![]() Superficial partial-thickness: burns involving the epidermis and superficial portions of the dermis they are painful, red and weeping, usually form blisters, and blanch with pressure.Superficial: burns involving only the epidermal layer of the skin they are painful, dry, red, and blanche with pressure.The traditional classification of burn depth as first, second, third, or fourth degree is being replaced by a system reflecting the future treatment requirements in the continuum of care, although 'fourth degree' is still used to describe the most severe burns. The American Burn Association classifies burns as minor, moderate, and major based upon burn depth and size.Burns to face, hands, feet, genitalia, or joints.> 10% TBSA partial and/or full thickness, age 50.> 20% total body surface area (TBSA) partial and/or full thickness, any age.Trauma Services BC defines a major burn as any of the following:.Critical Care Paramedics should follow Trauma Services BC's Provincial Burn CPG ( available from the Trauma Services BC web site).See J03: Cyanide for additional treatment information. ![]() Fires involving modern building materials, plastics, and furnishings can also produce large amounts of cyanide, and individuals exposed to the smoke from these fires can have significant cyanide exposures. Cyanide salts and hydrogen cyanide are used in electroplating, metallurgy, the production of organic chemicals, photography, plastics manufacturing, the fumigation of ships, and some mining processes. Sodium cyanide and potassium cyanide are both white solids with similar odours in damp air. Hydrogen cyanide is a colourless gas with a faint, bitter, almond-like odor.See J02: Carbon Monoxide for additional treatment information. Provide high-flow supplemental oxygen and monitor SpCO where available. Carbon monoxide poisoning should be suspected in any patient who was in an enclosed space. In any fire environment, carbon monoxide is a by-product of combustion and is one of the many chemical products in smoke.Fluid therapy to manage shock due to blood loss must strike a balance between the patient’s fluid requirements resulting from the burn and the need to prohibit further bleeding from the traumatic injury. Burns are often associated with other types of trauma.For partial thickness or deeper burns, estimate the body surface area involved using the Lund and Browder chart.In the immediate aftermath of a burn, patients should receive up to 2 liters of fluid to maintain a systolic blood pressure > 120 mmHg. If applying burns dressings, the 'shiny side' faces down/towards the patient.Consider utilizing ambulance heater if required. Paramedics and EMRs/FRs should continue to be diligent in monitoring for signs of hypothermia whilst cooling burns patients and avoid whole-body cooling if possible. In patients requiring immediate conveyance, the use of cool saline may be sufficient to help limit the damage caused by the burn. Burns should be cooled with cool (not cold) running water wherever possible, which may involve remaining on scene for over 20 minutes in patients without immediate life-threatening burns or injury, to access a source of cool running water. Cooling is also an important analgesic strategy in these patients. ![]() Cooling of burns immediately following injury is a critical intervention to reduce the risk of skin graft requirements, long-term scarring, chronic pain, and sensory disturbances. This is inclusive of any time bystanders have provided effective cooling measures.
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