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Critical Care > Burn Unit > Flashcards

Burn Unit Flashcards

1
Q

integumentary system fxn

A
  1. protect from infection
  2. prevent loss of body fluid
  3. thermoregulation
  4. produce vit D
  5. excretion
  6. identify / appearance
  7. sensation reception
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2
Q

burn injury patho

A

-increase infection risk
-massive fluid loss
-unable to regulate temp
-decrease vit D
-decrease ability to sweat
-change in self image
-nerve damage

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3
Q

these burns have more intense pain….

A

partial thickness burns r/t exposed nerve endings

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4
Q

these burns still have pain but not as much…

A

full thickness since nerve endings are destroyed, will still have tingling

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5
Q

elderly are more susceptible to burns…

A

skin thins –> deeper burns, poor healing

-decreased sensation
-reduced reaction time

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6
Q

thermal injury

A

skin damaged by heat
1. flame
2. scalding liquids
3. heat source

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7
Q

severity of thermal burn…

A

determined by…
1. duration of contact
2. temperature of agent
3. amount of tissue exposed
4. age of pt

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8
Q

children are more at risk for burns…

A

unaware of risk
unable to protect themselves

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9
Q

chemical injury types

A
  1. contact - skin
  2. fume inhalation - chlorine
  3. ingestion / injection
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10
Q

chemical injury

A

must be COMPLETELY removed / neutralized
-MSDS on units
-list every chemical on units

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11
Q

alkalis chemical injury

A

deeper tissue damage , liquefy proteins on skin allowing deeper spread

ex : oven cleaners / drain cleaners

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12
Q

acid chemical injury

A

coagulate the skin and proteins, LIMITING depth of damage

ex: bathroom cleaner, swimming pool cleaner

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13
Q

organic chemical injury

A

fat soluble and absorbed causing damage to kidney / liver

ex: chemical disinfectants and gasoline

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14
Q

chemical injury management

A

FLUSH with copious amounts of water

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15
Q

consideration for dry chemical burn…

A

BRUSH IT OFF, flushing with water will activate the chemical burn process

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16
Q

electrical injury

A

direct contact with electric source, WILL be an entry and exit point!!!

-has internal damage, extensive muscle damage, organs ischemic and necrotic

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17
Q

cardiac electrical injury

A

EKG changes and heart damage common, related to release of potassium!!!

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18
Q

musculoskeletal electrical inury

A

tetany and spasms –> fractures or compartment syndrome

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19
Q

renal electrical injury

A

myoglobin release (damaged muscle tissue), circulated to kidneys

-rhabdomyosis
**cola colored urine

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20
Q

important thermal questions…

A

WHEN was pt pulled from fire (heat source)
enclosed space??
pre-existing medical hx

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21
Q

PRIORITY assessment for thermal injury

A

AIRWAY, could have soot in airway, hoarse voice, wheezing

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22
Q

radiation injury

A
  1. ionizing radiation in industry
  2. nuclear accidents
  3. therapeutic radiation : chemo

**most frequent = SUNBURN

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23
Q

radiation injury presents with…

A

redness, edema, blistering, pain

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24
Q

burn injury severity

A
  1. type
  2. depth , extent , body part burned
  3. additional injury
  4. pt age
  5. pre-existing health

-major
-moderate
-minor

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25
Q

major burns

A
  1. adult w/ >25 % total body surface area partial thickness burn
  2. > 10% TBSA full thickness burn
  3. burns of hands, feet, face, ears, perineum
  4. inhalation
  5. electrical
  6. burn w/ fracture or trauma
  7. high risk pt
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26
Q

moderate burns

A

adult w/ 15-25% TBSA partial thickness

< 10% TBSA full thickness

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27
Q

burn center pt criteria

A

deep partial thickness 15-25% TBSA
full thickness > 2% TBSA
burn to face, hands, feet, genitalia, joint, perineum
chemical / electrical
inhalation
co-morbidities
associated trauma

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28
Q

superficial burn (1st degree)

A

3 P’s : pink , puffy , painful

cause : flame , SUNBURN , flash from explosion

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29
Q

partial thickness (2nd degree)

