MASTER TEACHING NOTES
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Detailed Lesson Plan
Chapter 29
Burns
90–110 minutes
Case Study Discussion
Teaching Tips
Discussion Questions
Class Activities
Media Links
Knowledge Application
Critical Thinking Discussion
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
I.
5
10
Master Teaching Notes
Introduction
Case Study Discussion
A. During this lesson, students will learn about assessment and emergency
care for patients with burn injuries.
B. Case Study
1. Present Dispatch and Upon Arrival information from the chapter.
2. Discuss with students how they would proceed.
II. The Skin: Structure and Function Review
A. Structure
1. The outermost layer, or epidermis, provides a watertight and resilient
barrier from the external environment.
2. The second layer, or dermis, contains small capillary beds and the
sensory structures of the skin.
3. The innermost layer or hypodermis (also knows as the subcutaneous
layer) is composed of fatty connective tissues and contains larger blood
vessels.
4. The layers range in thickness from one cell to several layers of skin.
B. Functions
1. Provides a physical barrier against the environment
2. Provides a barrier against infection
3. Provides protection from bacteria or other harmful agents
4. Insulates and protects underlying structures and bodily organs from
injury
5. Aids in the regulation of body temperature
6. Provides for sensation transmission (hot, cold, pain, touch)
7. Aids in elimination of some bodily wastes
8. Contains fluids necessary to the function of organs and systems
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29

What are the patient management
priorities in this situation?
 Describe how you will proceed with this
patient.
Discussion Question
What are the functions of the skin?
Critical Thinking Discussion
What complications should you anticipate
when a patient sustains injury to a large
area of skin?
PAGE 1
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
5
4
4
4
Content Outline
Master Teaching Notes
III. Airway, Breathing, and Circulation
A. Common causes of death in burn patients in prehospital setting
1. Occluded airway
2. Toxic inhalation
3. Trauma other than the soft-tissue trauma of burn itself
B. EMT priorities
1. Establish and maintain patient airway.
2. Establish and maintain adequate ventilation and oxygenation.
3. Ensure that any life-threatening bleeding has been controlled.
Discussion Questions
IV. Effects of Burns on Body Systems—Circulatory System
A. Extreme fluid loss can cause extreme fluid loss and increased stress on the
heart.
1. Creates edema (swelling) which compromises tissue perfusion
2. Causes burn shock after the first few hours
a. Vascular bed damage allows fluid and protein molecules to leak.
b. Leakage disturbs normal fluid balance of vascular system.
c. Blood plasma begins to seep from all capillary beds.
d. Fluid shifts from vessels into spaces surrounding cell.s
e. Total vascular volume becomes insufficient to meet the body’s
needs.
f. Edema may cause the body to swell to double its normal size.
B. Leads to shock (hypoperfusion)
Discussion Questions
V. Effects of Burns on Body Systems—Respiratory System
A. Swelling of the face or throat may cause airway closure.
B. Inhalation of superheated air may cause the lining of the larynx to swell and
may cause fluid to accumulate in the lungs.
C. Smoke and toxic gas inhalation may cause respiratory arrest, compromise,or
poisoning.
Discussion Question
VI. Effects of Burns on Body Systems—Renal System (Kidneys)
A. Fluid loss from a burn can cause decreased blood flow to the kidneys.
B. Decreases blood flow to the kidneys causes decrease in urinary output.
C. Burn will cause wastes to form in the blood, which may result in kidney
blockage.
D. Kidneys may partially or wholly cease to function.
Discussion Question
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29

What are some of the toxins a burn
patient may have inhaled?
 Under what circumstances are burn
patients prone to other types of trauma?
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How do severe burns affect the
circulatory system?
 How does burn shock develop?
Weblink
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access a web resource
on burn facts.
What are the respiratory complications of
burns?
How do severe burns affect the renal
system?
PAGE 2
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
VII. Effects of Burns on Body Systems—Nervous and Musculoskeletal
4
4
Systems
Knowledge Application
A. Burn injuries
1. Destroy nerve endings in the burn area
2. Cause loss of function to extremities or other body parts
B. Extremity burns
1. Cause loss of function
2. Cause long-term muscle wasting
3. Cause joint dysfunction because of scarring
4. Indirectly cause fear and anxiety
Given a series of scenarios, students
should be able to predict burn-related
complications to other body systems.
