BURNS Flashcards
Most effective defense against infection
Intact Skin
Types of Burns:
- Thermal Burn
2.Electrical Burn - Chemical Burn
4.Radiation Burn
Type of burn where there is exposure to hot surface
Thermal Burn
Management of thermal Burn
Small portion: Put on running water
Type of burn that is due to electrical source
Electrical Burn
“The more solid the structure the faster electricity to travel”
Area damage first with the electrical burn:
Bone, Ligament, Fascia
Life threatening complication with electrical burn:
ARRHYTHMIA
Check Vital Signs: HEART RATE
Priority for Electrical burn:
Safety of Victim + Rescuer
Initial action for electrical burn:
Stop the source
Lightning safest place:
“When the thunder roar get indoor”
-Safest: Close Area (Inside Building)
-Person struck by a lightning; find exit on the foot
Best position for electrical burn:
-Tripod Position
-Hands & Feet touches the Ground
There is presence of lightning and thunder, you saw patient struck by lightning and got unconscious (-) pulse.
Bring pt in safety/Closed area before CPR in lightning.
While saving patient, (Healthworker) you lose your life
Principle of Double Effect
Type of burn that is Due to strong acid
Chemical Burn
Evidence of Chemical Burn
(+) Liquefaction Necrosis
(+) Stain
PLAN OF CARE/MANAGEMENT: CHEMICAL BURN
Powder: Scrape or Remove with a Brush
Liquid: Flood with water
Type of burn that is exposed to UV ray
-Sunburn
-Sauna
-Radiation Therapy
Radiation Burn
Management for Radiation Therapy
Apply Cold Pack
Degree of Burn:
Affected is Epidermis
-Sunburn
-Exfoliation
-Dermatitis
Partial Thickness/ Superficial Partial (1st Degree)
P-R-S
Painful
Redness
Swelling
Degree of Burn:
-Affected is Epidermis + Dermis
-Most Painful
-(+) Blisters
1. Ulcerations
2.Scalds: Boiling Water
Deep Partial (2nd Degree)
Degree of Burn:
-Painless
-Nerve Damage
-Epidermis + Dermis + SQ Tissue+ White Eschar
Full Thickness/ 3rd Degree
Tissue damage by burn
Eschar
Totally Burned Patient how will you communicate?
Communicate thru Eyes
Degree of Burn:
-Epidermis + Dermis + SQ Tissue + Muscle, Bone, Organ
-Black Eschar
-Charred Eschar
-Contractures
4th degree burn
Stiffening of Muscle
Contractures
Contracture in the Neck:
Turn the Head 90 degrees (ROM)
Management for Contractures:
-Range of Motion Exercises
-Passive ROME (Assisted by Nurse)
Phase of Burn
Emergent Phase
Diuretic Phase
Recovery Phase
-Occurs 1st within 48 hours
-Stage of Shock
-Fluid Shift from IV (Plasma) to Interstitial
Emergent Phase
-Hypovolemia
-↓ BP (Shock)
-Oliguria (↓ Urine Output)
-Hemoconcentration
-↑ Viscosity: RISK FOR THROMBUS
-↑ Hematocrit
-Hyperkalemia (Metabolic Acidosis)
-Hyponatremia: Sodium rush into cells
-Occurs after 48 hours
-Fluid shift from Interstitial to intravascular
-Fluid Remobilization
Diuretic Phase
-Hypervolemia
-↑BP
-Polyuria (Diuretic Phase)
-Hypokalemia (Metabolic Alkalosis)
-Hyponatremia: Sodium Excreted thru Diuresis
-Hemodilution
-↓ Blood Viscosity
-↓Hematocrit
-Occurs 5-6 days after
Recovery Phase
Hypokalemia: K+ is needed in cellular repair
Hypocalemia: Ca+ used in scar formation
***Ca+ helps in the Cell repair
Plan of care: Recover Phase
Priority: Pain Management
DOC: Morphine Sulfate (Narcotic/Opiods)
Close the door
-Nerve is hypersensitive to wind
To relieve the Pain
-Bed Craddle
Tissue damage by burn
Eschar
How to communicate burn pt. who is totally burned?
Communicate thru eyes
What is the indicator that fluid therapy is effective in burn patient?
Hematocrit return to normal level
Prevent infection during recovery phase
-Private room
-Reverse Isolation
-Handwashing
-Wear Gloves
-Administer Tetanus Toxoid (Must be given with Antihistamine)
Wound care: Recover phase
I & D : Irrigation & Debridement
Technique: “Wet to Dry”
-Wet gause with NSS then remove, and wet the affected area, then apply dry dressing.
What gloves to use during removing old dressing?
Clean Gloves
What gloves to use during irrigation & applying new dressing?
Sterile Gloves
Topical antibiotic (burn ointment)
BURN OINTMENT
Treat Pseudomonas infection
Silver Nitrate (0.5%)
Sulfamylon (10%)
Silver sulfadiazine (1%)
Best way to apply topical antibiotics?
