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Burns
Objectives







Incidence and patterns of burn injury
Pathophysiology of local and systemic responses
to burn injury
Classify burn
Physical exam of the burned patient
Prehospital management of burned patient
Signs and symptoms of inhalational injury which
may influence management
Criteria for transport to a Burn Center
Incidence and Pattern of Burn
Types





Tissue injury caused by thermal, electrical,
radiation or chemical agents
Burns are another form of trauma
Associated with high mortality, lengthy
rehabilitation.
Greater than 2 million people/yr. seek care for
burns.
Morbidity and Mortality follow significant
patterns regarding gender, age, and
socioeconomic status
Skin
Largest body organ.
 Not a passive organ.

– Protects underlying tissues from injury
– Temperature regulation
– Acts as water tight seal
– Sensory organ

Very young and old have thin skin thus
short contact time = greater damage
when compared to mid aged persons
Skin concerns after burns

Infection

Problems with thermal regulation

Inability to maintain normal water balance
Skin layers

Two layers
– Epidermis
– Dermis

Epidermis
– Outer cells are dead
– Protective barrier and
water tight seal
– Deeper layers contain
pigment to protect against
UV radiation and produce
stratum corneum
Skin Layers

Dermis
– Consists of tough,
elastic tissue which
contains specialized
structures such as hair
follicles, sweat glands,
blood vessels, oil
glands, and nerve
endings
Burns
34-8
Burn Types
• Thermal (exposure to heat)
– Examples: flame, scald, flash
• Chemical
– Examples: acids, alkalis
• Electrical (including lightning)
• Radiation
34-9
Burn Severity
•
•
•
•
•
Depth
Extent
Location
Patient age
Conditions present
before the burn
• Associated factors
34-10
Burn Depth
• Superficial (first-degree)
burn
• Partial-thickness
(second-degree) burn
• Full-thickness (thirddegree) burn
34-11
Depth of burn
Partial thickness
burn =
involves epidermis
Deep partial
thickness =
involves dermis
Full thickness =
involves all of skin
Classification of Burns

First degree /
superficial burnpainful, red, and dry
and blanch with
pressure.
Superficial (First-Degree) Burn
• Involves only epidermis
• Minor tissue damage
• Skin red, tender, very
painful
– No blistering
• Does not usually require
medical care
• Heals in ~2 to 5 days
34-14
Superficial (First-Degree) Burn
34-15
Partial thickness burns
 Sunburn is a very superficial burn.
 Expect blistering and peeling in a few days.
 Maintain hydration orally.
 Heals in 3-6 days- generally no scaring
 Topical creams provide relief.
 No need for antibiotics
Partial-Thickness (Second-Degree) Burn
• Extends through epidermis into dermis
• Intense pain
• Some swelling
• Blistering may be present
• Skin pink, red, or mottled
• Heal in ~5 to 35 days
34-17
Classification of Burns

2nd degree / partial
thickness burncharacterized by
blisters, injury
extends through the
dermis to the
epidermis, basal
layers of skin are not
destroyed
Partial-Thickness (Second-Degree) Burn
34-19
Deeper partial thickness





Blisters are typical of partial thickness burns.
Don’t be in a hurry to break the blisters.
Heals in 14-21 days
Blisters provide biologic dressing and comfort.
Once blisters break, red raw surface will be very painful.
Full-Thickness (Third-Degree) Burn
• Destroys epidermis,
dermis
• Skin color varies
• Looks dry, waxy, or
leathery
• Numb – nerve endings
destroyed
• Rapid fluid loss
34-21
Classification of Burns

3rd degree / full thickness
burns- Entire thickness of
dermis and epidermis is
destroyed. Wound
characterized by
coagulatin necrosis and
appears pearly white,
charred or leathery.
Sensation and cap refill
are absent.
Full-Thickness (Third-Degree) Burn
34-23
Deeper partial thickness





Blisters are typical of partial thickness burns.
Don’t be in a hurry to break the blisters.
Heals in 14-21 days
Blisters provide biologic dressing and comfort.
Once blisters break, red raw surface will be very painful.
Mixed partial and full thickness
 Central yellow area might be full thickness.
 Outer edges are probably partial thickness.
 Initial management is the same.
 Later will need skin grafts for the full thickness
areas.
Zones of Burn Wounds
 Zone of Coagulation
 devitalized, necrotic, white, no
circulation
 Zone of Stasis ‘circulation sluggish’
 may covert to full thickness,
mottled red
 Zone of Hyperemia
 outer rim, good blood flow, red
Wound
excision until
fine punctate
bleeding
occurs
Factors which affect Burn injury
Water content
 Skin thickness
 Skin pigment
 Presence of absence of insulating
substances
 Peripheral circulation

