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1、BURNSLeaugeay Webre BS, CCEMT-P, NREMT-PScenarioParamedic is called to the scene of a structure fire. FD has removed a victim from the house. BSIScene safe1 patientA/C standbyFD/ PD on sceneNow what?General Impression33 yo male pt writhing in pain. Screams and begs for pain medication however poor h
2、istorian.S- blistering to back and chest, R upper ventral area leg exposed muscle; eyebrows singedA- PCN, codeineM- noneP- noneL- earlier todayE- woke up on fireA-B-C-Transport decision?% BSA burned?Tx?ObjectivesDescribe the structure and function of skinDiscuss the types of burns.Explain the degree
3、s of thermal burns.Discuss causes and treatments of inhalation injuries.Identify methods of approximating burn injuries.Describe and apply treatment modalities for the burn patient.Burns, thermal. Escharotomy to release chest wall and allow for ventilation of the patient.SkinLargest organ of the bod
4、yAnatomyEpidermisDermisSubcutaneous tissueLayersEpidermisDermisSubcutaneosUnderlying StructuresFasciaNervesTendonsLigamentsMusclesOrgansAnatomy & Physiology of the SkinFunctionProtection Regulation Prevention SensoryEpidermisOuter, thinner layerConsists of dead keratinized cellsProtects dehydration
5、trauma light infectionDermisGel like matrixConsists of collagen and elastinContains blood vessels, lymphatics, sweat glands, hair follicles, sensory fibersSubcutaneousConnective tissueAdipose tissue cushioning insulationCausesThermalElectricalChemicalRadiation ThermalMajority flame scald contact wit
6、h hot objectsChild with burns from a scaldDetermining Severity1st degree2nd degree3rd degree(4th degree)Depth of BurnSuperficial BurnPartial Thickness BurnFull Thickness BurnFirst DegreeSuperficial involve only epidermisLocal pain and rednessNo blistering presentHeal spontaneously 2-5 days without s
7、carringNot included when calculating % TBSABurn DepthSuperficial Burn:1st Degree BurnSigns & SymptomsReddened skinPain at burn siteInvolves only epidermisSecond DegreeInvolve epidermis and dermisPartial thickness superficial partial thickness red, painful, blistered deep partial thickness pale, mott
8、ledVery painfulInfection may evolve into 3rd degreeBurn DepthPartial-Thickness Burn: 2nd Degree BurnSigns & SymptomsIntense painWhite to red skinBlistersInvolves epidermis & dermisThird DegreeInvolve epidermis, dermis, subcutaneous tissueWhite, waxy, red, brown, leatheryDry and painless(muscle and b
9、one)Burn DepthFull-Thickness Burn: 3rd Degree BurnSigns & SymptomsDry, leathery skin (white, dark brown, or charred)Loss of sensation (little pain)All dermal layers/tissue may be involvedFourth DegreeInclude involvement of muscle and boneCharred in appearancePainlessPathophysiologyLocal changes- 111
10、F produce injuryArea of DamageZone of coagulationZone of stasisZone of hyperemiaJacksons Theory of Thermal WoundsZone of CoagulationArea in a burn nearest the heat source that suffers the most damage as evidenced by clotted blood and thrombosed blood vesselsZone of StasisArea surrounding zone of coa
11、gulation characterized by decreased blood flow.Zone of HyperemiaPeripheral area around burn that has an increased blood flow.Jacksons Theory of Thermal WoundsZone of HyperemiaZone of StasisZone of CoagulationZone of CoagulationCentral area of burnNecrotic from time of exposureZone of StasisModerate
12、degree of insultDecreased tissue perfusionVascular damage/ leakageMay progress to necrosis 24-48 hoursZone of HyperemiaVasodilationInflammationViable tissueBodys Response to BurnsEmergent Phase (Stage 1)Pain responseCatecholamine releaseTachycardia, Tachypnea, Mild Hypertension, Mild AnxietyFluid Sh