A

superficial partial thickness
deep partial thickness

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30
Q

superficial partial thickness

A

epidermis and limited portion of dermis
-blisters, bullae, serous fluid
-painful w/ sensation intact and edematous

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31
Q

superficial partial thickness cause

A

flame , scald , flash , contact

**heals 10-21 days

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32
Q

deep partial thickness

A

epidermis and most of dermis
-blisters, bullae, serous fluid
-pale ivory, waxy, moist appearance!!!
-painful w/ sensation intact and edematous

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33
Q

deep partial thickness causes

A

flame , scald, flash , contact

**heal 3-6 weeks

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34
Q

full thickness burns (3-4th degree)

A

destruction of entire epidermis and dermis , skin does NOT regrow

-down past fat, fascia, muscle, bone

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35
Q

full thickness burn pain

A

possibly w/ 3rd degree
MINOR in 4th degree, around edges

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36
Q

full thickness burn appearance

A

dried leathery eschar
white / yellow / brown with thrombosed vessels
loss of elasticity
marked edema

**needs grafting

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37
Q

full thickness treatments

A

amputation
fasciotomy
escharotomy

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38
Q

full thickness burn causes

A

flame
chemicals
high voltage

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39
Q

why is there less pain with full thickness burns….

A

nerve endings are damaged / destroyed

**will be pain around edges where it is only partial thickness

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40
Q

resuscitative phase

A

first 48 hrs until diuresis… starts pre-hospital

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41
Q

resuscitative phase goals

A
  1. AIRWAY secure
  2. circulation –> fluids!!!
  3. prevent infection
  4. body temp
  5. emotional support
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42
Q

resuscitative phase pre-hospital

A
  1. REMOVE source of thermal damage
  2. ABCs / cervical spine
  3. O2 100% , maybe intubate
  4. circulation assessment
  5. remove clothing / jewelry
  6. trauma assessment
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43
Q

pre-hospital interventions

A
  1. cover to prevent hypothermia –> use CLEAN DRY SHEET with > 20% TBSA
  2. large bore IV and FLUID
  3. pain management
  4. vitals , baseline assessment
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44
Q

ED resuscitative interventions

A
  1. AIRWAY , c-spine evaluation
  2. circulation –> escharotomy or fasciotomy
  3. calculate fluid requirement : pre-burn wt.
  4. pain management
  5. tetanus administration
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45
Q

why is it important to start an IV immediately….

A

once fluid shift begins it may be impossible to locate a vein

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46
Q

why should we use IV narcotics….

A

altered absorption via muscle and stomach

-IM / sub-q they will remain in tissue space and will be absorbed rapidly once fluid shift is resolved

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47
Q

what is the preferred pain med for burns…

A

MORPHINE!!!

**dilaudid if allergic to morphine

48
Q

factors determining airway obstruction…

A
  1. pts injured in closed space
  2. pts with extensive burns or burns of face
  3. intra-oral charcoal esp on teeth / gums
  4. pts unconscious at time of injury
  5. singed hair, nails, eyelids, eyelashes
  6. coughing up carbonaceous sputum
  7. voice hoarseness / brassy cough
  8. accessory muscle use / stridor
  9. edema, erythema, ulceration of mucosa
  10. wheezing , bronchospasm
49
Q

inhalation injuries are more likely to have….

A

rapid obstruction within a short time, wheezing sounds will DISAPPEAR , this demands immediate intubation

50
Q

inhalation injury resuscitative phase

A
  1. carbon monoxide is the leading cause of death from a fire
  2. injuries above glottis
  3. injuries below glottis
51
Q

carbon monoxide poisoning

A

“cherry red” color from vasodilating, confusion, dizziness, headache, n/v

52
Q

carbon monoxide poisoning tx

A

100% oxygen for at least 2 hrs or hyperbaric chamber

53
Q

injuries above glottis

A

upper airway obstruction, common in head / neck burns and smoke inhalation

-edema will worsen with fluid resuscitation , tissues rehydrate then swell from capillary leak

54
Q

injuries above glottis intervention…

A

early intubation since edema can occur within minutes to hours

55
Q

injuries below glottis

A

the lungs!!!
-pts may be asymptomatic for 48 hrs
-have normal CXR and ABGs
-occurs with dry heat injury as well

56
Q

inhalation injury 3 major points…

A
  1. pulmonary edema = elevate HOB, humidified O2, call rapid
  2. early intubation
  3. CONSTANT monitoring
57
Q

cardiac resuscitative phase

A

-cardiac rhythm = electrical has heart damage
-hypovolemic shock

58
Q

fluid / electrolyte complications

A
  1. dehydration
  2. reduced blood volume
  3. decreased UO
  4. hyperkalemia
  5. metabolic acidosis
59
Q

elevated hematocrit….