Tissue damage depends on
temperature and time
Surface temperature of 44 C (111 F) begins to
produce burns. But is dependent on exposure
time.
 Temperature >44C and < 51C (124F) the rate of
epidermal necrosis doubles with each degree of
temperature increase.
 At > 70 C (185F) or greater, exposure time
required to cause transepidermal necrosis is less
than 1 second.
 Normal process of water evaporation is
accelerated 5 to 15 time to that of normal skin.

Pathophysiology of Burns
(Local response)


Based on Jackson’s
thermal wound theory
Zone of hyperemia
– Increased blood flow due
to normal inflammatory
response

Zone of stasis
– Potentially viable tissue
– Cells are ischemic due to
clotting and
vasoconstriction

Zone of coagulation
– Coagulation necrosis has
occurred
– Tissue is non viable
Extent of Burn
Key Points
• Only partial-thickness and full-thickness burns are
included when calculating extent of a burn
• Extent of the burned area is important to determine
– The depth of the burn must also be considered, although
superficial burns are not included in the calculation of the
extent of a burn
34-31
Extent of Burn
Rule of Nines
• “Rule of Nines”
– Guide used to estimate body surface area
burned
– Divides adult body into 9%, or multiples of
9%, sections
– Modified for children and infants
34-32
Extent of Burn
Rule of Nines
Body Area
Head and neck
Front of trunk
Back of trunk
Each arm
(shoulder to fingertips)
Each leg (groin to toe)
Genitals
Adult
9%
18%
18%
9%
Child
18%
18%
18%
9%
Infant
18%
18%
18%
9%
18%
1%
13.5% 13.5%
1%
1%
34-33
Extent of Burn
Rule of Nines
34-34
Extent of Burn
Rule of Palms
• “Rule of Palms” can be used for:
– Small or irregularly shaped burns
– Burns scattered over the body
• Palm of patient’s hand equals 1% of patient’s
body surface area
34-35
Burns Best Treated in a Burn Center
• Second-degree burns involving over 10% total body
surface area (TBSA) in adults or 5% TBSA in
children
• Chemical burns
• All burns involving hands, face, eyes, ears, feet, or
genitals
• Circumferential burns of the torso or extremities
• Any third-degree burn in a child
• All inhalation injuries
• Electrical burns, including lightning injury
• All burns complicated by fractures or other trauma
• All burns in high-risk patients including older adults,
the very young, and those with preexisting
conditions such as diabetes, asthma, and epilepsy
34-36
Care of small burns
What can YOU do?
Care for Thermal Burns
• If patient still in area of heat source,
move to safe area
• If clothing is in flames – stop, drop, and
roll
• Remove smoldering clothing and jewelry
– Cut around areas where clothing is
stuck to skin
34-38
Primary Survey
• Stabilize cervical spine if needed
• Was the patient in a confined space and
exposed to smoke, flames, or steam?
– How long was he exposed?
– Did he lose consciousness?
– Were hazardous chemicals involved?
– Be alert for potential airway problems
34-39
Burn injuries
(Primary Survey)
Recall that burn patients are first and
foremost trauma patients
 Circulation
 Airway
 Breathing
 Disability
 Exposure

Airway

Airway control
– Chin lift
– Jaw thrust
– Insert oral pharyngeal
airway
– Assess need for ET
intubation

Maintain in-line
cervical
immobilization in
patients at risk
Breathing
Listen: verify breath sounds
 Assess rate and depth of respirations
 Administer high flow O2
 Monitor chest wall excursion in presence
of full thickness torso burns

Inhalational injury
Present in 10 – 20 % of burn patients
 Identified in 60 – 70 % of patients who
die in burn centers

Inhalation Injury
•
•
•
•
Facial burns
Soot in the nose or mouth
Singed facial or nasal hair
Swelling of lips or inside
mouth
• Coughing
• Inability to swallow
secretions
• Hoarse voice
34-44
Airway assessment and
management
Humidified 100% O2 by mask
 Endotracheal intubation indicated if

– Airway obstruction imminent as signaled by
progressive hoarseness and/or stridor
– LOC is such that airway protective reflexes
are impared
Warning signs/clues
Facial burns, singed nasal hairs
 Carbonaceous sputum
 Tachypnea, intercostal retractions
 Hoarsness
 Agitation (hypoxia)
 Rales, rhonchi, diminished breath sounds
 Inability to swallow
 Naso or oro-pharynx erythema

Circulation
Monitor BP, pulse rate, skin color
 Establish IV access

– If possible, place iv in non-burned skin, but
may place it in burned skin if needed.
– How would you secure IV in burned tissue?