13、ift Phase (Stage 2)Length 18-24 hoursBegins after Emergent PhaseReaches peak in 6-8 hoursDamaged cells initiate inflammatory responseIncreased blood flow to cellsShift of fluid from intravascular to extravascular spaceMASSIVE EDEMA“Leaky CapillariesSystemic ChangesMassive release of inflammatory med
14、iatorsProduce vasoconstriction/ dilationIncreased capillary permeabilityEdemaFluid ShiftsInitial decrease blood flow to burned areaFollowed by increased arterial vasodilationRelease of vasoactive substance resulting in increased capillary permeability and edemaCardiovascularLoss of plasma volumeIncr
15、eased peripheral vascular resistanceDecreased cardiac output decreased blood volume decreased venous return increased blood viscosity decreased contractilityRenalDecrease circulating plasmaIncrease hematocritDecreased CO decreased renal blood flow oliguria acute renal failureGastrointestinalDecrease
16、d gastrointestinal blood flowIncreased mucosal hemorrhage 20% ileusImmune SystemDepressed immune function 20% directly proportional to burn sizesepsisBodys Response to BurnsHypermetabolic Phase (Stage 3)Last for days to weeksLarge increase in the bodys need for nutrients as it repairs itselfResoluti
17、on Phase (Stage 4)Scar formationGeneral rehabilitation and progression to normal functionHypermetabolismFollowing severe burn and resuscitation tachycardia increased CO increased O2 demand massive proteolysis & lipolysis severe nitrogen lossSystemic ComplicationsHypothermiaDisruption of skin and its
18、 ability to thermoregulateHypovolemiaShift in proteins, fluids, and electrolytes to the burned tissueGeneral electrolyte imbalanceEscharHard, leathery product of a deep full thickness burnDead and denatured skinSystemic ComplicationsInfectionGreatest risk of burn is infectionOrgan FailureRelease of
19、myoglobinSpecial FactorsAge & HealthPhysical AbuseElderly, Infirm or YoungCritical Burn AreasFace HandsFeetGroinJointsCircumfrentialInhalation InjuriesLeading cause of death Closed space incident Presence of heavy smoke History of unconsciousnessBurns, thermal. Partial- and full-thickness burns from
20、 structure fire. Note facial involvement.Inhalation InjuryToxic InhalationSynthetic resin combustionCyanide & Hydrogen SulfideSystemic poisoningMore frequent than thermal inhalation burnCarbon Monoxide PoisoningColorless, odorless, tasteless gasByproduct of incomplete combustion of carbon productsSu
21、spect with faulty heating unit200x greater affinity for hemoglobin than oxygenHypoxemia & HypercarbiaOther EvidenceFacial burnsProfuse secretionsCarbonaceous sputumLacrimationSinged nasal hairHoarsenessWheezingStridorEdemaHypoxemiaTachycardiaInhalation InjuryAirway Thermal BurnSupraglottic structure
22、s absorb heat and prevent lower airway burnsMoist mucosa lining the upper airwayInjury is common from superheated steamRisk FactorsStanding in the burn environmentScreaming or yelling in the burn environmentTrapped in a closed burn environmentSymptomsStridor or “Crowing inspiratory soundsSinged faci
23、al and nasal hairBlack sputum or facial burnsProgressive respiratory obstruction and arrest due to swellingTypes of InjuriesCarbon monoxide poisoningInjury above glottisInjury below glottisCO PoisoningAffinity for Hgb 200-250X than O2Cherry red only present at levels 40%+N,+V, HA, decreased LOC, wea
24、kness, tachypnea, tachycardia False pulse oximetry reading 100% O2 time for elimination 40 min21% O2 time elimination 250 minutesCarboxyhemoglobinNormal- 0Smokers, truck drivers in heavy traffic- 1515-40%- neurological dysfunction weakness, dizziness, +N, +V, HA40-60%- obtunded severe decreased LOCC
