Burns Flashcards
Burns Stats
Third Leading Cause of Death
Number One Cause of Death in Children from Birth to Five Years of Age
Annually, 700,000 people are burned
Two thirds of all burns are caused by fire
Home is the sight of 85% of all burns
Causes: heat from flames, surfaces, fluids, chemicals, radiation, electrical current
The skin
Number 1: Protects against Infection
-Prevents loss of body fluids
-Controls body temperature
-Functions as a sensory and excretory organ
-Produces Vitamin D
-Determines Identity
Assessing burn depth
Superficial (First Degree) - epidermis; pink and red, blanchable and quickly refill, painful when acute, itching while healing, heal 1-2 weeks with no scarring, most common is sunburn
Partial Thickness (Second Degree)- divided into superficial and deep; hair follicles, sweat glands preserved, very pink, blisters, wet and weeping with serous exudate. very painful
Full Thickness (Third Degree) - epidermis, dermis, hair follicles, sebaceou glands all destroyed, painless d/t nerve endings being destroyed; require grafting to heal
Rule of 9’s
TBSAB: total body surface area burned - expressed in %
Head and neck 9
Each arm 9
Ant trunk 18
Post trunk 18
Legs 18 each
Perineum 1
Limits: Not everybody has the same body proportions! Calculations in peds are totally different - use Lund-Broedur calculation
Burn risks
Upper part of body: increased mortality
Head, neck, chest: pulm complications
Perineum: infection risk
Age >60: thin skin
<2: reduced antibody response
History: Anything that alters fluid balance
Renal conditions
HF
Hepatitis w/ ascites
COPD
What is a life threatening burn?
> 25% adult >20 child
Full thickness >10
Face, hands, eyes, ears, perineum
Inhalation
Electrical
Causes of burns
Thermal - flame? Object? Liquid?
Chemical - destroy tissue by protein coagulation. Alkaline typically worse than acid.
Electrical - only entrance and exit wounds are apparent. Internal injuries can be extensive. Can’t see what the problems are.
Radiation - similar, often localized
On-site thermal
Irrigate with fresh water for at least 20 minutes
Remove wet clothing and cover with blankets
Remove jewelry
Transport quickly
If fire in a closed space: give oxygen
On-site chemical
Dilute the chemical
Remove contaminated clothing (watch your own hands)
Flush wound with water >30mins
Why are children under two and adults over 60 more likely to die of burns?
-translucent nature of skin
-poor antibody response
Burn nursing diagnoses
Altered Gas Exchange
Decreased Cardiac Output
Fluid Volume Deficit
Alteration in Comfort
Potential for Infection
Impaired Skin Integrity
Ineffective Thermoregulation
Electrical burns
Turn off Source of Current
Use non-conductive materials to remove from electricity source
Immobilize
Three phases of burn car
-Emergent Phase: Begins with the injury and lasts 24-48 hours or, in the critically ill patient, up to two weeks
-Acute Phase: Begins when initial fluid replacement is complete and fluid shifts from interstitial back to vascular space
-Rehabilitative Phase: from hospital admission to resumption of functioning level in society (the entire process from beginning to end
Priorities: Emergency Phase
-Strict isolation! #1 cause of death is sepsis.
-Fluid resuscitation. Average burn patient gains about 10% of body weight because of fluid shifts - intravascular fluid deficit despite total fluid normal. -Large bore catheter, central line, pressure bags
-Calculate TBSAB with Formulas: Evans 1cc x kg x TBSAB NS per 24 hours
-Brooke: 1.5cc x kg x TSBSAB with LR
-Parkland: current standard. 4cc x kg x tbsab LR
-Most fluid loss in first 8 hours after burned - half of this must be given in first 8 hours
-NG/OG tube and Foley catheter
-Tetanus shot
-Culture all wounds
-Tub or shower
-Assess fluid level: Lucid, good VS, cap refill, urine output 50cc+/hr, normal weight, pulse <120, normal CVP,
-Medicate pain, sometimes anxiety
How much of the calculated fluid is given that initial 8 hours?
1/2 of the calculated fluid for the first 24 hours is given in that initial 8 hours
