Acute care and treatment of Burns Flashcards
prevention of burns/fires
⬤ Don’t throw anything other than wood in a fire, don’t leave a fire unattended, avoid accelerant’s (gasoline, kerosene, aerosol spray)
⬤Frostbite - Pay attention to weather forecasts.
Dress in several layers of loose warm clothing.
Wear hats that fully cover the ears, warm boots, & mittens. Drink plenty of warm fluids but avoid alcohol & caffeine. Avoid or limit outdoor activities when the temperature nears or dips below 5°F (-15°C). (CDC 2013). Take frequent breaks indoors from the cold.
⬤ Be fully alert when cooking, turn all handles inwards away from little hands
⬤ Always wipe the stove, oven, exhaust fan to prevent grease buildup
⬤ If food catches on fire starts cover it with a lid DO NOT touch until it has completely cooled, turn heat off with an oven glove on, never use water to stop a kitchen fire
⬤ IF AT ANY POINT the fire gets out of control, leave the area with all other loved ones
⬤ Set water temp to no higher than 120 F, ALWAYS feel the water with hand before going into water or placing child in the water, if its to hot for you its too hot for them!
types of burn injuries
Thermal burns - heat touches and burns
Chemical burns - hydrochloric acid and gasoline (industrial workers)
Smoke inhalation burn - breathing in smoke - burns airway (high mortality)
Electrical burns - wires - electricity travels through nerve endings
Cold thermal injury - refigerator worker
Radiation burns -
Patient B, 35 yr old, homeless, Male, comes into
the emergency department with a burn inflicted
after taking an illicit drug falling on top of a fire and
falling asleep on it.
What type of burn is this?
thermal burn
Classification of Burn Injury
We have to determine the severity of the burn….
Things we are looking at include….
Depth, extensity, location, preexisting conditions, alcohol and drug use, concurrent trauma
cross section of skin
lund brower chart
quick TBSA assessment
Lund Brower chart
extent of burn
can worsen by day
depth of burns
- Superficial burn (1st) - epidermis - sunburn - blanching
- Superficial Partial-thickness burn (2nd) - dermis - blister and blanching
- Deep partial thickness burn (2nd converting) - 3rd day calculation
- Full-thickness burn (3rd) - white, leathery, charcoal - fat, muscle and bone
- 4th is down to the bone
Patient B arrives to the tank room in the burn unit, upon
arrival he is intubated and already started on a sedative
(propofol) and analgesic drip (fentanyl), he is to be
debrided immediately along with a quick ABC
assessment of the patient. His skin is not blanching and
is dry, leathery, and brown.
What degree burn would he have?
After debridement we calculate his Lund Brower chart at
a 77% TBSA burn
What are some things we should be assessing for?
3rd degree burn
Nerve pain
Have to regrow pain receptors
Smoke inhalation, ETT tube, pulse ox above 92%, ABGs, capillary refill, Hypovolemic shock
what is an escharotomy
In order to avoid compartment syndrome Pt B
received bilateral escharotomies on all peripheral
extremities due to increased edema
phases of burn management
- Emergent (resuscitative)
- Acute (wound healing)
- Rehabilitative (restorative)
main concerns of emergent phases
72 hours
Hypovolemic shock
Hypoxia
Edema (pulmonary or tissues)
Emergent Phase Pathophysiology
Greatest threat is hypovolemic shock
- Occurs rapidly, caused by a massive shift of fluids out of blood vessels because of increased capillary permeability
Fluid and electrolyte shifts
- K+
- Na+
- Magnesium/Phosphorus
Inflammation, healing and Immunologic changes
Immune system is challenged when burn injury occurs
Burn patients always receive a tetanus vaccine
parkland formula
For fluid resuscitation most hospitals utilize the
parkland formula which is
4ml x TBSA % x Weight in Kg
Most times we use LR
may use plasmalyte, albumin, and plasma for volume replenishment
We get a TBSA % and their weight we begin fluid
resuscitation on Patient B…LR is started immediately, a foley is placed to monitor urine output. Along with an Aline and central line to give adequate IV access. We see this A-line pressure in red….
What is this patient experiencing and what type of shock is going on?
Hypovolemic shock
Pt B has their first ABG come back reading at
- Arterial pH - 7.20
- CO2 - 68
- O2 - 105
- HCO3 (bicarb) - 14
- Carboxyhemoglobin level within normal range
Their BMP comes back with some abnormal values
their K at - 6.3, Mag at 1.8, Na 129 and Phosphorus
at normal levels
What do these lab results indicate about Pt B?
respiratory acidosis
emergent phase complications
So we have addressed burn shock and
edema now onto hypoxia….
Respiratory system
- Assess for pulmonary edema, etc
Cardiovascular system
- Dysrhythmias and hypovolemic shock
- Impaired microcirculation and increased viscosity
results in sludge
- Venous thromboembolism (VTE)
Urinary system
- Acute tubular necrosis (ATN)
