12b burns 1 Flashcards
Management of burn injury
- Initial evaluation and resuscitation
- Initial wound excision and biological closure
- Definitive wound closure
- Rehabilitation and reconstruction.
Initial Evaluation
▪ Prevent danger / injury to rescuer
▪ Stop ongoing injury: extinguish flames, cool the burn, irrigate chemical
burns
▪ ABCs: Establish airway, breathing and circulation
▪ Start oxygen and large-bore IVs
▪ Remove clothes/restrictive objects/jewellery and cover the wound
▪ Do assessment surveying all body systems and obtain a history of the
incident and pertinent patient history
▪ Note: treat patient with falls and electrical injuries as for potential
cervical spine injury
Resuscitation burns
▪ Patient is stabilised and condition is continually monitored (HR, BP, RR & Temp and SpO2)
▪ Patients with electrical burns should have ECG
▪ EUC, FBC, Coags, Amylase & Carboxyhaemoglobin
▪ 2 x large bore IVC through unburned tissue (on scene if possible)
▪ Patient is transported to Emergency Department
▪ Fluid resuscitation including strict Fluid Balance monitoring- ID Foley urinary catheter
is inserted
▪ Patient with burns exceeding 20–25% should have an NG inserted and placed to suction
▪ Address pain; only IV medication should be administered
Management of shock burn
▪ Maintain blood pressure of greater than
100 mmHg systolic and urine output of
30–50mL/hr, maintain serum sodium at
near-normal levels
fluid resuscitation burn
Parkland Baxter formula
Parkland Baxter formula
▪ Adult: 3-4mL / kg / % burn in 24 hours ▪ 50% of volume in first 8 hours from time of burn ▪ Remaining 50% of volume over next 16 hours
What happens: Fluid and electrolyte shift with burn
▪ Generalised dehydration
▪ Reduced blood volume and haemoconcentration
▪ Decreased urine output
▪ Trauma causes release of potassium into extracellular fluid:
hyperkalaemia
▪ Sodium traps in oedema fluid and shifts into cells as potassium is
released: hyponatraemia
▪ Metabolic acidosis
With fluid resuscitation burn
▪ Fluid re-enters the vascular space from the interstitial space
▪ Haemodilution
▪ Increased urinary output
▪ Sodium is lost with diuresis and due to dilution as fluid enters
vascular space: hyponatraemia
▪ Potassium shifts from extracellular fluid into cells: potential
hypokalaemia
▪ Metabolic acidosis
Pain management burn
▪ Analgesics – IV use during emergent and acute phases – Morphine – Fentanyl – Other ▪ Role of anxiety in pain ▪ Effect of sleep derivation on pain ▪ Non-pharmacological measures
Wound Care
▪ Wound cleaning – Hydrotherapy ▪ Use of topical agents ▪ Wound debridement ▪ Wound dressing, dressing changes and skin grafting
Wound debridement burns
– Natural debridement (slouging off)
– Mechanical debridement (sterile scissors)
– Surgical debridement
– Chemical debridement – solutions that remove dead
cells
Nutritional support
▪ Burn injuries produce profound metabolic abnormalities, and patient
with burns have great nutritional needs related to stress response,
hypermetabolism and requirement for wound healing
▪ Goal of nutritional support is to promote a state of nitrogen balance
and match nutrient utilisation
▪ Nutritional support is based upon patient preburn status and % of
TBSA burned
▪ Enteral route is preferred. Jejunal feedings are frequently utilised to
maintain nutritional status with lower risk of aspiration in a patient
with poor appetite, weakness or other problems
Other nursing management issues to consider burns
▪ Respiratory function
▪ Temperature regulation
▪ Restoration of function
▪ Management of anxiety / Psychological support of patient
and family including patient and family education
Potential complications burns
▪ Excessive fluid volume ▪ Risk of infection ▪ Imbalanced nutrition ▪ Acute pain ▪ Impaired physical mobility ▪ Ineffective coping ▪ Interrupted family processes ▪ Deficient knowledge 13 ▪ Acute respiratory failure ▪ Distributive shock ▪ Acute renal failure ▪ Compartment syndrome ▪ Paralytic ileus ▪ Heart failure and pulmonary oedema ▪ Sepsis ▪ Visceral damage (electrical burns)
