn, and other severity classifications
described by local protocol. (C-1)
4-4.8 Differentiate criteria for determining the
severity of a burn injury between a pediatric patient and an adult patient.
(C-3)
4-4.9 Describe special considerations for a
pediatric patient with a burn injury. (C-1)
4-4.10 Discuss considerations which impact
management and prognosis of the burn injured patient. (C-1)
4-4.11 Discuss mechanisms of burn injuries. (C-1)
4-4.12 Discuss conditions associated with burn
injuries, including trauma, blast injuries, airway compromise, respiratory
compromise, and child abuse. (C-1)
4-4.13 Describe the management of a burn injury,
including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/
communication strategies, and other management described by local protocol.
(C-1)
4-4.14 Describe the epidemiology of a thermal burn
injury. (C-1)
4-4.15 Describe the specific anatomy and physiology
pertinent to a thermal burn injury. (C-1)
4-4.16 Describe the pathophysiology of a thermal
burn injury. (C-1)
4-4.17 Identify and describe the depth classifications
of a thermal burn injury. (C-1)
4-4.18 Identify and describe the severity of a
thermal burn injury. (C-1)
4-4.19 Describe considerations which impact
management and prognosis of the patient with a thermal burn injury. (C-1)
4-4.20 Discuss mechanisms of burn injury and
conditions associated with a thermal burn injury. (C-1)
4-4.21 Describe the management of a thermal burn
injury, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, and psychological support/
communication strategies. (C-1)
4-4.22 Describe the epidemiology of an inhalation
burn injury. (C-1)
4-4.23 Describe the specific anatomy and physiology
pertinent to an inhalation burn injury. (C-1)
4-4.24 Describe the pathophysiology of an inhalation
burn injury. (C-1)
4-4.25 Differentiate between supraglottic and
infraglottic inhalation injuries. (C-3)
4-4.26 Identify and describe the depth
classifications of an inhalation burn injury. (C-1)
4-4.27 Identify and describe the severity of an
inhalation burn injury. (C-1)
4-4.28 Describe considerations which impact
management and prognosis of the patient with an inhalation burn injury. (C-1)
4-4.29 Discuss mechanisms of burn injury and
conditions associated with an inhalation burn injury. (C-1)
4-4.30 Describe the management of an inhalation burn
injury, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, and psychological support/
communication strategies. (C-1)
4-4.31 Describe the epidemiology of a chemical burn
injury and a chemical burn injury to the eye. (C-1)
4-4.32 Describe the specific anatomy and physiology
pertinent to a chemical burn injury and a chemical burn injury to the eye.
(C-1)
4-4.33 Describe the pathophysiology of a chemical
burn injury, including types of chemicals and their burning processes and a
chemical burn injury to the eye. (C-1)
4-4.34 Identify and describe the depth
classifications of a chemical burn injury. (C-1)
4-4.35 Identify and describe the severity of a
chemical burn injury. (C-1)
4-4.36 Describe considerations which impact
management and prognosis of the patient with a chemical burn injury and a
chemical burn injury to the eye. (C-1)
4-4.37 Discuss mechanisms of burn injury and conditions
associated with a chemical burn injury. (C-1)
4-4.38 Describe the management of a chemical burn
injury and a chemical burn injury to the eye, including airway and ventilation,
circulation, pharmacological, non-pharmacological, transport considerations,
and psychological support/ communication strategies. (C-1)
4-4.39 Describe the epidemiology of an electrical
burn injury. (C-1)
4-4.40 Describe the specific anatomy and physiology
pertinent to an electrical burn injury. (C-1)
4-4.41 Describe the pathophysiology of an electrical
burn injury. (C-1)
4-4.42 Identify and describe the depth
classifications of an electrical burn injury. (C-1)
4-4.43 Identify and describe the severity of an
electrical burn injury. (C-1)
4-4.44 Describe considerations which impact
management and prognosis of the patient with an electrical burn injury. (C-1)
4-4.45 Discuss mechanisms of burn injury and
conditions associated with an electrical burn injury. (C-1)
4-4.46 Describe the management of an electrical burn
injury, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, and psychological support/
communication strategies. (C-1)
4-4.47 Describe the epidemiology of a radiation
exposure. (C-1)
4-4.48 Describe the specific anatomy and physiology
