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Medsurg 3 > Burns > Flashcards

Burns Flashcards

1
Q

Reduce chemical burns 2

A

Approved labeled containers
Educate workers-protection

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2
Q

Reduce Electrical burns 4

A

Avoid frayed wiring
Avoid outdoor activities in storms
make sure power is off before doing work
wear eyewear and gloves when making repairs.

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3
Q

Reduce inhalation burn 1

A

instal smoke and carbon detectors

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4
Q

reduce scald burn 4

A

Use anti scald devices
Lower hot water temp to 120
check bath with back of hand or thermometer
supervise bath

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5
Q

Where do alkalis burns come from? 5

A

Cement, Oven and drain cleaners, heavy cleaners-phenols, disinfectants, petroleum, (creosote and gasoline)

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6
Q

What causes Metabolic asphyxiation
And what percent of what

A

Inhaling carbon monoxide and or hydrogen cyanide- mostly from inhalation at fire.
Carboxihemaglobin greater than 20%

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7
Q

What is compromised in an upper airway 3
lower? 3

A

mouth oropharyns layrnx
trachea, bronchiole, and alveoli

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8
Q

Eschar

A

tightens and constricts

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9
Q

Assessment for inhalation burns 7
and what can it progress to?

A

Singed nasal hair, hoarsness, painful swallowing, dark mucosa, carbonaceous sputum, hx of being burned in enclosed space, burns around neck and chest
ARDS

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10
Q

When does pulmonary edema develop?

A

12 to 48 hours

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11
Q

Patho of electrical burns

A

Intense heat from electric current that damages nerves and vessels causing tissue anoxia and death.

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12
Q

Electrical burn and bones vs vessels vs organs

A

Bones and fat have more resistances that vessels and nerves
worst organs are brain, kidneys, and heart.

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13
Q

What else may electrical burns cause?

A

Flash burn someone may ignite

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14
Q

How to tx electrical burn 4

A

It is most likely under the skin so hard to tell. Find points of contact. can cause mm contractions that break long bones and vertebrae so C spine mobilization.

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15
Q

What do electrical burns put a patient at risk for? 5

A

DysR and cardiac arrest ( up to 24 hours later), broken bones, metabolic acidosis, myoglobinurea-rabdo so AKI or ATN

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16
Q

upper airway manifestations of injury 4

A

copious secretions, stridor, substernal and intercostal retractions, airway obstructions.

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17
Q

Lower airway manifestations 6

A

ALC, Carb sputum, dyspnea, facial burns, hoarsness, wheezing

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18
Q

How do we decide severity of burn?

A

Depth, extent of burn calculated as TBSA, location, and age, med history, circumstances, complicating factors.

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19
Q

Superficial burn is?
4 s/s

A

Partial thickness Superficial epidermal damage first degree burn
Erythema, Blanching on pressure, pain, mild swelling, after 24 hours skin my blister and heal

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20
Q

Deep burn is?
3 s/s

A

Partial thickness epidermis and dermis involved with varying depths. skin elements form and skin can regenerate.
fluid filled vesicles that are red, shinny, wet
severe pain from nerve injury
mild to mod swelling

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21
Q

3rd and 4th degree burns 4 about
4 s/s

A

Full thickness, skin elements and nerves are destroyed, coagulation necrosis is present, need surgical interventions.

Dry waxy white leathery hard skin, visable thrombosed vessles, no pain, might involve mm tendons or bones

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22
Q

how do we measure depth?
Extent of burn?

A

Full or partial thickness
lund brower or rule of nines (LB is more accurate nines is fast).

23
Q

Describe patho of a burn

A

Increased vascular permeability, edema, decreased blood volume, decreased vascular volume, increased hematocrit, increased viscosity, increased peripheral resistance =Burn shock

24
Q

What are we concerned about with burns?

A

Hypovolemic shock in first 8 hrs.
Infection

25
Q

How do we measure splash burns/irregular Burns.

A

Assume palm is 1 percent use to approximate irregular size

25
Q

How do we measure splash burns/irregular Burns.

A

Assume palm is 1 percent use to approximate irregular size

26
Q

Rule of nines

A

Head- 4.5% x 2
Trunk 18% X2
legs 9%x2
Arms 1.5% X2
Genitals -1%

27
Q

One thing to remember when calculating BSA of burns

A

Superficial burs do not count

28
Q

What is important about location of burn?

