Burns Flashcards
What is a burn
- Injury to the skin or other organic tissue primarily caused by
- Heat
- Radiation
- Radioactivity
- Electricity
- Friction
- Or contrast with chemicals
Length of stay for burn patients
0.5-1 day for % of burn for total body surface area
1.A person with 80% TBSA burn will stay in the ICU for 40-80 days and will be discharged when hemodynamically stable
Number one cause of death from burns
Residential fire
Risk factors for mortality of burns
- Age
- Sex
- Religion
- Type of burn
- Percent of burn
- Cause of burn
- Time to cooling and resuscitation
- Regional factors
- Socioeconomic
- Other risk factors
Burn prevention
- HIgh income vs low income
- Smoke detectors
- Hot water heater temps (Set them lower)
- Housing codes
- Cooking
- Open fires
- Kerosene
- Loose clothing
- Electrical cords (Burn your face)
- Hot irons/curling irons
- Flammable liquids
Tar Burn
- Contact burn (Hand touching tar)
- Tar cools on contact
- Removal of tar is NOT an emergency (don’t remove right away)
- Please pass the mayo (Apparently mayo breaks down tar)
Causes of chemical burns
- Strong acids
- Drain cleaners
- Paint thinner
- Gasoline
- Concrete
- Lawn chemicals
- Hair products
Thermal burns
- Most common type of burn
- Children are at highest risk
- Can come from any heat source
- Damage ranges from superficial to all layers of the skin
- Deepest going to the muscle tendons, ligaments and bone
Pathophysiology burn cycle
- Heat causes coagulation necrosis of the skin and sub Q
- Release of vasoactive peptides
- Altered capillary permeability
- Loss of fluid causing severe hypovolemia
- Decreased CO and myocardial function causing altered pulmonary resistance and pulmonary edema
- Decreased UOP
- Infection
- SIRS
- MODS
Burns affect on: Renal
- Decreased Urine osmotic pressure (UOP) and GFR
- Toxins released from burn cause acute tubular necrosis
- Myoglobinuria
- Needs early resuscitation
Burns affect on: Lungs
- P/F ratio (would be decreased)
- Pulmonary edema
- ARDS
- Aspiration
- Septicemia
Burns affect on: GI
- Muscular atrophy causes decreased absorption and increased intestinal permeability advancing to increased bacterial translocation… essentially sepsis
- Acute gastric dilation first 2-4 days
- Paralytic ileus
- Curling ulcer
- Acute cholecystitis or pancreatitis
- Abdominal compartment syndrome
Burns affect on: Immune
- Decreased Function of our T and B lymphocytes and macrophages causing increased infection rate and sepsis
- Common infections
- Step
- Pseudo
- Staph
- Candida albicans
- Other gram negative organisms
Burns affect on: Metabolism
- Hyper metabolic rate: elevated glucose, free fatty acids and amino acids
- Negative nitrogen balance
- Electrolyte imbalance
- Deficiencies in vitamins and essential elements
- Metabolic acidosis due to hypoxia and lactic acidosis (Plus the whole kidneys)
Burn shock
- Not simple shock, combo of Hypovolemic and distributive and accompanied by cardiogenic shock
Burn shock patho
- Not a simple shock
- Caused by massive tissue destruction; activation of the inflammatory response system
- Burn shock is an ischemia and reperfusion injury
- Massive burn: you can have myocardial depression factor occur, causing Decreased CO and decreased SVR this combo will decrease tissue perfusion
- Microcirculation of blood
First stage of burn shock
- Hypodynamic
- Hypovolemic with rapid fluid loss from the intravascular space within the first 24-48 hours
Goal of burn shock
- Maintain organ function by resuscitation and if successful the pattern of shock can be reversed
Burn: priority nursing assessment
- ABC
- Assess the severity of the burn
- Type
- Depth
- Location
- Extent
- Assess response to treatment
- Temp
- Vitals
Burn assessment
- Depth
- Size
- Cause
- Time
- Site affected
- Smoke inhalation
- Other
- Time of cooling
- Any treatment
- Questionable cause of fire (Arson?)
First degree burn
- Superficial thickness
- Only in the epidermis
- Painful
- Does not blister
- Does not scar
Superficial partial thickness burn
- Also called a second degree burn
- May not require surgery but may scar and be more painful
- Blisters and weeps
- Increasing depth, increased risk of infection/scarring
- Involves the epidermis only
Can be like.a sun burn
Deep partial thickness burn
- Also called second degree
- Require surgery and form more scars and are less painful
- Red color, and eschar present
- Blisters and weeps
- Increasing depth, increased risk of infection/scarring
- Involves the epidermis and some portion of the dermis
Hallmark sign is capillary return: if sluggish blanching its a deep dermal burn
Full thickness burn
- Also called third degree
- Dry
- Insensate to light touch and pin prick (not painful)
- Can be black in color
- Small areas will heal with substantial scar or contracture
- Large areas require skin grafting
- High risk of infection
- Involves the entirety of the dermis