A

blood is very viscous, could be sign of dehydration

60
Q

third spacing

A

fluid shifts into extravascular space
-burns >20% TBSA have edema on burned area and unburned areas

61
Q

when does maximum edema occur after burns…

A

24-48 hours post burn

62
Q

kidney resuscitative phase

A

decreased kidney bloodflow –> acute kidney injury

-myoglobin is released from damaged muscles circulating to kidney

-will have decreased UO

63
Q

urine output goal for burn pts…

A

30-50 mL / hr , pts will get foley for strict i/o every hour

64
Q

GI resuscitative phase

A

ischemia r/t redistribution of blood to brain and heart

-PARALYTIC ILEUS, check bowel sounds
-H-2 blockers and PPI to reduce ulcers
-NEED BM or gas to check that GI system is working

65
Q

metabolic resuscitative phase

A

increased metabolic state for up to 9-12 months post burn, increased body temp = increased metabolism

66
Q

nonsurgical resuscitative mgmt

A
  1. FLUIDS
  2. pain management w/ narcotics
67
Q

fluid management

A

based on % TBSA
-used for pts with > 20% TBSA burns

68
Q

fluid administration times

A
  1. half of fluid first 8 hrs from time of injury
  2. second half over next 16 hours from time of injury

**all fluids need to be given within first 24 hours

**fluid overload risk, especially if they have CHF

69
Q

fluid administration formula

A

4mL x kg x TBSA

70
Q

what to hold 8-12 hours post burn on fluid management…

A

colloids
-blood
-albumin
-hetastarch
-plasma protein fraction
-dextran

71
Q

albumin

A

pulls fluid back into the vascular space

72
Q

electrical burn fluid mgmt

A

HIGHER fluid volume
-urine output needs to be 75-100 mL/hr

**myoglobin is released –> AKI

73
Q

escharotomy

A

used in full thickness and circumferential burns

-loss of circulation
-loss of movement
-relieves pressure
-monitor distal pulses!!!!

74
Q

fasciotomy

A

seen w/ electrical burns
-used to relieve compartment syndrome

75
Q

acute phase

A

begins 48-72 hrs post burn

76
Q

acute phase respiratory

A
  1. CXR
  2. fever
  3. WBC count
77
Q

acute phase cardiac

A

monitor weight
monitor i/o
-urine output is the best indiacor of intravascular fluid status

78
Q

acute phase GI

A

can start tube feeds if there is bowel function

-monitor for ulcers
-will need high calories, high protein

79
Q

acute phase skin

A

INFECTION IS #1 killer in this phase

-maintain joint fxn and mobility

80
Q

acute phase wound care

A
  1. HANDWASHING to reduce infection risk
  2. isolation r/t infection risk
  3. pain meds BEFORE beginning
  4. change gloves when moving to different burn areas –> infection
81
Q

acute phase debridment

A

mechanical
enzymatic
autolysis
surgical

82
Q

mechanical debridement

A

hydrotherapy - special showers / bedside washing

**uses coarse gauze to remove dead tissue

83
Q

enzymatic debridement

A

collagenase - uses enzymes

84
Q

autolysis

A

moist wound healing

85
Q

silver sulfadiazine (silvadene)

A

-broad spectrum / candida
-wet topical dressing
-partial and full thickness burns
-cooling effect , painless application
-may cause leukopenia!!!
-DO NOT USE W/ SULFA ALLERGY

86
Q

bacitracin

A

-no gram negative / fungal coverage
-partial thickness burn wounds and grafts
-not as effective on full thickness
-BEST for use on face leave open to air
-can use ophthalmic ointment near / around eyes