VIII. Effects of Burns on Body Systems—Gastrointestinal System
A. Burn causes blood flow to decrease.
B. Blood is rerouted from gastrointestinal system to the rest of the body.
1. Causes nausea or vomiting in many patients with more than ten percent
BSA
2. Can further upset normal chemical balances
3. May lead to ulcers
IX. Assessment and Care of Burns—Classifying Burns by Depth
10
A. Superficial burns (first-degree burns)
1. Involve only the epidermis
2. Usually caused by a flash, hot liquid, or the sun
3. Skin will be red and dry.
4. May result in slight swelling
5. Usually very painful because pain receptors in dermis are still intact
6. Will take several days to heal; epidermis may peel but will not scar.
B. Partial thickness burns (second-degree burns)
1. Involve epidermis and portions of dermis
2. Caused by contact with fire, hot liquids or objects, chemical substances,
or the sun (thermal flame burns, severe scalding)
3. Plasma and tissue fluid collects between layers of skin and forms
blisters
4. Very painful because pain receptors are intact
5. Two classifications: superficial and deep
a. Superficial partial thickness
i. Thin-walled blisters
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
Discussion Questions

How would you recognize a partial
thickness burn?
 Why are patients with severe burns
prone to hypothermia?
PAGE 3
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
ii. Pink, moist skin
iii. Soft, tender skin
b. Deep partial thickness
i. Thick-walled blisters that often rupture
ii. Red and blanched white skin
iii. Sense of pressure at burn site
iv. Poor capillary refill to burn site
v. Intense pain resulting from nerve-ending damage
C. Full thickness burns (third-degree burns)
1. Involves all layers of skin
2. Caused by contact with extreme heat sources: hot liquids or solids,
flame, chemicals, electricity (being trapped in confined space with
flames; being exposed to high heat source or chemicals)
3. Skin becomes hard, dry, tough, leathery.
4. Skin may appear white and waxy to dark brown or black and charred.
5. Dead soft tissue is called an eschar.
6. Not very painful because nerve endings have been destroyed
7. Surrounding areas of partial thickness burns may be intensely painful.
D. Fourth-degree burns (severe full thickness burns)
1. Extend completely through the epidermis and dermis deep into the
tendons, ligaments, muscles, and so on
2. Usually associated with electrical injuries
3. Require extensive skin grafting to allow the burn site to heal
10
X. Assessment and Care of Burns—Determining the Severity of Burn
Injuries
A. Reasons to classify the severity of the burn injury
1. To provide optimal medical care
2. To make the best patient transport decision
3. To report accurately to the receiving facility
B. Factors to consider
1. Burn injury location—Locations where injuries are considered critical
a. Face, eyes, ears—Potential for respiratory compromises
b. Hands and feet—Potential for loss of function
c. Genital or groin region—Potential for loss of function, increased
chance of infection
d. Areas of major joint function (hips, shoulders)—Potential for loss of
joint function
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
Teaching Tip
Use the example of a cooked chicken
breast or a fried egg to describe how a full
thickness burn denatures the proteins of the
tissues so that it cannot be “uncooked” and
will require surgery and grafting.
Knowledge Application
Given a series of scenarios involving
multiple patient variables, students should
be able to determine the severity of burns
and provide appropriate burn treatment.
Weblink
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access a web resource
on Kidshealth’s information about burns.
PAGE 4
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
e. Circumferential burns (those which encircle a body area)—
Circulatory compromise and nerve damage
2. Age and preexisting medical conditions
a. Age
i. Children under five and adults over 55 have less tolerance for
burn injuries.
ii. Because of large skin surface ratio to body mass, children have
the potential for greater fluid loss.
iii. Infants have higher risk for shock (hypoperfusion), airway
difficulties, and hypothermia.
iv. You must consider the possibility of child abuse when a child
has a burn injury.
v. Older adults have a prolonged healing process and possible
underlying medical conditions.