pertinent to a radiation exposure. (C-1)
4-4.49 Describe the pathophysiology of a radiation
exposure, including the types and characteristics of ionizing radiation. (C-1)
4-4.50 Identify and describe the depth classifications
of a radiation exposure. (C-1)
4-4.51 Identify and describe the severity of a
radiation exposure. (C-1)
4-4.52 Describe considerations which impact
management and prognosis of the patient with a radiation exposure. (C-1)
4-4.53 Discuss mechanisms of burn injury associated
with a radiation exposure. (C-1)
4-4.54 Discuss conditions associated with a
radiation exposure. (C-1)
4-4.55 Describe the management of a radiation
exposure, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, and psychological support/
communication strategies. (C-1)
4-4.56 Integrate pathophysiological principles to
the assessment of a patient with a thermal burn injury. (C-3)
4-4.57 Integrate pathophysiological principles to
the assessment of a patient with an inhalation burn injury. (C-3)
4-4.58 Integrate pathophysiological principles to
the assessment of a patient with a chemical burn injury. (C-3)
4-4.59 Integrate pathophysiological principles to
the assessment of a patient with an electrical burn injury. (C-3)
4-4.60 Integrate pathophysiological principles to
the assessment of a patient with a radiation exposure. (C-3)
4-4.61 Synthesize patient history information and
assessment findings to form a field impression for the patient with a thermal
burn injury. (C-3)
4-4.62 Synthesize patient history information and
assessment findings to form a field impression for the patient with an
inhalation burn injury. (C-3)
4-4.63 Synthesize patient history information and
assessment findings to form a field impression for the patient with a chemical
burn injury. (C-3)
4-4.64 Synthesize patient history information and
assessment findings to form a field impression for the patient with an
electrical burn injury. (C-3)
4-4.65 Synthesize patient history information and
assessment findings to form a field impression for the patient with a radiation
exposure. (C-3)
4-4.66 Develop, execute and evaluate a management
plan based on the field impression for the patient with a thermal burn injury.
(C-3)
4-4.67 Develop, execute and evaluate a management
plan based on the field impression for the patient with an inhalation burn
injury. (C-3)
4-4.68 Develop, execute and evaluate a management
plan based on the field impression for the patient with a chemical burn injury.
(C-3)
4-4.69 Develop, execute and evaluate a management
plan based on the field impression for the patient with an electrical burn
injury. (C-3)
4-4.70 Develop, execute and evaluate a management
plan based on the field impression for the patient with a radiation exposure.
(C-3)
AFFECTIVE
OBJECTIVES
At the completion
of this unit, the paramedic student will be able to:
4-4.71 Value the changes of a patient's self-image
associated with a burn injury. (A-2)
4-4.72 Value the impact of managing a burn injured
patient. (A-2)
4-4.73 Advocate empathy for a burn injured patient.
(A-2)
4-4.74 Assess safety at a burn injury incident.
(A-3)
4-4.75 Characterize mortality and morbidity based on
the pathophysiology and assessment findings of a patient with a burn injury.
(A-3)
4-4.76 Value and defend the sense of urgency in burn
injuries. (A-3)
4-4.77 Serve as a model for universal precautions
and body substance isolation (BSI). (A-3)
PSYCHOMOTOR OBJECTIVES
At the completion
of this unit, the paramedic student will be able to:
4-4.78 Take body substance isolation procedures
during assessment and management of patients with a burn injury. (P-2)
4-4.79 Perform assessment of a patient with a burn injury.
(P-2)
4-4.80 Perform management of a thermal burn injury,
including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/
communication strategies, and other management described by local protocol.
(P-2)
4-4.81 Perform management of an inhalation burn
injury, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/
communication strategies, and other management described by local protocol.
(P-2)
4-4.82 Perform management of a chemical burn injury,
including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/
communication strategies, and other management described by local protocol.
(P-2)
4-4.83 Perform management of an electrical burn
injury, including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/
communication strategies, and other management described by local protocol.
