Burns Flashcards
what is the epidermis
primary barrier
responsible for regeneration
what is the dermis
provides mechanical strength
what is the hypodermis
subq fat
protects; absorbs shock, thermal insulation,
energy stores
what is the resuscitative phase
Injury to onset of diuresis (0-2 days)
* ABC’s
* fluid resuscitation/perfusion
what is acute phase
Diuresis to near completion of wound closure (days to months)
* Wound care
* Infection control
* Healing
* Nutritional support
what is the rehab phase
Major wound closure to return to optimal level of
adjustment
* psychosocial adjustment
* minimize scarring and contractures
* reenter society
assessment of burn
Where occurred- environment
* Age
* Location
* History of the trauma
* Size
* Depth
* Severity
* Source
* Zone of injury
sources of burns
Radiation: sun or cancer therapy
* Chemical
* Electrical
* Dry and moist heat (thermal)
* Cold (frostbite)
1st degree burn/superficial thickness
above dermis (epidermis)
* Sunburn, flash burn
* Heals w/in a few days
* Dry, red,
* Some swelling
* Painful
* Tingling, itching, peeling
2nd degree burn/partial thickness
into dermis
* Scalds, flames, brief hot objects
* Heals 2-3 weeks
* Some scarring and depigmentation possible
* May require grafting
* Pink to red, blisters, weeping, pain, edema
3rd degree/full thickness
epidermis, dermis, sometimes
subcutaneous tissue; may involve connective tissue & muscle
* Scalds, flames, prolonged hot objects, tar, grease, chemicals,
electrical current
* Requires grafting
* Dry, pale, white, red, brown, leathery, or
charred
* Edema
* No pain
* Eschar may slough
what need to be intact for skin to regenerate
dermis
4th degree burn/deep full thickness
down to
muscle/bone
* Prolonged exposure, high-voltage electrical
injury
* Black, dry
* No pain
* Grafting of no benefit
* Amputations likely
how to estimate burn size
- Calculate TBSA burned in
percentage - Methods:
- Rule of Nines
- Palmer: size of hand=1% of bsa
severity of burn injury
Age
* Depth of burn
* TBSA- injuries that affect > 20% TBSA
considered severe
* Inhalation injury
* Concomitant injuries
* Location- face, perineum, hands, feet,
major joints
* Comorbid conditions
when to suspect an inhalation injury
closed space injury
facial injury
singed nasal hair
carbonaceous sputum
wheezing
pharyngeal edema
hoarseness
airway injuries
carbon monoxide poisoning
inahaltion injury above the glottis: singed nasal hair, facial burn, carbonaceous sputum
inhalation injury below the glottis
resuscitative phase of burn injury at scene
At scene:
* Extinguish flames/remove
from source
* Airway maintenance
* Smoke inhalation
* CO poisoning
* High flow O2, intubation
* Cool the burn
* Remove restrictive objects
* Clothing, jewelry
* Cover the burn- infection
resuscitative phase at facility
- Airway
- Assess patency
- Assess for signs/symptoms
of inhalation injury/carbon
monoxide exposure - Intubation if necessary
- Suction- provide pain
medication - Monitor for upper airway
edema
resuscitative pahse at facility circulation
Circulation
* Assess vitals, pulses, capillary refill; watch for hypovolemic shock &
compartment syndrome
* Continuous cardiac monitoring
* 2 large-bore IVs, central line
* IV fluid resuscitation
* Foley- monitor urine output (adults: 0.5-1 mL/kg/hr; children <40kg:
1ml/kg/hr)
* Risk for AKI
* Red-colored urine- damage to RBCs and myoglobin
* Monitor I & O hourly
resuscitative phase at facility breathing
- Breathing
- Oxygen (high flow, humidified)
- Lung sounds
- Mechanical Ventilation
- Chest Expansion- escharotomy
needed?, avoid tight dressings - Monitor for pulmonary edema,
ARDS
what is the adult fluid resuscitation formula
2mL LR x Kg x % TBSA burned for 24-
hr period
* 1st 8 hrs - 1/2 volume
* next 16 hrs- 1/2 volume
how to care for wounds
- Cooling- stop burn process on scene of injury (remove clothing,
tepid water/saline) - Cleaning
- Covering- dressings, cover patient with dry sheet/blanket, prevent
hypothermia - Comfort- pain control (pharmacologic/nonpharmacologic), warm
room - Prevent infection- protective environment, aseptic technique,
tetanus, topical antimicrobials
initial wound treatment
- Clean with mild soap and water
- Strip away dead, devitalized tissue
- Burn wound culture
- Photographs
- Escharotomy of circumferential burns
- Dressing
- Fasciotomy
- Tetanus
- Pain control
pain control
- Morphine or fentanyl IV
PCA
Nonpharmacologic methods to enhance meds - Administer prior to procedures/suctioning
- Assess for hypoxia
- Protect from air currents, linens
- Anxiolytics
gi issues
- Abdominal assessment- risk
for paralytic ileus and
abdominal compartment
syndrome - NG tube- prevent aspiration,
decompress stomach - Risk for stress ulcers- acid-
reducing meds - Increased nutrition needs
- May require
enteral/parenteral nutrition
resuscitative phase- labs and diagnostics
Chest x-ray
* Glucose: increased
* BUN/Cr: increased
* Hgb/Hct: increased
* Electrolytes
* Sodium: decreased
* Potassium: increased
* Chloride: increased
* ABG: metabolic acidosis
* Urinalysis: osmolality
* Total protein & albumin: decreased
acute phase of burn injury
- Prevent Infection, organ system failure,
metabolic derangement - Encourage Healing
- cleanse/hydrotherapy
- remove/debride
- topical preparations
- protection
- dressings
- skin coverings
- grafting
acute phase complications
- Infection- sepsis, ventilator associated pneumonia
- Heart failure, pulmonary edema
- Fluid shifts back to intravascular space
- Blood clots
- Pressure injuries
- Respiratory distress, ARDS
- Delirium
preventing infection
● Protective environment.
● Restrict plants and flowers, fresh
fruits, vegetables.
● Limit visitors
● Single use equipment
● Monitor for infection
● Administer tetanus toxoid
● Administer antibiotics to treat infection
● Use strict asepsis with wound care
gi concerns/nutritional support
*Paralytic ileus
*Curling’s ulcer
*Hypermetabolic,
hypercatabolic state
*Increased calorie needs
* Oral route- high-calorie,
high-protein meals/supplements
*Dietary consult
what does bronchoscopy do
determine extent of burn injury to airway
labs for acute phase
hbg/hct- decreased
k+- decreased
WBC- increased
rehab phase
can last years
Minimize contractures and
scarring
* Splinting, positioning, exercise,
ambulation, pressure dressings,
surgery
* Client participation in ADLs and
self-care activities
* Home Health Support
* Psychosocial support and
reintegration
* Follow-up appointments
rehab complicatoins
Neuropathies and nerve entrapment
* Wound breakdown and/or pressure injury
formation
* Hypertrophic scarring
* Contractures
* Joint instability
* Complex pain
electrical burns
- Path of least resistance
- Low voltage
- High voltage
- Entry and exit sites
- Tetanic contractions
- Burns
- Arrhythmias
burn care resuscitation
- injury to onset of
diuresis (0-2 days) - ABC’s
- fluid resuscitation
burn care acute
- diuresis to
permanent wound
closure (days to
months) - infection control
- healing
burn care rehab
Extends for years
after injury
* minimize scarring,
contractures, and
other complications
* reenter society