Assess circulatory status of
circumferentially burned extremities
Disability, Neurologic Deficits
Typically alert and oriented. If not, why
not?
 Remember AVPU?

– A-Alert
– V-Responds to verbal stimuli
– P-Responds to painful stimuli
– U-Unresponsive
Disability, Neurologic Deficits

Please remember before you intubate, if
possible, to get any pertinent history
– AMPLE history
– A – Allergies
– M – Medications
– P – Previous medical/surgical history
– L – Last meal (time)
– E – Events/environment surrounding the
injury; ie. Exactly what happened
Exposure/Environmental control
First must remove patient to a safe area
 Stop the burning process

– Exstinguish fire – cool smoldering areas
– Remove ALL clothing and ALL jewelry
– Cut around areas where clothing is stuck to
the skin
– Cool adherent substances (Tar, Plastic)
Exposure/Environmental control
Once patient in safe area
 Maintain patient’s temperature

– Warm room or rig
– Keep patient covered; dry sheets, blankets
– Warm IV fluids
Circumstances of Injury
Circumstances of Injury: Flame

How did it occur?
– Inside or outside?
– Clothing ignition?
– Time to extinguish flame?
– Extinguished how?
– Gasoline or other fuel involved?
– Explosion? Patient thrown?
– Are purported circumstances of injury
consistent with burn characteristics?
Circumstances of Injury: Flame
Structure fire?
 Smoke filled space?
 Others injured or killed in event?
 Was there LOC at the scene?
 How did the patient escape

– Did the patient jump? How far was the drop?
– Through glass?
Circumstances of Injury: Flame
Automobile crash?
 How badly was the car damaged?
 Other injuries?
 Did they hit anybody? Check around,
under the vehicle.
 Car fire?

Circumstances of Injury: Scald

What is the history of the injury?
– What was the liquid?
– What was the volume of liquid involved?
– What was the temperature of the liquid?
 If tap water, what was the heater temperature setting?
 If heated by other source, was the liquid boiling
–
–
–
–
Was the patient wearing clothing?
How quickly was it removed?
Was the burned area cooled?
Was other first aid administered?
Circumstances of Injury: Scald

Is abuse or neglect
suspected?
– How quickly was care
sought?
– Where did the burn
occur?
– Who was with the
patient when the
injury occurred?
– Does the story fit the
injury?
Circumstances of Injury:Chemical
Circumstances of Injury:Chemical
What was the agent?
 Is it still around? Vapor?, Liquid?, Solid?
 How did the exposure occur?
 What was the duration of contact?
 What decontamination occurred?
 Was there an explosion? Was the patient
thrown?
 What is the toxicity of the agent?

Chemical Burns
• Degree of injury is based on:
– Mechanism of action of the chemical
– Strength of the chemical
– Concentration and amount of the chemical
– How long the patient was in contact with the
chemical
– Body part in contact with the chemical
– Extent of tissue penetration
34-60
Care for Chemical Burns
• Scene size-up
– Gloves, eye protection, other PPE as
necessary
– Additional resources may be needed
before you can safely enter the area
34-61
Care for Chemical Burns
• General impression / primary survey
– Manage airway and breathing
– Stabilize cervical spine if needed
– Remove patient’s jewelry
– Remove clothing, including shoes and
socks
34-62
Care for Chemical Burns
• Stop the burning process
– Brush off dry chemicals
• Brush chemical away from the
patient
– Flush the burn with large
amounts of room
temperature water
• Use low pressure
• Flush for at least 20 minutes
• Treat other injuries, if present
34-63
Eye
Chemical Burn
• Most urgent eye injury
• Damage depends on:
– Type and concentration of the chemical
– Length of exposure
– Elapsed time until treatment
34-64
Early Signs of a Chemical Burn
• Pain
• Redness
• Irritation
• Tearing
• Inability to keep
eye open
• A sensation of
“something in my
eye”
• Swelling of the
eyelids
• Blurred vision
34-65
Chemical Burn to the Eye
• Emergency care
– Ask patient to remove contact lenses, if
present
– Immediately flush the eye with water or
normal saline
– Continue flushing for at least 20 minutes
– Flush away from the unaffected eye
34-66
Circumstances of Injury:Electrical
What kind of current was involved?
 What was the duration of contact?
 Was the patient thrown or did the patient
fall?
 What was the estimated voltage?
 Was there LOC?
 Was CPR administered?