25、onsider hyperbaric therapy- 25-40%Injury Above GlottisThermal, chemicalRequire early intubationSeverely hypovolemicInjury Below GlottisUsually chemicalRepiratory distressRequire early intubationARDSMSOFEstimating % BSA BurnedRule of palmsRule of ninesBody Surface AreaRule of NinesBest used for large
26、 surface areasExpedient tool to measure extent of burnRule of PalmsBest used for burns 10% BSARules of NinesRule of PalmsA burn equivalent to the size of the patients hand is equal to 1% body surface area (BSA)TreatmentStop the burnABCsEstimate % BSA burnedCool burnPrevent hypothermia & infectionPai
27、n controlAirwayO2 on ALL patients Acute pulmonary insufficiency Pulmonary edema 2-3 days Bronchopneumonia 5-7 daysConsider intubation Sx/ liklihood of impending airway obstructionCirculationFluid replacement critical to survivalTissue destruction results in increased capillary permeabilityProfound f
28、luid loss from the intravascular spaceLarge amounts fluid lost from loss of skin integrity due to evaporationParkland Formula4ml x wt kg x %BSA burned = 24 hr infusion1st half over first 8 hoursCalculated from time of injury2nd/ 3rd degree burns onlyFluid ResuscitationRestore effective plasma volume
29、Maintain vital organ functionHypovolemia/ renal failure- complicationsPulmonary edemaAssess adequacy by UA outputCool BurnWithin 30 minutes inhibits lactate production and acidosis promotes catecholamine function and ardiovascular homeostasis inhibits burn wound histamine release blocks histamine me
30、diated increased vascualr permeabilityCont minimizes edema formation suppresses thromboxane mediator of vascular occlusion progressive dermal ischemiaHypothermia & InfectionCover with dry sterile sheetKeep warmPain ControlMorphine sulfate decreases amount of protein binding rapidly eliminated small,
31、 frequent doses may use up to 50mg/hrFentanylVersed Special ConsiderationsCircumfrential burns may require fasciotomyPediatrics more susceptible to circumfrential 10% 502nd/3rd degree burns 20% TBSA2nd/3rd degree burns to critical areas3rd degree 5% TBSASignificant electrical/ chemical burnsInhalati
32、on injuryCircumfrential burnsPreexisiting conditions medical or concomitant traumaScene Size-upFire DepartmentSCBA and protective clothingInitial AssessmentABCs MUST be intactConsider ET or RSIRapid evacuation of patient if scene is unstableAssessment of Thermal BurnsFocused and Rapid Trauma Assessm
33、entAccurately approximate extent of burn injuryRule of Nines or Rule of PalmsDepth of burnArea of body effectedAny burn to the face, hands, feet, joints or genitalia is considered a serious burn“Ringing burnsAge of patient affectedAssessment of Thermal BurnsPainChanges in skin condition at affected
34、siteAdventitious soundsBlistersSloughing of skinHoarsenessDysphagiaDysphasiaAssessment of Thermal BurnsGeneral Signs & SymptomsBurnt hairBurnt hairBurnt hairEdemaEdemaEdemaParesthesiaParesthesiaParesthesiaHemorrhageHemorrhageHemorrhageOther soft tissue injuryOther soft tissue injuryOther soft tissue
35、 injuryMusculoskeletal injuryMusculoskeletal injuryMusculoskeletal injuryDyspneaDyspneaDyspneaChest painChest painChest painAssessment of Thermal BurnsAny partial or full thickness burn involving hands, feet, joints,face, or genitalia30% BSAPartial ThicknessInhalation Injury10% BSAFull ThicknessCrit
36、ical2% BSAFull Thickness50% BSASuperficial2% BSAFull Thickness15% BSAPartial Thickness15% BSAPartial ThicknessModerateMinorBurn SeverityBurn SeverityOngoing AssessmentNon-critical: Reassess Q 15 minCritical: Reassess Q 5 minBurn Center CareAssessment of Thermal BurnsLocal & Minor BurnsLocal coolingP