A

it can influence severity
face, neck, circumferentail to chest or back
eyes, hands, feet, joints,
ears and nose perineum and butt= risk for infection
Circum to extremities can cause compartment syndrome

29
Q

High Risk populations concerns for burns 4 ish

A

Preexisting heart, lung, or kidney disease. PVD, diabetes, gen physical weakness or malnut from alcohol or drug use,
fractures, head injuries or other trauma.

30
Q

Prehospital burn care
2 things
Small burns?
large?
Clothes?
2 more things
best time to start cooling?

A

Secure the scene
Stop the burn
thermal 10% or less= cool tap water
if electrical or greater than 10% or unconscious CAB elevate burns
Remove clothes unless melted
flush if needed
prevent hypothermia
1min

31
Q

Cooling a burn

A

No ice-vasoconsrict
cool no longer than 10 mins
no immersion

32
Q

How to tx CO poisoning

A

100%. humidified 02

33
Q

three things about fluid resuscitation

A

2 lg bore IV
TBSA> 15%
Lactated ringers

34
Q

What are the phases of burn management

A

Emergent (resuscitative), acute (wound healing) and rehab (Restorative)

35
Q

One thing about emergent care for burns Emergent care

A

Cath if burn is > than 15%

36
Q

different emergency care for electrical burns 2

A

Blood gasses
find sites

37
Q

How do you flush eyes?

A

inside corner out with LR if available

38
Q

What defines the emergent phase

A

Solving life threatening problems, can last up to 72 hours, preventing hypovolemic shock and edema formation it ends with diuresis with low specific gravity and capillary permeability is restored
hypoNa+ hyperK+

39
Q

Why is a burn patient at risk for infection

A

Skin barriers are compromised and WBC are impaired

40
Q

2 common things that happen with burn patients

A

Peri illius
shivering

41
Q

how do you diagnose inhalation injury?

A

fiberoptic bronchoscopy and carboxyhemoglobin

42
Q

when does a patient with face burns need to be intubated?

A

1-2 hours

43
Q

Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all

A

the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs

43
Q

Fluid replacement for burns called?
adults
peds
electrical and rabdo?
after 24hr
one thing about all

A

the parkland
2ml/kg/TBSA
3ml/kg/TBSA
4ml/kg/TBSA
33%
1/2 in first 8hrs then other 1/2 in 16 hrs

44
Q

what do we want urine output to be?
electrical?

A

.5-1ml/kg/hr or
75-100ml/hr

45
Q

Nutrition for burns?

A

High cal high prot early
enteral

46
Q

Wound care for burns
Debridement
Open method
Closed method

A

debridement in emergent phase removes necrotic tissue, extensive is done in OR

topical antimacrobial no dressing-face

antimacrobila ointment sterile gauze

47
Q

When do you use cadaver graft?

A

burn is 50% or over

48
Q

three thing about meds and burn patients
two types of meds

A

IM doesn’t work
Give tetnes but later
topical not systemic
anticoags
GI support

49
Q

What is the Acute phase?
Start?
End?
Time?
3 things to look at
5problems

A

When diuresis starts
ends when partial thickness wounds are healed and fullthickness are gafted
Can take weeks to months
WBC is better GI is better
Electrolytes are all over the place
Infection is a problem
still cardio and pulmonry problems
contractures
high glucose from stress

50
Q

degrees

A

First degree (superficial thickness): redness, some pain/tenderness, mild swelling, blanching
Second degree (partial thickness): blisters, mottled white, mod/severe pain, blanching, mod edema
Third degree (full thickness): dry, dull, tight, leather like, eschar present, waxy, white or brown charred look, burn odor, no sense of pain, no blanching-no cap refill
Fourth degree: deep structure involvement-bone

51
Q

nutrition for burns

A

Nutritional support very important to meet hypermetabolic state and to allow for wound healing. Patients require 2-3 X daily caloric intake for 6mths post burn. Intubated patients require enteral feedings (better than TPN) to preserve GI function and GI blood supply. Use of anabolic steroids for large burns, encourage fluids to prevent constipation

Medsurg 3 (13 decks)

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