(P-2)
4-4.84 Perform management of a radiation exposure,
including airway and ventilation, circulation, pharmacological,
non-pharmacological, transport considerations, psychological support/ communication
strategies, and other management described by local protocol. (P-2)
DECLARATIVE
I. Introduction
A. Epidemiology
1. Incidence
a. Supportive statistics
2. Mortality/ morbidity
a. Supportive statistics
3. Risk factors
4. Prevention strategies
B. Review the anatomy and physiology of
the integumentary system
II. General system pathophysiology,
assessment and management
A. Pathophysiology
1. Pathophysiologic and systemic
complications of a burn injury
a. Fluid loss
b. Electrolyte loss
c. Increased catecholamine release
d. Acidosis
e. Vasoconstriction
f. Renal failure
g. Liver failure
h. Heart failure
i. Hypoxia
j. Anoxia
k. Arrhythmias
l. Formation of eschar
m. Hypothermia
n. Hypovolemia
o. Infection
p. Complications of a circumferential burn
B. Assessment findings
1. Types of burn injuries
a. Thermal burn
b. Inhalation burn
c. Chemical burn
d. Electrical burn
(1) Lightning
e. Radiation exposure
2. Depth classification of a burn injury
a. Superficial burn
b. Partial-thickness burn
c. Full-thickness burn
d. Other depth classifications according
to local protocol
3. Methods for determining body surface
area percentage of a burn injury
a. The "rule of nines"
(1) Adult
(2) Pediatric
b. The "rule of palms"
c. Other methods according to local
protocol
4. Severity of a burn
a. Minor burn
b. Moderate burn
c. Severe burn
d. Other severity classifications
according to local protocol
5. Criteria for determining severity of a
burn injury
a. The adult patient
b. The pediatric patient
(1) Special considerations
6. Considerations which impact management
and prognosis of the burn injured patient
a. Age
b. Preexisting medical conditions
c. Trauma
7. Mechanisms of burn injuries
a. Burn trauma
b. Blast/ explosion trauma
c. Fall injury
d. Other injuries
8. Conditions associated with burn
injuries
a. Trauma
(1) Soft tissue injuries
(2) Musculoskeletal injuries
b. Blast injuries
c. Airway compromise
d. Respiratory compromise
e. Child abuse
9. Signs and symptoms of burn injuries
a. Pain
b. Changes in skin condition relative to
the affected burn site
c. Adventitious sounds
d. Sloughing of the affected skin
e. Hoarseness
f. Dysphagia
g. Dysphasia
h. Burnt hair
i. Nausea/ vomiting
j. Unconsciousness
k. Altered level of consciousness
l. Edema
m. Paresthesia
n. Hemorrhage
o. Other soft tissue injuries
p. Musculoskeletal injuries
q. Dyspnea
r. Chest pain
C. Management
1. Airway, oxygenation, and ventilation
2. Circulatory management
3. Pharmacological support
a. Analgesia
4. Non-pharmacological management
5. Transport considerations
a. Appropriate mode
b. Appropriate facility
6. Psychological support/ communication
strategies
a. Patient and family advocacy
III. Specific burn injuries
A. Thermal burn injury
1. Epidemiology of a thermal burn injury
a. Incidence
(1) Supportive statistics
b. Mortality/ morbidity
(1) Supportive statistics
c. Risk factors
d. Prevention strategies
2 Review
the specific anatomy and physiology pertinent to the integumentary system
3 Review
of heat energy and the components of the burning agent
4 Pathophysiology
of a thermal burn injury
a0 The process of burn shock
(1) Emergent phase
(2) Fluid shift phase
(3) Hypermetabolic phase
(4) Resolution phase
b0 Jackson’s
thermal wound theory
(1) Zone of
coagulation
(2) Zone of stasis
(3) Zone of
hyperemia
c0 Inhalation injury (present in 60-70% of
all burn patients who die)
(1) Carbon monoxide poisoning
(2) Cyanide intoxication
d0 Infectious insult
e0 Eschar formation
(1) Respiratory compromise secondary to
circumferential eschar around the thorax
(2) Circulatory compromise secondary to
circumferential eschar around an extremity
(3) Escharotomies
5 Assessment
findings in a thermal burn injury
a0 Depth classifications of a thermal burn
b0 Severity of a thermal burn
