Burn Injury Treatment-Resuscitation, acute care, and rehab Flashcards
What are the 3 phases?
- Resuscitation Phase
- Acute Care
- Rehab
Resuscitation
What are the top 2 things that happen here?
Aggressive fluid replacement
Manage pain
Resuscitation-Aggressive fluid replacement
How is the body in the first 24-36 hours?
Body can’t absorb nutrients yet due to leaky capillaries
Resuscitation-Fluid replacement
What is the tx here (4)?
- Give LR or crystalloids (saline)
- Have large bore IV away from burn area (central line preferred)
- UOP needs to be 0.5-1 mg/kg/hr
- SBP needs to be over 90
Resuscitation-Fluid replacement
What fluid is given after 36 hr?
Add in colloids like albumin, plasma, and hespan
Resuscitation-Manage pain
What drug?
IV narcotics
Resuscitation-Manage pain
T/F: Giving IM and SQ injections are absorbed quick
No–Dont give IM or SQ due to fluid shifts
Resuscitation-Manage pain
Cant give IM or SQ injections except for what?
May need the tetanus vaccine; only exception to the injection rule
Resuscitation-Manage pain
Why can’t we give PO meds?
Due to delayed gastric motility
Acute care
What are the top 3 priorities here?
- Prevent infection
- Nutrition after a burn
- Pain
Acute care-Prevent infection
How do we prevent?
Monitor signs of infection
Prevent:
- Strict hand washing
- Protective isolation
- Gown, glove, mask
- Protect wound from infection
- Topical antimicrobial
- Wound care
- Good nutrition is key to lowering infection rates
Acute care-Nutrition after a burn
What is BMR like?
Increased 40-100%
Acute care-Nutrition after a burn
What is the preferred route of feeding?
Oral/enteral
- several small meals per day
- TPN if slow GI motility
Acute care-Nutrition after a burn
How much protein needed?
2-4x normal amount
Acute care-Nutrition after a burn
How many calories needed a day?
8000 kcal/d
Acute care-Nutrition after a burn
T/F: need a vitamin supplement
T
Acute care-Pain
What are the best drugs to manage pain?
NO IM OR SQ!!!
- Morphine sulfate
- fentanyl
Acute care-Pain
Why would we give a benzo?
For anxiety
Rehabilitation
What are the 3 main goals?
- Prevent contractors
- Prevent scarring
- Get pt. to pre-burn state
Rehab-Prevent contractures
What position?
Fowlers without a pillow
Rehab-Prevent contractures
What happens to affected extremity?
Elevation and extension
Anti-deformity positions
Rehab-Prevent contractures
What kind of exercise?
ROM
Rehab-Prevent scarring
How is this done and for how long?
JOBST garmet
wear for 1 year to decrease contractures and prevent scarring
What is purpose of JOBST garment?
- To decrease contractures
- Prevent scaring
Rehab- Get patient to what state?
Pre-burn state