37、artial thickness: 15% of BSAFull thickness: 15% BSAFull thickness: 5% BSAMaintain warmthPrevent hypothermiaConsider aggressive fluid therapyModerate to severe burnsBurns over IV sitesPlace IV in partial thickness burn site.Management of Thermal BurnsParkland Burn Formula4 mL x Pt wt in kg x % BSA =
38、Amt of fluidPt should receive of this amount in first 8 hrs.Remainder in 16 hrsConsider 1 hour dose0.5ml x Pt wt in kg x % BSA = Amt of fluidManagement of Thermal BurnsModerate to Severe BurnsCaution for fluid overloadFrequent auscultation of breath soundsConsider analgesic for painMorphineNubainPre
39、vent infectionManagement of Thermal BurnsInhalation InjuryProvide high-flow O2 by NRBConsider intubation if swellingConsider hyperbaric oxygen therapyCyanide ExposureSodium Nitrite, Amyl Nitrite, Sodium ThiosulfateForms methemoglobin binds to cyanideNon-toxic substance secreted in urineInhale 1 ampu
40、le of Amyl Nitrite300 mg Sodium Nitrite over 2-4 minutes12.5 gm of Sodium ThiosulfateManagement of Thermal BurnsScenarioLightning InjuriesOne of the top three causes of environmental death (flood, temp extremes)Not AC or DC but a unidirectional, massive, current impulse with several return strokes b
41、ack to the cloudTremendously large current impulsively flows for an incredibly short timeDifference Between Lightning and ElectricityDuration of exposure to currentNot enough time for skin burnsInternal burns and renal failure usually inconsequentialCardiac arrestRespiratory arrestVascular spasmNeur
42、ological damageImmediateVentricular asystoleOften spontaneously resumeProlonged respiratory arrestResults in secondary cardiac arrestIschemia due to vascular spasmsMI, spinal artery syndromesLong TermSurvivors 10-20x fatalitiesNeuropsychological and neurocognitive changesChronic pain syndromesChest
43、painSympathetic nerve system dysfunctionSleep disorders, HA, cardiac effectsDemographicsSunday, Saturday, WednesdayNoon- 6pm, 6- 12 pmMay be in or outdoorsMales, 10 miles from thunderstorm, clouds/ rain may not be presentShelter- school buses, metal top vehiclesAvoid trees, small shelters, bleachers
44、, fences, towers, any current transmitting structures, pools/ water, high areasAvoid use telephones, electronic equipment, any contact with conductive surfaces inside (plumbing, doing dishes), EMS/ fire dispatch radioArcing electrical burns, through shoe around rubber sole. High-voltage (7600 V) alt
45、ernating currentElectricalAge related injury peaks infancy-4 years 20-25 year old males- primarily work relatedFactors Affecting SeverityVoltage and amperageResistance of body tissueType and path of currentDuration and intensity of contactElectrical BurnsTerminologyVoltageDifference of electrical po
46、tential between two pointsDifferent concentrations of electronsAmperesStrength of electrical currentResistance (Ohms)Opposition to electrical flowElectrical BurnsOhms LawV: VoltageR: ResistanceI: CurrentBased on electron flow thru TungstenEmit more light the more current passed thruElectrical BurnsJ
47、oules LawP: PowerSkin is resistant to electrical flowGreater the current the greater the flow thru the body and greater the release of heatElectrical BurnsGreatest heat occurs at the points of resistanceEntrance and Exit woundsDry skin = Greater resistanceWet Skin = Less resistanceLonger the contact
48、, the greater the potential of injuryIncreased damage inside bodySmaller the point of contact, the more concentrated the energy, the greater the injuryElectrical BurnsElectrical Current FlowTissue of Less ResistanceBlood vesselsNerveTissue of Greater ResistanceMuscleBoneResults inSerious vascular an