With Gloved Hands
-To control pressure during application
Burn ointment: This turns skin into black
Silver Nitrate (0.5%)
Burn ointment:
-DOC: as antibiotic
-Penetrates into skin
-Kills Pseudomonas
-Painful
-administer analgesic 1 hour before apllication
Sulfamylon (10%)
Burn ointment:
-Causes leukopenia (Agranulocytosis)
Silver Sulfadiazine (1%)
Purposes of Skin Grafting:
-Allows new skin to grow
-Prevent infection
-Relieve the pain
-Relieve constrictures
-Prevent water loss
skin grafting where Donor is from human skin
Homograft
Types of Homograft:
Autograft
Isograft
Allograft
skin grafting:
Donor and recipient are the same
Autograft
***Still experiences graft rejection
Skin grafting from genetically related
Ideal donor: Identical Twins
Relatives
Isograft
Skin grafting from not genetically related
Allograft
Skin grafting where donor is from an animal/ Pigskin
Heterograft/ Xenograft
Harvest Site for donor in skin grafting:
T-A-B-S
Thigh
Abdomen
Back
Scalp
It helps to relieve pain, prevent sticking of exudates in the topsheet.
Bed Craddle
Good to know
Contagious Pt: Isolation room
Immunosuppressed Pt: Private Room
Care for the Skin Grafting:
-Apply on non-bleeding area
-Secure with suture or staple
-Suture is removed alternately 3-4 days after
**-Never apply lotion or powder on graft: Never expose graft on direct sunlight.
**-In case of dislodge: Soak the graft on NSS and immediately bring to hospital to reattach.
Procedure: Cutting through a dead skin; Grid pattern.
Escharotomy
Purpose of Escharotomy?
Relieve Constrictures
Purpose of Escharotomy in chest:
Promote Breathing
Purpose of Escharotomy in extremities:
Promote blood flow/ Circulation
How to determine if its effective:
-Return of distal Pulse
Diet for Burns AFTER THE BURN:
NPO
Due to “Curling’s Ulcer” (Stress-induced ulcer)
↓
↑Hcl due to adrenaline rush
Diet for burn during RECOVERY:
↑Calories: Provide energy
↑Protein: Tissue repair
Vit. C: Resistance for infection
Zinc: Resistance for infection
What Principle to use when there is Fire and you are INSIDE?
RACE Principle
Rescue
Alarm
Confine/Contain Fire
Extinguish
What Principle to use when there is Fire and you are OUTSIDE?
ARCE principle
Alarm :”Hey the building is burning”
Rescue
Contain/Confine
Extinguish
Characteristic/Definition & Management for Small Fire:
Characteristic of small fire:
1) Waste Basket
2) Fire is not taller than you
Priority: Extinguish
RACE PRINCIPLE
RESCUE
-Remove the victim
-Drop & Roll
-Throw a Blanket
ALARM
-Activate the fire alarm
-Scream: “Help”
CONFINE/CONTAIN
-Close the door
-Crawl & Cover the nose with wet towel
EXTINGUISH
-Water
-Fire Extinguisher
EXTINGUISH
-Water
-Fire Extinguisher
CONFINE/CONTAIN
-Close the door
-Crawl & Cover the nose with wet towel
ALARM
-Activate the fire alarm
-Scream: “Help”
RESCUE
-Remove the victim
-Drop & Roll
-Throw a Blanket
Management for patient in a wheelchair during fire?
Throw a blanket on the patient to trap Oxygen.
FIRE EXTINGUISHER
PASS
Pull the pin
Aim low
Squeeze the Lever
Sweeping manner towards the fire
When to use Fire extinguisher?
-On the onset of fire
-Fire is not taller than you
-Indicates Smoke Inhalation
-Indication of Carbon Monoxide Poisioning
Cherry Red Mucous
Class of Fire: utilize on Light Materials
Symbol: Green Triangle
Class A
*Abo
Class of Fire: utilized on Gas Fire/ Grease/ Oil
Source
Symbol: Square Red
Class B
*Boom
Class of Fire: utilized on Electrical Source
Symbol: Blue Circle
Class C
Curyente
Class of Fire: utilized on Metal Source
Symbol: Yellow Star
Class D
Di magigiba: Metal
Class of Fire
Class A: Light materials
Class B: Gas fire/ Grease/ Oil source
Class C: Electrical Source
Class D: Metal source
After the Burn Process
Priority: Establish Airway
Indicates Bronchoconstriction:
-Hoarseness
-Wheezing
-Tightness of throat
-Stridor
What should be available?
-Intubation set
-O2 Tank
EMERGENT PHASE
Priority: Fluid Replacement
A) PLRS (Crystalloid)
B) Normal Hematocrit: Indicates adequate fluid replacement in burns.
STEPS IN FLUID REPLACEMENT
- Get the weight (Kg)
-Lbs / 2.2 = kg - Rule of Nine
- Parkland’s/ Baxter’s Rule
4ml PLRS x % TBSA x Wt (Kg)
Parkland’s/Baxter’s Formula
4ml x %TBSA x kg