c0 Criteria for determining severity of a burn injury
(1) The adult patient
(2) The pediatric patient
d0 Considerations which impact care and
prognosis of the thermal burn injured patient
e0 Mechanisms of burn injury
(1) Scalding
(2) Steam
(3) Flame
(4) Flash
(5) Retained heat
(6) Other trauma
f0 Conditions associated with thermal
burn injuries
6 Management
of a thermal burn injury
a0 Remove patient to safe area
b0 Stop the burning process
c0 Airway, oxygenation, and ventilation
d0 Circulatory management
e0 Pharmacological management
(1) Topical applications
(2) Tetanus and antibiotic therapy
(3) Fluid therapy
f0 Non-pharmacological management
(1) Thermal burn injury management according
to local protocol
g0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
(3) Transport considerations in conjunction
with burn injury management according to local protocol
h0 Psychological support/ communication
strategies
B0 Inhalation burn injury
1 Epidemiology
of an inhalation burn injury
a0 Incidence
(1) Supportive statistics (e.g., 20-35% of
the patients admitted to burn centers have an inhalation injury)
(2) Chemical inhalation injuries are more
frequent than thermal inhalation injuries
b0 Mortality/ morbidity
(1) Supportive statistics
c0 Risk factors
(1) Often associated with a burn environment
(2) Factors that increase the risk for
inhalation injury
(a) Standing
(b) Screaming
(c) Enclosed area
d0 Prevention strategies
2 Review
the specific anatomy and physiology pertinent to the respiratory system
3 Pathophysiology
of an inhalation injury
a0 Compromises the upper airway (supraglottic)
b0 Compromises the lower airway (infraglottic)
c0 Complications may occur later
4 Assessment
findings in an inhalation injury
a0 Mechanism of injury/ conditions associated with an
inhalation burn injury
(1) Toxic inhalations
(2) Smoke inhalation
(3) Carbon monoxide poisoning
(4) Thiocyanate intoxication
(5) Thermal burn
(6) Chemical burn
b0 Criteria for determining severity of a
burn injury
(1) The adult patient
(2) The pediatric patient
c0 Considerations which impact care and
prognosis of an inhalation burn injured patient
d0 Conditions associated with inhalation burn trauma
e0 Focused history
5 Management
of an inhalation burn injury
a0 Airway, oxygenation, and ventilation
b0 Circulatory management
c0 Pharmacological management
(1) Sodium thiosulfate therapy
d0 Non-pharmacological management
(1) Thermal burn injury management according
to local protocol
(2) Hyperbaric therapy - for carbon monoxide
e0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f0 Psychological support/ communication
strategies
C0 Chemical burn injury
1 Epidemiology
of a chemical burn injury
a0 Incidence
(1) Supportive statistics
b0 Mortality/ morbidity
(1) Supportive statistics
c0 Risk factors
d0 Prevention strategies
2 Anatomy
and physiology review
3 Pathophysiology
a0 Types of chemicals which cause chemical burn injuries
(1) Acids
(2) Bases (alkali)
(a) Cement
(3) Dry chemicals
(4) Phenols
b0 Characteristics of the burning process
of chemicals
(1) The burning process of an acid
(2) The burning process of an alkali
(3) The burning process of dry chemicals
4 Assessment
of a chemical burn injury
a0 Mechanism of injury/ conditions for a
chemical burn injury
(1) Industrial accidents most frequent
b0 Depth classification
c0 Severity
d0 Criteria for determining severity of a burn injury
(1) The adult patient
(2) The pediatric patient
e0 Considerations which impact care and
prognosis of a chemical burn injured patient
5 Management
of a chemical burn injury
a0 Airway, oxygen, and ventilation
b0 Circulatory management
c0 Pharmacological management
d0 Non-pharmacological management
(1) Acid burn injury management according to
local protocol
(2) Alkali burn injury management according
to local protocol
(3) Chemical burn injury to the eye
according to local protocol
(4) Dry chemical burn injury according to
local protocol
e0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f0 Psychological support/ communication