b. Preexisting medical conditions that may increase the severity of a
burn injury
i. Respiratory illness or condition
ii. Cardiovascular problem
iii. Diabetes
3. Body surface area (BSA) percentage
a. Rule of nines—Standard way to quickly determine BSA
b. Regions representing nine percent BSA in adults
i. Head and neck together
ii. Each upper extremity
iii. Chest
iv. Abdomen
v. Upper back
vi. Lower back
vii. Anterior of each lower extremity
viii. Posterior of each lower extremity
ix. Genital region = 1 percent BSA
c. Regions and percentages of BSA for infants under age one
i. Head and neck together—18 percent
ii. Each upper extremity—9 percent
iii. Chest and abdomen—18 percent
iv. Upper and lower back—18 percent
v. Each lower extremity—14 percent
d. For children over age one—for each year beyond one, add 0.5
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
PAGE 5
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
percent to each leg and subtract 1% for the head
e. Rule of ones (rule of palms)—compare burn to surface area of palm
of patient’s hand; X palm surface areas = X% BSA
XI. Assessment and Care of Burns—Types of Burns
10
A. Thermal burns
1. Associated with heat applied to the body
2. Caused by flame, hot water (scalds), steam
3. Severity of burn is related to time of exposure to source, temperature of
heat, and potential for inhalation injury.
4. Scalds in children may be sign of child abuse.
B. Inhalation burns
1. Associated with high-temperature air or steam that is inhaled
2. Inhalation damages mucosa of upper airway
3. Resultant edema may restrict airflow and lead to airway obstruction
4. Possible inhalation of toxic gases (carbon monoxide, cyanide)
C. Chemical burns
1. Produced by acids, alkalis, other heat-generating chemicals
2. Type of chemical, concentration, and duration of exposure determines
severity of burn
D. Electrical burns
1. Result from resistance of electrical current flow in the body
2. Primarily internal
3. May result in cardiac arrest
4. Rarely caused by lightning (see Chapter 24)
E. Radiation burns—caused by absorption of radiation into the body (see
Chapters 43 and 45)
XII. Assessment and Care of Burns—Causes of Burns
10
A. Flame burn
1. Contact with open flame
2. Clothing may ignite, causing further burn injury.
3. Synthetic fibers will melt, causing additional contact burn.
B. Contact burn
1. Contact with hot object
2. Burn is localized to area of contact.
C. Scald
1. Contact with hot liquid: more viscous liquid = more severe burn
2. Intentional scald usually involves entire extremity.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
Discussion Question
What are indications of airway burns and
smoke inhalation?
Weblinks
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access web resources
on household battery burns and fireworks.
PAGE 6
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
3. Accidental scald shows patches of burns caused by splashing.
D. Steam burn
1. Contact with hot steam
2. Often more severe than flame burns
3. Often result of industrial accident or contact with car radiator
4. Can cause thermal burns to distal airways in lungs
E. Gas burn
1. May cause upper airway burns
2. May cause distal airway injury from byproducts of combustion
F. Electrical burn
1. Caused by tissue resistance to electrical energy
2. Results in internal burns
3. May ignite clothing, resulting in flame burn
G. Flash burn
1. Caused by flammable gas or liquid that ignites quickly
2. Areas of the body protected by clothing usually are not burned.
10
XIII. Assessment and Care of Burns—Assessment-Based Approach:
Burns
A. Scene size-up
1. Determine whether the scene is safe to enter.
2. If it is unsafe, wait for properly equipped and trained personnel to
remove the victim.
3. Take appropriate Standard Precautions when entering the scene.
B. Primary assessment
1. Stop the burning with water or saline.
2. Attempt to remove any smoldering clothing or jewelry.
3. Do not remove any clothing adhering to the patient; cut around it.
4. Evaluate patient’s airway, breathing, and mental status.
5. Provide oxygen or positive pressure ventilation if the patient is having
difficulty breathing.
6. Determine whether the patient is a priority for transport.
a. Is patient unresponsive with no gag reflex?
b. Is patient responsive, but not following commands?
c. Is there airway compromise or difficulty breathing?
d. Are there signs of shock or uncontrolled bleeding?
e. Is the patient in severe pain?
C. Secondary assessment
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
Discussion Question
What actions can you take to stop the
burning?
Weblinks
Go to www.bradybooks.com and click on
the mykit link for Prehospital Emergency
Care, 9th edition to access web resources
with an interactive tutorial on burns from the
National Library of Medicine and
information about burn centers.
PAGE 7
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
1. Perform a physical exam.
2. Check for other injuries.
3. Take and record baseline vital signs.
4. Obtain history from patient or family and bystanders.
5. Watch for signs and symptoms of burn depth and inhalation injuries.
D. Emergency medical care
1. Remove the patient from the source of the burn and stop the burning
process.