Circumstances of Injury:Electrical

The great pretender
– Small surface injuries may be associated with
severe internal injuries
– Causes about 1000 deaths/yr.
Electrical Burns
•
Severity of an electrical injury is related to:
– Amperage (current flow)
– Voltage (current force)
– Type of current (AC/DC)
– Current pathway through the body
– Resistance of tissues to current
– Duration of contact
34-69
Electrical Burns
• Skin normally resists the flow of electric
current into the body
– Electricity entering the body is converted
to heat
– Current follows paths of least resistance
• Blood vessels, nerves, muscles
34-70
Care for Electrical Burns
• Make sure the power is off!
• Contact additional resources if needed
before entering the area
34-71
Care for Electrical Burns
•
Manage ABCs
•
Stabilize cervical
spine if needed
•
Watch closely for
respiratory and
cardiac arrest
–
Make sure an AED
is available
34-72
Care for Electrical Burns
•
•
Treat other injuries if present
Look for entrance and exit wounds
34-73
First contact
After patient in safe area…
 Complete head to toe exam
 Pre-existing medical conditions? Tetnus
status? Other injuries?

Determine Burn Severity
You must assess % of body surface area
(BSA) involved
 Depth of injury (1st, 2nd, or 3rd degree)

– Realize that this is difficult to do as burns may
“mature” over time AND getting an exact
percentage is usually not possible
Age of patient
 Associated / pre-existing disease or illness
 Burns to hands, face, genitalia.

Extent of Burn

Initial estimate of 2nd and
3rd degree burns: “rule of
nines”
– Adult areas = 9% BSA or
multiples
– Not accurate for
infants/children due to
larger BSA of head and
smaller BSA of legs.

To estimate scattered
burns, palm of hands and
fingers of patient = 1%
BSA
Burn Depth
Very young and very old patients have
thinner skin
 Therefore, contact time at similar
temperatures will be worse for them.

Pre-hospital management principles
Stop the burning process
 Universal precautions
 Initiate fluid resusucitation per the consensus
protocol:

–
–
–
–
2 - 4 ml % BSA burn
½ in 1st 8 hrs
½ over next 16 hrs
*this is for adults only, pediatric patients require
consensus formula + D5LR maintenence fluids
Pre-hospital management principles

Vital signs

Assess extremity perfusion
– * remove all rings, watches, other jewelry
– *Elevation of burned areas if possible

Ventilation status

Pain relief/management
Initial Burn Wound Care

Thermal burns
– Cover with clean, DRY cloth
– NO ice or cold water soaks
Initial Burn Wound Care

Electrical Injury
– Be aware of both cutaneous an internal injury
 Entrance and exit points versus contact points
 Arcing wounds vs electrical flash wounds
– Consider electrical current cardiac effects
Initial Burn Wound Care

Chemical burns
– Scene control
– Brush powders from skin and clothes
 Watch shoes and socks
– Remove contaminated clothing
– Flush with COPIUS amounts of water
– Eye irrigation if involved
– Exposure protection for yourselves and
anyone involved with patient care
Burn center referral criteria

The ABA identifies the following as injuries
requiring a Burn Center referral:
– 2nd degree burns > 10% TBSA
– Burns to face, hands, feet, genitalia,
perineum, major Joints
– 3rd degree burns
– Electric injury (lightning included)
– Chemical burns
Burn center referral criteria





Inhalational injuries
Burns accompanied by pre – existing medical
conditions
Burns accompanied by trauma, where burn
injury poses greatest risk of morbidity or
mortality
Burns to children in hospitals without pediatric
services
Patients with special social, emotional or
rehabilitative needs
Summary
Be able to assess injuries
 Be able to develop priority – based plan of
care
 Base care plan on type, extent, degree of
burn
 Consult with a burn center physician
 Decide upon local treatment and transport
with burn center physician

