Burn care - emergent/resuscitative phase Flashcards
Define what the emergent/resuscitative phase of burn care includes?
Care given from onset of injury to completion of resuscitation
What are airway/breathing priorities for emergent burn care?
- secure airway
- provide oxygen
- monitor ABG
- monitor for inhalation injuries
- pt may need intubation/ventilation
What are cardiovascular priorities for emergent burn care?
- vital signs
- EKG
- monitor for hypovolemia
- monitor for K + imbalances due to cell destruction
What are compartment syndrome/edema priorities for emergent burn care?
- check pulses
- cap refill qh
- elevate extremity
What are fluid/electrolyte/renal function priorities for emergent burn care?
- large bore IV’s x 2
- begin fluid resus with LR
- insert catheter
- monitor I/O’s
- assess kidney labs and urine
What are the GI priorities for emergent burn care?
- NPO
- enteral feeding or NGT
- monitor for distension, nausea, coffee ground emesis
What is curlings ulcer?
Condition that may develop due to reduced GI flow and mucosal damage, give PPI’s (-prazoles) or histamine antagonists
What are pain/neuro priorities for emergent burn care?
- IV opioids
- PCA pump
- monitor for mental status changes
What are infection/sepsis/hypothermia priorities for emergent burn care?
- assess white blood cell count
- temperature (95-100 degrees room temp)
- antibiotics
What is fluid shift during emergent stage burn?
Vasoconstriction near burn (blood vessels in burnt skin are blocked), therefore blood flow to skin is reduced, and fluid leaks into interstitial space
What does fluid shift cause (emergent burn phase)?
- leaking of fluid causes hypotension and edema
- vascular dehydration causes hemoconcentration (elevated HCT and HGB)
What is compartment syndrome?
Burn area become taut and distended, impaired perfusion of tissues which compromises viability
What happens to K+ and Na+ during emergent phase of burn?
- injury causes release of K+ (hyperkalemia)
- Na+ becomes trapped in edema fluid and shifts into cells as K+ is released (hyponatremia)
How is electrolyte imbalance managed during emergent burn phase?
- use of ringers lactate to maintain BP >100 and urine output of 30-50mL/h
- monitor serum Na+ during LR administration
How is burn fluid replacement dosed?
Use parkland formula
