Burns Flashcards
What are some of the causes of burns ?
Heat eg. Liquid/steam\
Radiation eg. Sun, radiotherapy
Electricity - electric current
Chemicals - alkaline vs acidic
Cold eg.frostbite
Friction eg road rash during car accident
What is TBSA
Total body surface area
What are the types of burns
Superficial
Partial thickness
Deep partial thickness
Full thickness
What layers of the skin did superficial burns affect ?
Epidermis
What layers of the skin do partial thickness burns affect ?
Epidermis and dermis
What layers of the skin do deep partial thickness burns affect?
Epidermis, dermis, hair follicles, sub cut glands, sweat glands
What layers do full thickness burns affect?
All layers of the skin including tissue, muscle and bone
What does burn severity depend on?
Depth of burn
% of TBSA burned
Age
Med hx - diabetes, HF
Location - face, neck, head etc
Inhalation injury
What layers of the skin are burnt in a 1st degree burn?
Epidermis (superficial)
What are the characteristics of a 1st degree burn ?
- v red/pink
- warm 2 touch
- no blisters/scars
- v quick cap refill
What layers of the skin are burned in a 2nd degree burn ?
Epidermis and dermis (partial thickness)
What are the characteristics of a 2nd degree burn?
- v painful
-shiny & moist - red/pink
- will blister/scar
-+/- skin graft
-blanches
What layers of the skin are burned in a 3rd degree burn ?
Epidermis, dermis, hypodermis
( hair follicles, sweat glands and nerves destroyed)
What are the characteristics of a 3rd degree burn?
- no pain
-skin will not heal - skin graft - black, yellow, red
-hard areas - Eschar
What is Eschar?
Burned dead tissue
What must be done in a 3rd degree burn to promote healing?
Eschar must be removed
What layers of the skin are burned in a 4th degree burn?
Epidermis, dermis, hypodermis, bones, muscle, ligaments etc
V deep
What are the characteristics of a 4th degree burn ?
- all layers destroyed
- black w Eschar
- all sensation gone
- ++ skin grafting
What is inhalation injury ?
Damage to respiratory system due to breathing in smoke - carbon monoxide, chemicals, thermal etc
What are the S+S of someone who has suffered inhalation injury ?
- burns on nose/mouth
- carbonaceous sputum (black)
- sooty nose/mouth
- hairs singeing
- ++ red lips
- probs w talking
- confusion/anxiety
What are the phases of burn Mgt
Emergent
Acute
Rehabilitative
When does the emergent phase begin and end ?
Starts @ onset of burn injury
Ends @ restoration of cap permeability
First 24-48 hrs
What is the ot at risk of during the emergent phase ?
Hypovolemic shock
Resp distress
Compartment syndrome
When have we entered the acute phase ?
Cap permeability stabilised until wound closure
( 48-72 hrs until wound heals )
What are our main focuses during the acute phase ?
- continue fluid replacement & monitor response - U/O, I&O, vitals, bloods
-wound care - resp function
- pain assessment + mgt
- physio & OT- maintain ROM
- nutritional care (dietician)
- psych care
When does the rehabilitation phase begin?
From when burn is healed until pt is able 2 function again
What is our main focus during the rehabilitation phase?
- psychological support
- ADLs
- physio
- OT
- cosmetic correction if needed
What are the priorities of burns treatment ?
- prevention of infection
- prevention of hypovolemia
- maintain norm body temp
What is the emergency mgt pathway for burn wounds ?
- stop burning process
- remove jewellery or hot clothing
-cool burn- place under cool tap 4 20 mins/ apply hydro gel - pain relief (analgesia)
- check for trauma + life threatening injuries
- check tetanus status and provide immunisation if needed
- assess burn size
-assess burn depth - assess if pt required admission to burns unit
What are the tools used to determine TBSA?
- Lund & Browler chart - 2x collegues
- Rule of 9 Chart
What does TBSA of <30% result in
Local response
What does a TBSA of >30% result in ?
Local &. Systemtic response
How are minor burns treated (1st nd 2nd degree)
- no hospitalisation
-treated out-patient with wound care and dressing changes
What are the 3 C’s for prehospital care for minor burns
-cool water : briefly soak area + no ice, creams or antibiotic ointment to open ski
- cover the area : w a clean dry cloth
- clothing removal : remove clothing and jewellery that is not adhered to the burned skin
What is the no.1 intervention for major burns
- IV normal saline (0.9% NaCl)
- IV Compound Sodium Lactate (Hartman’s)
What are the S&S of major burns in the 1st 24hrs
- hyperkalemia : Tall, peaked T Waves on ECG (1st priority to correct)
- low sodium (hyponatremia) <135 ( electrolyte imbalances)
- ^ haemoglobin & haematocrit (H&H)
What is the treatment for major burns in the 1st 24hrs ?
- fluid resuscitation : IV norm saline + IV lactated Ringer’s
- nutrition but only after fluid resus- admin feeding once bowel sounds return
- infection prevention esp w open burns
How do you know if fluid resuscitation is working ?
-U/O > 30mls/hr
- BP >/= 90 systolic
- HR <120bpm
What is the patient education given for the rehabilitation phase ?
- water based lotions (minimises itching + scaring )
- wear pressure garments (minimise scarring + keeps skin nd tissues tight whilst promoting circulation)
- exercise daily (ROM)
- sunscreen = protective clothing when going out in open sun
What is the wound care mgt for burns ?
- keep wound clean &moist
- clean + remove foreign bodies (prevention of infection)
- Irrigate wound - norm saline, tap H2O,
- debridement if Eschar
- analgesia b4 dressing change
- take photos of wound
- remove loose skin + keep small blisters
- covered with non-adhesive dressing
- if infection- daily dressing nd antibiotics
What are the diff type of dressings for wounds?
Hydrogels, honey dressings, foams, anti-microbials
What’s is the NI for burn care ?
- Fluid resus (based on TBSA)
- monitor IV
- record + docu I&O
- high carbo diet (avoid fats)
- antimicrobial dressings (reduce infection)
- admin meds- antibiotics, analgesics, sedatives
- comp burns- rev by plastics
- psych support
- rehab programme