Physical Examination
• Check pulses in all extremities
– Circumferential burn can act as a
tourniquet
• After all immediate life-threats have been
managed, care for the burn itself
34-86
Physical Examination
•
•
•
•
Quickly determine burn severity
Vital signs
Medical history
Questions related to the burn:
– How long ago did the burn occur?
– How did it occur?
– What was done to treat the burn before
you arrived?
34-87
Treat the Burn
• Cool the burn with cold water
• Cover burned area with a dry dressing or sheet
• Keep patient warm
– Cover with clean, dry sheets
• Remove all jewelry
• Look for other injuries
– Treat and immobilize possible fractures
– Treat soft-tissue injuries if present
– Treat shock if present
• Keep burned extremities elevated above the heart
• Transport to closest appropriate facility
34-88
Treat the Burn
• Do not apply ice, butter, oils, sprays, lotions,
or ointments to a burn
• If a blister has formed, do not break it
– Loosely cover the blister with a sterile
dressing
• Do not place ice or wet sheets on a burn
• Do not transport a burn patient on wet
sheets, wet towels, or wet clothing
34-89
Infant / Child Considerations
• Larger BSA than adults in relation to total
body size
– Greater fluid and heat loss
• More likely to develop shock or airway
problems than adults
• Consider possibility of abuse when treating a
burned child
• Report all suspected cases of abuse to
appropriate authorities
34-90
Care of small burns
 Clean entire limb with
soap and water (also under nails).
 Apply antibiotic cream
(no PO or IV antibiotic).
 Dress limb in position of function,
and elevate it.
 No hurry to remove blisters unless infection occurs.
 Give pain meds as needed (PO, IM, or IV)
 Rinse daily in clean water; in shower is very practical.
 Gently wipe off with clean gauze.
Blisters
 In the pre-hospital setting, there is no
hurry to remove blisters.
 Leaving the blister intact initially is less
painful and requires fewer dressing
changes.
 The blister will either break on its own,
or the fluid will be resorbed.
Blisters break on their own
Upper arm burn day 1
day 2
Burn “looks worse” the next day because of
blisters breaking and oozing
Upper arm
burn
121
 Blisters show probable partial thickness burn.
 Area without blister might be deeper partial
thickness.
Debride blister using simple instruments
Medic debriding blister
After debridement
Before and after debridement
 Removing the blister leaves a weeping, very
tender wound, that requires much care.
Silver sulfadiazene
Arm burn 4 days
Arm burn 7 days – note the exudate
Foot burn
debridement
Before debriding
and applying
cream,
clean entire foot
(including
toes and nails).
Silver- impregnated dressings
(Silverlon)
 Apply wet silver dressing
directly on the burn.
 Creams or dressings
under the silver dressing
impede the antimicrobial action.
 Keep it moist!
 Remove it, rinse it out, replace it on the
burn.
Steps in using silver-impregnated
dressings
 Clean the burn and surrounding area.
 Soak silver-impregnated dressing and gauze in
STERILE WATER or BOTTLED DRINKING
WATER
 Apply silver-impregnated dressing
(over-lapping edges are best).
 Wrap with the moist gauze.
 Secure with mesh, gauze, or tape.
 Keep it moist with WATER, every 12h or so
More frequent in hot arid environments
pics
Soak silver dressings and gauze
in WATER (not saline).
Apply the
silver dressing.
Wrap with moist gauze.
Secure with mesh, gauze, or tape.
First few days
 Moisten dressing with WATER every 12h or
so.
 Remove outer gauze and silver dressing every
day.
Inspect the burn.
Rinse exudate off burn.
 Rinse exudate off silver dressing with WATER.
 Return same silver dressing to the burn.
 Apply new outer gauze moistened with
WATER.
pics
Moisten well
to remove it each day.
Rinse it out, and put it
back on the burn.
Moisten with WATER
q12h or so.
After several days
 Replace silver dressing
every 2 - 5 days
depending on amount of exudate,
cellular debris
 First wet the silver dressing before removing
it.
 Don’t pull on it if it’s stuck – moisten it more.
 Apply new moist silver dressing and gauze.
QUESTIONS ABOUT
SMALL BURNS?
SUMMARY
 Describe the differences between partial and
full-thickness burns.
 Describe how to estimate the size of a burn.
 Describe initial care of small burns.
 Describe follow-up and post-burn care.
NEXT TOPIC - BURNS OF SPECIAL AREAS
Burns of special areas
of the body