2. Establish and maintain an airway and breathing.
3. Classify the severity of the burn and transport immediately if critical.
4. Cover the burned area with a dry sterile dressing.
5. Keep the patient warm and treat other injuries as needed.
6. Transport the patient to the appropriate facility.
E. Special considerations for dressing burns
1. Avoid materials that shred or leave particles.
2. Never apply ointments, lotion, or antiseptics to burn injuries.
3. Never break or drain blisters.
4. If hands and/or toes are burned, remove all rings and jewelry and
separate all digits.
5. If eyes are burned, do not attempt to open eyelids.
a. If a thermal burn, apply sterile dressing to BOTH eyes.
b. If a chemical burn, flush with water from medial to lateral side.
F. Reassessment
1. Monitor vital signs and check interventions every five minutes for
unstable patients and every 15 minutes for stable patients.
2. Continually evaluate the airway.
XIV.
5
Discussion Questions

Why should you avoid moist or wet
dressings in burns (with the possible
exception of burns of less than ten
percent BSA)?
 What actions can you take to prevent
hypothermia in a patient with significant
burns?
Assessment and Care of Burns—Chemical Burns
A. Protect yourself first.
1. Never enter an unsafe scene.
2. Wear gloves and eye protection at a minimum.
3. If necessary, wear an impervious (fluid-proof) gown or suit.
B. Brush off dry chemicals before flushing with water.
C. Ensure that the chemical may be diluted with water, then flush.
1. Consult a hazardous materials guidebook.
2. Make sure fluid runs away from the injury.
3. Remove the patient’s clothing and jewelry.
4. Continue to flush while en route to the hospital.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
PAGE 8
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
XV. Assessment and Care of Burns—Electrical Burns
5
A. Never try to remove a patient from an electrical burn source unless you are
trained and equipped to do so.
B. Never touch a patient still in contact with the electrical source.
C. Administer oxygen by nonrebreather mask or positive pressure ventilation.
1. 10–12 per minute for an adult patient
2. 12–20 per minute for an infant or child
D. Monitor the patient for cardiac arrest.
E. Assess the patient for muscle tenderness, twitching, and any seizure activity.
F. Always assess for an entrance and exit burn injury.
G. Transport the patient as soon as possible.
XVI. Assessment and Care of Burns—Summary: Assessment and Care
5
A.
B.
Review possible assessment findings and emergency care for burn injuries.
Review Figures 29-14 and 29-15.
Discussion Question
Why should you consider external burns
“the tip of the iceberg” when managing
patients with electrical burns?
Teaching Tip
Stress the importance of burn prevention.
Critical Thinking Discussion
What are some ways in which EMTs can
help prevent burn injuries in their own
communities?
Class Activity
Give groups of students 15 to 20 minutes to
develop ideas for a burn prevention
program. Each group will report back to the
class.
XVII. Follow-Up
10
Case Study Follow-Up Discussion
A. Answer student questions.
B. Case Study Follow-Up
1. Review the case study from the beginning of the chapter.
2. Remind students of some of the answers that were given to the
discussion questions.
3. Ask students if they would respond the same way after discussing the
chapter material. Follow up with questions to determine why students
would or would not change their answers.
C. Follow-Up Assignments
1. Review Chapter 29 Summary.
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29

What are the indications that the patient
has an inhalation injury?
 What do you predict this patient’s
recovery will be like?
Class Activity
Alternatively, assign each question to a
group of students and give them several
minutes to generate answers to present to
the rest of the class for discussion.
PAGE 9
Chapter 29 objectives can be found in an accompanying folder.
These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines.
Minutes
Content Outline
Master Teaching Notes
2. Complete Chapter 29 In Review questions.
3. Complete Chapter 29 Critical Thinking.
D. Assessments
1. Handouts
2. Chapter 29 quiz
PREHOSPITAL EMERGENCY CARE, 9TH EDITION
DETAILED LESSON PLAN 29
Teaching Tips

Answers to In Review and Critical
Thinking questions are in the appendix
to the Instructor’s Wraparound Edition.
Advise students to review the questions
again as they study the chapter.
 The Instructor’s Resource Package
contains handouts that assess student
learning and reinforce important
information in each chapter. This can be
found under mykit at
www.bradybooks.com.
PAGE 10