87
Q

sulfamylon cream (slurry)

A

-broad spectrum, effective against pseudomonas, little fungal coverage
-cream used on full thickness burns to EARS ONLY
-partial thickness burns and grafts
-wet dressing, do NOT use on large wound burns = hypothermia
-STINGING on application

88
Q

acticoat, silverlon, mepilex

A

-broad spectrum, effective on MRSA and fungus
-partial thickness, donor sites
-only changed 4-7 days
-do NOT use on initial large wounds = hypothermia
-used in pts with SJS/TEN
-DO NOT use with normal saline–> will deactivate silver
-stinging on application

89
Q

enzymatic cream (collagenase)

A

-no antimicrobial effects, normally mixed w/ other ointment
-full thickness, digests necrotic tissue w/o damaging good tissue
-painless application
-full thickness burns who are not surgical candidates r/t age or medical hx

90
Q

autograft

A

taken from unburned area of pts own skin (DONOR SITE)

-ideal coverage for all burn pts
-permanent coverage

91
Q

allograft

A

human skin from cadaver

-used as temporary covering once eschar is removed to close wound
-will start to eventually reject

92
Q

xenograft (heterograft)

A

skin from other species - normally pig

-temporary coverage
-will eventually reject

93
Q

cultured skin

A

pts own skin is sent to lab and grown in larger patches

-permanent coverage
-used with burns of 70% or more TBSA = do not have enough donor skin
-EXPENSIVE, very fragile, susceptible to infection

94
Q

artificial skin

A

silicone membrane used to replicate dermis

-permanent coverage
-provides functional dermis
-high infection risk

95
Q

important pt care to remember after grafts…

A

DO NOT SLIDE pts in bed , graft will shear off

96
Q

infection / sepsis s/s

A
  1. disorientation
  2. decrease UO
  3. metabolic acidosis
  4. tachypnea
  5. tachycardia
  6. hyperglycemia
  7. hyper / hypothermia
  8. paralytic ileus
97
Q

rehabilitative phase

A

begins at wound CLOSURE and ends with return to highest level of fxn

98
Q

wound healing mobility…

A

as wounds heal they contract decreasing mobility

**contractures

99
Q

splinting

A

during immobilization after grafting to prevent deformity

100
Q

pressure garments

A

flatten hypertrophic areas and provide vascular support to healed wounds

**WEAR 23 HRS / DAY
**use 12-24 months until scar matures

101
Q

positioning

A

affected extremities should be elevated at all times to prevent contractures

102
Q

occipital pressure ulcers

A

reposition / turn to redistribute pressure

103
Q

ears chondritis

A

caused by pressure necrosis , NO PILLOW = keeps ears free of pressure

104
Q

neck flexion deformity

A

NO PILLOW

105
Q

shoulder adduction contracture

A

position at 90 degree of abduction / flexion

106
Q

wrists contracture

A

support in neutral position with splint / pillow

107
Q

hand edema, claw hand, web space

A

elevate , resting hand splint, dynamic flexion, thumb splint

108
Q

hip contracture

A

position flat, trochanter rolls at hips to prevent external rotation

109
Q

knees contractures

A

elevate, avoid tight dressing, ace wraps for ambukation

110
Q

SJS / TEN

A

commonly associate with…
1. medication reaction adverse
2. viral infection
3. staph toxin

111
Q

SJS / TEN s/s

A

sloughing of epidermis from dermis
extremely painful lesions
SJS = < 30% TBSA
TEN = > 30% TBSA

112
Q

SJS / TEN mgmt

A
  1. AIRWAY is priority , sloughing of oral mucosa / bleeding
    -fluid replacement
    -nutrition
    -wound care = need wound care nurse
    -possibly burn center transfer
113
Q

compartment syndrome s/s

A

1st sign is pain out of proportion to expected
-paresthesia
-pallor
-paralysis
-pulselessness!!! LATE SIGN
-pressure

114
Q

rhabdomyolysis

A

damaged muscle tissues r/t myoglobin

**COLA COLORED URINE
**elevated CK but normal BUN
**75-100 mL/hr UO

115
Q

AKI

A

will have elevated BUN and Creatinine

Critical Care (15 decks)

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