Face
Mouth
Neck
Hands and feet
Genitalia
Face
 Be VERY concerned for the airway!!
 Eyelids, lips and ears often swell
alarmingly.
 In fact, they look even worse the next day.
 But they will start to improve daily after
that.
 Cleanse eyes with warm water or saline.
 Apply antibiotic ointment or liquid tears
until lids are no longer swollen shut.
 Bacitracin cream/ointment will serve
Hands and feet
This is rather deep
and might require
grafting.
But initial
management is basic.
Dressings should not impede
circulation.
Leave tips of fingers exposed.
Keep limb elevated.
Hands and feet
 Fingers might develop
contractures if active
measures are not taken
to prevent them.
Infant / Child Considerations
34-114
Older Adult Considerations
•
Mechanisms and severity of burn injury related to:
–
Living alone
–
Wearing loose-fitting clothing while cooking
–
Falling asleep while smoking
–
Declining vision, hearing, and sense of smell
–
Slowed reaction time
–
Problems with balance and/or memory
34-115
Escharotomy
 Eschar = burned skin
 Escharotomy = cut burned skin to
relieve underlying pressure
 Similar to bivalving a tight cast.
 Cut along inside and outside of
limb from good skin to good skin
 Knife can be used, or cautery.
 Use local or no anesthesia.
(Full-thickness burn should have
no sensation, but underlying
tissues do!)
Escharotomy of forearm
 Incise along medial
and/or lateral
surfaces.
 Avoid bony
prominences.
 Avoid tendons,
nerves, major
vessels.
Escharotomy
 Patient had escharotomy of
both legs.
 Incisions will heal.
 They will not be closed by
DPC.
 These large burns are often
treated by the “open”
technique,
that is, without dressings.
Electrical burn
 Outer skin might
not appear too bad.
 But heat was conducted
along the bone.
 Causes the most damage.
 Burns from inside out.
 Usually requires fasciotomy
Fasciotomy





Fascia = thick white covering of muscles.
Fasciotomy = fascia is incised (and often overlying skin)
Skin and fascia split open due to underlying swelling.
Blood flow to distal limb is improved.
Muscle can be inspected for viability.
Dressing and Bandaging
34-121
Dressing and Bandaging
• Dressing
– Absorbent material placed directly over a
wound
• Bandage
– Used to secure a dressing in place
34-122
Dressing and Bandaging
• Functions of dressing and bandaging
wounds:
– Help stop bleeding
– Absorb blood and other drainage from the
wound
– Protect wound from further injury
– Reduce contamination and risk of infection
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Dressings
• A dressing should be:
– Lint free
– Large enough to cover the wound
• Should extend beyond wound edges
– Sterile whenever possible
– Applied directly over the wound
• Do not slide it in place
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Types of Dressings
34-125
Sterile Gauze Pads
• Loosely woven material
• Classified by size in inches
–2x2
–4x4
34-126
Trauma Dressing
• Thick dressing
• Various sizes
• Two layers of gauze
with absorbent cotton
in center
• Uses
– Large wounds
– Pad injured limb
inside a splint
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Occlusive Dressing
• Made of nonporous material
• Used to cover open wound and make
airtight seal
– Chest wound
– Neck wound
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Nonadherent Pads
• Gauze pads with special coating
• Used to cover leaking open wound but not
stick to it
34-129
Eye Pads
• Uses:
– Cover eyes after minor eye injury
– Cover small wound, such as a puncture
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Bandages
34-131
Bandages
• Applied to keep a dressing in place
• Does not have to be sterile
• Before applying to an extremity:
– Remove patient’s jewelry
– Check pulse distal to the wound
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Roller Gauze (Kling)
•
Secures dressing in place
– 1-inch roll for fingers
– 2-inch roll for wrists, hands, feet
– 3-inch roll for elbows, upper arms
– 4- to 6-inch roll for ankles, knees, legs
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Roller Bandage
•
•
Soft, slightly elastic material
Available in various widths
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Elastic Bandage
• Do not use to secure a dressing in place
• May act as a tourniquet if injured area swells
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Triangular Bandage
• Large piece of muslin
• When folded, can be used as a
bandage or sling
34-136
Self-Adherent Wrap
• Elastic wrap coated with self-adhering
material
• Often used as a pressure bandage
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Pressure Bandage
• Applied over a wound site to control
bleeding
• Cover the wound with a dressing
• Apply direct pressure until the bleeding is
controlled
• Secure the dressing in place with a bandage
• Assess the pulse distal to a bandage
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Applying a Roller Bandage
34-139
Applying a Roller Bandage
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Applying a Roller Bandage
34-141
Applying a Roller Bandage
34-142
Head or Ear Bandage
34-143
Upper Arm Bandage
34-144
Elbow Bandage
34-145
Wrist or Forearm Bandage
34-146
Knee Bandage
34-147
Foot or Ankle Bandage
34-148
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