burns Flashcards
What are the 3 phases of burns
Emergent- shock phase
Acute-diuresis
Rehab- starts at beginging
Describe the main events of the emergent phase
Edema, fluid loss, hyperkalemia, clotting issues, increased cardiac workload, paralytic ileus
Describe patho of emergent phase
Rapid fluid loss d/t capillary permeability- capillaries open and creates extreme loss of fluid, not enough circulating fluid, massive cell destruction== hypovolemic shock
Edema forms everywhere– c/o compartment syndrome
Blood cells are destroyed, potassium goes into extracellular space causing hyperkalemia c/o kidney damage r/t flow and filtering out destroyed cells–may have red urine d/t myoglobin
Clotting problems d/t cell destruction- prolonged clotting time and thrombocytopenia, Pt may become immobile—paralytic ileus d/t immobilization and blood shifting away to more vital organs c/o Cushing ulcer GI d/t stress
Increased cardiac workload & O2 demand d/t hypovolemic shock, carboxyhemoglobin- hemoglobin will bind to carbon monoxide in fire/smoke burns- Pulse Ox not helpful!
When does the emergent phase end?
4 hours- 4 days after accident, when reabsorption of fluids occur
When does the acute phase begin?
Diuresis
48-72 hours after injury
What are the major issues during acute phase?
Monitor fluid/ electrolytes Pain Infection prevention Cleansing wounds wound grafts
How do we manage pain for burn patients? what must be considered?
INTENSE PAIN
Can give anesthetics, large doses of pain medications
PCA opioids, nsaids
Must consider kidney function- may go into renal failure
Risk vs benefits
If clients has burns on arms where is best place to try to get IV
Central line- you can give IV, get blood draws and give TPN through line
what is a wound graft and what are key things about wound grafts?
Wound graft is a piece of skin from somewhere on the body, perforated and then stretched and placed onto new site- best from pt themselves
Occlusive dressing to immobilize and provide humidity, wet to dry dressings
Infection, bleeding, sheering and pressure can cause graft to be lost
Donor site- clean dry and free from pressure
Very painful! Heals 7-14 days
How are wounds cleansed and what infection control is used?
Hydrotherapy- c/o hypothermia
Very tiring for patient
Don gowns and gloves, clean and culture equipment, topical antimicrobials
Silver sulfadiazine wet- dry dressing
Silver nitrate solution
Rehab phase
Preventing scar formation- use of compression
Psychosocial - PTSD, body image, support groups
Increase mobility- PT/OT, prevention of contractions, resume ADL’s- have client do as much for themselves as possible
Cotton loose fitting clothes
Itching- use lotion, PAT dont scratch
what to do at the scene FIRST and what to do in each situation
figure out source
Fire- extinguish/remove
Chemical- remove and flush 10 mins w/ H20
Electrical- make sure no longer connected to source, turn off electrical source
Primary survery
ABCDE
What are each of the ABCDE in primary survey
A-airway- Maintain airway and cervical spine protection
B- Breathing and ventilation- c/o inhalation/swelling- intubate
C-Circulation and cardiac status- 20%< burned- 2 large IV with LR’s fluid
D- Disability/ neuro- Pt should be alert, oriented if not think carbon monoxide and intubate
E- exposure- completely undress patient, remove clothing etc- keep them warm
What fluid resuscitation is given at the scene for each age group?
if 20%< of body burned
<5 =125 LR/ HR
6-13 = 250 LR/ HR
14 < = 500 LR/ HR
What are the three types of burns?
Fire/smoke
Chemical
Electrical
Electrical burn
Complex! deep tissue injury- not easy to assess grossly
Exit and entry wounds can help identify pathway
Compartment syndrome is common
Special fluid amounts diff from chem/fire/smoke
Chemical burns
Remove chemical and rinse for min 10 mins
Fluids get treated like fire/smoke burn
Fire/smoke burn
100% O2 given
Early intubation for facial/chest/inhalation
Carbon monoxide poisoning- PULSE ox not accurate need ABG
Why is pulse ox not helpful during fire/smoke burn?
Carboxyhemoglobin
D/T hemoglobin binding to either O2 or carbon monoxide- hemoglobin does not know difference and will bind to whichever is greater and more available
Which burn is blanchable, red, dry with minimal or NE edema, possible blisters?
1st degree
Which level does first degree go to in the skin
Epidermis
Which burn is blistered, non blanchable, red base, edema and weeping surface?
2nd degree
Which type of burn goes to the dermis?
2nd degree
Which type of burn is dry, leathery, edema, and co-ag vessels possibly present?
3rd degree
Which type of burn usually warrants an amputation?
4th degree
What rule is used for body surface area?
Rule of 9
What are the lower extremities considered with BSA
9% on each side of LOWER extremities
18% for entire leg
What is considered 4.5% for BSA?
Frontal or posterior side of face
Entire head = 9%
Anterior or posterior aspect of UPPER extremities
Entire arm= 9%
Which is considered the greatest area of BSA
chest/ back= 18% EACH side
What are the resuscitation guidelines regarding BSA
2ml x KG x BSA for fire/chemical
4ml x KG x BSA for electrical
What is the frequency of the fluid resuscitation?
2ml x kg x BSA= xxx 4ml x kg x BSA= xxx given over 24 hours! 1st 1/2 given over 8 hours 2nd 1/2 given over 16 hours