49、d nervous injuryImmobilization of musclesFlash burnsVoltageHigh 1000 voltsLow resistance injuryComplicationsCardiac arrythmiasRespiratory muscle paralysisThrombosisRenal failureFractures DC- direct current discrete exit AC-alternating current more explosiveCurrent Passage MortalityHand to hand- 60%H
50、and to foot- 20%Foot to foot- 5%Special ConsiderationsRespiratoryCardiac Concomitant traumaRenal failureRequire fluid resuscitationElectrical InjuriesSafetyTurn off powerEnergized lines act as whipsEstablish a safety zoneLightning StrikesHigh voltage, high current, high energyLasts fraction of a sec
51、ondNo danger of electrical shock to EMSAssessment & Management of Electrical and Lightning InjurieslAssess patientlEntrance & Exit woundslRemove clothing, jewelry, and leather itemslTreat any visible injuries lThermal burnslECG monitoringlBradycardia, Tachycardia, VF or AsystolelACLS ProtocolslTreat
52、 cardiac & respiratory arrestlAggressive airway, ventilation, and circulatory management.lConsider Fluid bolus for serious burnsl20 ml/kglConsider Sodium Bicarbonate: 1 mEq/kglConsider Mannitol: 10 gAssessment & Management of Electrical InjuriesContact electrical burns, 120-V alternating current nom
53、inal. The right knee was the energized sideChemicalStrong acids coagulation necrosisStrong bases liquefication necrosisWill continue burning until neutralized or dilutedDegree of Damage/ToxicityChemical natureAmountConcentrationMechanismDurationChemical BurnsChemical destroys tissueAcidsForm a thick
54、, insoluble mass where they contact tissue.Coagulation necrosisLimits burn damageAlkalisDestroy cell membrane through liquefaction necrosisDeeper tissue penetration and deeper burnsOral caustic chemical burnsStrong Acids and AlkalisStrong acids and alkalis may cause burns to the mouth, pharynx, esop
55、hagus, and sometimes the upper respiratory and GI tractsIngestions of caustic and corrosive substances generally produce immediate damage to the mucous membrane and the intestinal tractAcids generally complete their damage within 1 to 2 minutes after exposureAlkalis, particularly solid alkalis, may
56、continue to cause liquefaction of tissue and damage for minutes to hoursAlkali burn to eyeSigns and SymptomsFacial burnsPain in the lips, tongue, throat, or gumsDrooling, trouble swallowingHoarseness, stridor, shortness of breathShock secondary to bleeding or vomitingManagementEstablish an airway, c
57、onsider intubation, or if necessary, cricothyrotomyContact poison controlGastric lavage or charcoal often contraindicatedIV with NS or LRRapid transportHydrocarbonsA group of saturated and unsaturated compounds derived primarily from crude oil, coal, or plant substancesFound in many household produc
58、ts and in petroleum distillatesHydrocarbonsViscosity is the most important physical characteristic in potential toxicityThe lower the viscosity, the higher the risk of aspiration and associated complicationsClinical features of hydrocarbon ingestion vary widely, depending on the type of agent involv
59、ed May be immediate or delayed in onsetSigns and SymptomsBurns due to local contactWheezing, dyspnea, hypoxia, and pneumonitis due to aspiration or inhalationHeadache, dizziness, slurred speech, ataxia (irregular or difficult-to-control movements), and dulled reflexesFoot and wrist drop with numbnes
60、s and tinglingCardiac dysrhythmiasManagementMost are not life-threateningOccasionally gastric lavage may be of benefitIn seriously symptomatic patients, protect the airway and establish an IV if NS or LRContact poison controlTransportChemical BurnsScene size-upHazardous materials teamEstablish hot,