strategies
D0 Chemical burn injury of the eye
1 Epidemiology
of a chemical burn injury
a0 Incidence
(1) Supportive statistics
b0 Mortality/ morbidity
(1) Supportive statistics
c0 Risk factors
d0 Prevention strategies
2 Anatomy
and physiology review of the eye
3 Pathophysiology
a0 Types of chemicals which cause chemical burn injuries to the
eye
(1) Acids
(2) Bases (alkali)
(a) Cement
(3) Dry chemicals
(4) Phenols
(5) Mace/ pepper spray
4 Assessment
of a chemical burn injury
a0 Mechanism of injury/ conditions for a
chemical burn injury
(1) Industrial accidents most frequent
b0 Severity
c0 Criteria for determining severity of a eye injury
d0 Considerations which impact care and prognosis of a chemical
injury to the eye
5 Management
of a chemical burn injury of the eye
a0 Airway, oxygenation, and ventilation
b0 Circulation management
c0 Pharmacological management
d0 Non-pharmacological management
e0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f0 Psychological support/ communication
strategies
E0 Electrical burn injuries
1 Epidemiology
of an electrical burn injury
a0 Incidence
(1) Supportive statistics
b0 Mortality/ morbidity
(1) Supportive statistics
c0 Risk factors
d0 Prevention strategies
2 Anatomy
and physiology review
3 Review
of the characteristics of electrical current
4 Pathophysiology
a0 External burn injuries
b0 Internal burn injuries
c0 Musculoskeletal injuries
d0 Cardiovascular injuries
e0 Respiratory injuries
f0 Neurological injuries
g0 Myoglobin release and renal involvement
5 Assessment
of an electrical burn injury
a0 Mechanism of injury/ conditions for an electrical burn
injury
(1) Contact burn injuries
(2) Arc injuries
(3) Flame or flash burn injuries
(a) Welder’s flash
(4) Lightning injuries
(a) Direct stroke
(b) Side flash (splash)
(c) Step voltage
b0 Depth classification
c0 Severity
d0 Criteria for determining severity of an electrical burn
injury
(1) The adult patient
(2) The pediatric patient
e0 Considerations which impact care and
prognosis of an electrical burn injured patient
6 Management
of an electrical burn injury
a0 Airway, oxygenation, and ventilation
b0 Circulation management
c0 Pharmacological management
d0 Non-pharmacological management
(1) Thermal burn injury management according
to local protocol
e0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
f0 Psychological support/ communication
strategies
F0 Radiation exposure
1 Epidemiology
of a radiation exposure
a0 Incidence
(1) Supportive statistics
b0 Mortality/ morbidity
(1) Supportive statistics
c0 Risk factors
(1) Accidents associated with the improper
handling of radiological materials
d0 Prevention strategies
2 Anatomy
and physiology review
3 Types
of radiation which cause burn injury
a0 Alpha radiation
b0 Beta radiation
c0 Gamma radiation
4 Characteristics
of ionizing radiation
a0 Alpha radiation
b0 Beta radiation
c0 Gamma radiation
5 Aspects
of exposure
a0 Duration of exposure
b0 Distance from the source
c0 Shielding
6 Other
considerations of exposure
a0 Direct exposure to ionizing radiation
b0 Exposure to contaminants containing small particles of
active material
7 Assessment
of a radiation exposure
a0 Mechanism of injury
b0 Depth classifications
(1) Immediate versus delayed injuries and
affects
c0 Severity
(1) Immediate versus delayed injuries and
affects
d0 Criteria for determining severity of a
radiation exposure and associated burn injury
(1) The adult patient
(2) The pediatric patient
e0 Considerations which impact care and
prognosis of a radiation exposure and burn injuries
8 Management
of a radiation exposure and associated burn injuries
a0 Scene safety
b0 Airway, oxygenation, and ventilation
c0 Circulation management
d0 Pharmacological management
e0 Non-pharmacological management
(1) Injury management according to local
protocol
(2) Management of a radiation accident scene
f0 Transport considerations
(1) Appropriate mode
(2) Appropriate facility
g0 Psychological support/ communication
strategies
IV Integration