61、warm and cold zonesPrevent personnel exposure from chemicalSpecific ChemicalsPhenolDry LimeSodiumRiot Control AgentsAssessment & Management of Chemical BurnsSpecific ChemicalsPhenolIndustrial cleanerAlcohol dissolves PhenolIrrigate with copious amounts of waterDry LimeStrong corrosive that reacts wi
62、th waterBrush off dry substanceIrrigate with copious amounts of cool waterPrevents reaction with patient tissuesAssessment & Management of Chemical BurnsSodiumUnstable metalReacts vigorously with waterReleases Extreme heatHydrogen gasIgnitionDecontaminate: Brush off dry chemicalCover the wound with
63、oil substanceAssessment & Management of Chemical BurnsRiot Control AgentsAgentsCS, CN (Mace), Oleoresin, Capsicum (OC, pepper spray)Irritation of the eyes, mucous membranes, and respiratory tract.No permanent damageGeneral Signs & SymptomsCoughing, gagging, and vomitingEye pain, tearing, temporary b
64、lindnessManagementIrrigate eyes with normal salineAssessment & Management of Chemical BurnsH2RadiationDecontamination is paramountTreated like any other burnRadiation InjuryRadiationTransmission of energyNuclear EnergyUltraviolet lightVisible LightHeatSoundX-RaysRadioactive SubstanceEmits ionizing r
65、adiationRadionuclide or RadioisotopeRadiation InjuryBasic PhysicsProtonsProtonsProtonsPositive charged particlesPositive charged particlesPositive charged particlesNeutronsNeutronsNeutronsEqual in mass to protonsEqual in mass to protonsEqual in mass to protonsNo electrical chargeNo electrical charge
66、No electrical chargeElectronsElectronsElectronsMinute electrically charged particlesMinute electrically charged particlesMinute electrically charged particlesWhen emitted from radioactive When emitted from radioactive When emitted from radioactive substances are termed Beta Particlessubstances are t
67、ermed Beta Particlessubstances are termed Beta Particles(continued)Radiation InjuryBasic PhysicsIsotopesIsotopesAtoms with unstable nuclear Atoms with unstable nuclear compositioncompositionIonizing RadiationIonizing RadiationHalf-lifeHalf-lifeTime required for half the nuclei to Time required for h
68、alf the nuclei to lose activity through decaylose activity through decayRadiation InjuryRadioactive SubstancesAlpha ParticlesAlpha ParticlesAlpha ParticlesSlow movingSlow movingSlow movingLow-energyLow-energyLow-energyStopped by Stopped by Stopped by clothing and paperclothing and paperclothing and
69、paperPenetrate a few Penetrate a few Penetrate a few cell layers on skincell layers on skincell layers on skinMinor external Minor external Minor external hazardhazardhazardHARMFUL if HARMFUL if HARMFUL if ingestedingestedingestedBeta ParticlesBeta ParticlesBeta ParticlesSmaller than AlphaSmaller th
70、an AlphaSmaller than AlphaHigher energy than Higher energy than Higher energy than alphaalphaalphaStopped by Stopped by Stopped by aluminum or similar aluminum or similar aluminum or similar materialsmaterialsmaterialsLess local damage Less local damage Less local damage than alphathan alphathan alp
71、haHARMFUL if inhaled HARMFUL if inhaled HARMFUL if inhaled or ingestedor ingestedor ingestedRadiation InjuryRadioactive SubstancesGamma RaysGamma RaysGamma RaysHighly energizedHighly energizedHighly energizedPenetrate deeper than Penetrate deeper than Penetrate deeper than Alpha or BetaAlpha or Beta
72、Alpha or BetaEXTREMELY EXTREMELY EXTREMELY DANGEROUSDANGEROUSDANGEROUSPenetrate thick Penetrate thick Penetrate thick shieldingshieldingshieldingPass entirely thru Pass entirely thru Pass entirely thru clothing, and bodyclothing, and bodyclothing, and bodyExtensive cell damageExtensive cell damageEx
73、tensive cell damageIndirect DamageIndirect DamageIndirect DamageCause internal tissue Cause internal tissue Cause internal tissue to emit Alpha and Beta to emit Alpha and Beta to emit Alpha and Beta particlesparticlesparticlesLEAD SHIELDINGLEAD SHIELDINGLEAD SHIELDINGNeutronsNeutronsNeutronsMost Pen
74、etrating Most Penetrating Most Penetrating than other radiationthan other radiationthan other radiation3-10 times greater 3-10 times greater 3-10 times greater penetration than penetration than penetration than GammaGammaGammaLess internal hazard Less internal hazard Less internal hazard when ingest
75、ed than when ingested than when ingested than Alpha or BetaAlpha or BetaAlpha or BetaDirect tissue Direct tissue Direct tissue damagedamagedamageOnly present in Only present in Only present in Nuclear Reactor Nuclear Reactor Nuclear Reactor CoreCoreCoreRadiation InjuryEffects on BodyGeiger Counter n
76、eeded Geiger Counter needed Geiger Counter needed to detectto detectto detectR/hr: Milliroentgens per R/hr: Milliroentgens per R/hr: Milliroentgens per hourhourhour1,000mR = 1R1,000mR = 1R1,000mR = 1RRADRADRADRadiation absorbed Radiation absorbed Radiation absorbed dose of local tissuedose of local
77、tissuedose of local tissueREMREMREMRoentgen equivalent in Roentgen equivalent in Roentgen equivalent in manmanmanInjury to irradiated part Injury to irradiated part Injury to irradiated part of organismof organismof organismRAD=REM for all RAD=REM for all RAD=REM for all purposespurposespurposesAlte
78、rs bodys cell DNAAlters bodys cell DNAAlters bodys cell DNACumulative damage Cumulative damage Cumulative damage over lifetime exposureover lifetime exposureover lifetime exposureDecreased WBCsDecreased WBCsDecreased WBCsAcuteAcuteAcuteEffects in minutes-Effects in minutes-Effects in minutes-weekswe
79、eksweeksLong-TermLong-TermLong-TermEffects years or Effects years or Effects years or decades laterdecades laterdecades laterRadiation Injury: SafetyClean AccidentExposed to radiationNot contaminated by productsProperly decontaminatedLittle danger to personnelDirty AccidentAssoc with Fire at scene o
80、f rad. AccidentTrained Decon. PersonnelDISTANCESHEILDINGTIMEPark upwindNotify Radiation Response or Haz-Mat Response TeamLook for radioactive placardsMeasure radioactivityDecontaminate patients before careRoutine medical care (ABCs, etc)Radiation InjuryManagementRadiation BurnsNotify Hazardous Mater
81、ials TeamEstablish Safety ZonesHot, Warm, & ColdPersonnel positioned Upwind and UphillUse older rescuers for recoveryDecontaminate ALL rescuers, equipment and patientsAssessment & Management of Radiation BurnsRadiation Injury Whole Body Exposure RAD vs. Body EffectsBurning sensation in minutes, N/V
82、in 10 minConfusion ataxia, Watery Diarrhea in 2 hrs100% Fatal in short time1,000+N/V, Diarrhea in hours100% Fatal within two weeks with Med. Care600-1,000N/V, Diarrhea, Weakness & Fatigue in Hours50% Fatal within 6 weeks without Med Care200-600N/V, Diarrhea, Anxiety, Tachycardia125-200Anorexia, N/V
83、and Fatigue in 2 days75-125Asymptomatic, WBC changes50-75Asymptomatic5-25Effect(RAD)Radiation InjuryLocal Exposure (RAD) vs Local EffectPermanent destruction of exposed tissue50,000Chronic ulcer, risk of cancer5,000Atrophy, vascular lesion, altered pigment2,500Asymptomatic (usually), Altered function of exposed area500Asymptomatic50Effect(RAD)Ongoing assessmentRe-evaluate initial assessmentRe-evaluate all interventionsAssessment & Management of Electrical, Chemical & Radiation Burns
