Burns Flashcards
What are the 3 types of burns?
Thermal (contact with flame, heat, liquids)
Electrical (energy converted to heat)
Chemical (contact, inhalation, ingestion, injection)
*First degree burn symptoms
Involves only epidermis
Reddened skin
Pain at burn site
No blistering
Second degree burn symptoms
Epidermis and dermis
Red
Painful
Blistered
Pale areas
Mottled areas
Third degree burn symptoms
Involves epidermis, dermis, subcutaneous tissue
Dry, leathery skin (white, dark brown, or charred)
Loss of sensation (little pain)
All dermal layers/tissue may be involved
Forth degree burn symptoms
Includes involvement of muscle and bone
Loss of function
Painlessness
Black, charred appearance
May require amputation, escharotomy, fasciotomy
How long does it take first degree burns to heal?
2-5 days
How long does it take for second degree burns to heal?
10 days to 6 weeks
Which layers of skin do blisters occur between?
Why shouldn’t burn blisters be popped?
Occurs at dermal-epidermal junction
Fluid filled with inflammatory mediators
Properties of burn eschar
Occurs with full thickness burn
Dead and has no normal function
Must be removed through debridement
Why are circumferential burns a surgical emergency?
They are limb threatening or threat to internal organs if burns to trunk
Veins collapse due to edema
Need to do fasciotomy
Reasons to suspect inhalation injury
Closed space incident
Presence of heavy smoke
History of unconsciousness
Symptoms of inhalation injury
Facial burns
Profuse secretions
Carbonaceous sputum
Lacrimination
Singed nasal hair
Hoarseness
Wheezing
Stridor
Edema
Hypoxemia
Tachycardia
What lab is drawn immediately if carbon monoxide inhalation is suspected?
COHb
Treatment for carbon monoxide inhalation
100% oxygen via non-rebreather mask
S/s of CO poisoning
*Majority of pts are asymptomatic
50% have cherry red color
Possible HA
Possible confusion
Possible coma
No tachypnea or cyanosis - CO2 not affected
PaO2 normal
SaO2 normal
Symptoms of inhalation injury above glottis
Hoarseness
Dry cough
Labored breathing
Stridor
Difficulty swallowing
Treatment for inhalation injury above glottis
Intubate b/c edema = airway obstruction
Symptoms of inhalation injury below glottis
*Carbonaceous sputum
Bronchospasm
Wheezing
Consequences of electrical injuries:
*Cardiac arrhythmias (b/c of shock)
Cardiac and pulmonary arrest
Intracranial bleeding
Decreased LOC (d/t ammonia build up from protein breakdown)
Paralysis of extremity
Loss of peripheral pulses and limbs
*Myoglobinuria
Serum CK > 1000 IU (troponin = muscle breakdown)
Why might higher fluid volumes need to be given electrical injuries?
Goal for UOP
What else should we be looking for?
*to adequately resuscitate the d/t muscle damage and myoglobinuria
*Urine output should be 75-100 mL/hr
Assess carefully for compartment syndrome
What occurs during stage 1 of burns: emergent phase
And what symptoms will the patient experience
First 12-24 hours
Pain response
Catecholamine release (pt feeling anxious)
Tachycardia, tachypnea, mild HTN, mild anxiety
What occurs during stage 2 of burn: diuresis phase how long does this phase last?
Lasts 18-24 hours (reaches peak in 8 hours)
Damaged cells initiate *inflammatory response
- increased blood flow to cells
- shift of fluid from intravascular to extravascular (3rd spacing)
- MASSIVE EDEMA d/t “leaky capillaries”
Treatment for stage 2 of burn (diuresis phase)
Pt has no BP b/c fluid in wrong place (distributive shock) so need to constrict vessels
*Give dopamine/dobutamine
What occurs with stage 3 of burns: hypermetabolic phase how long does it last?
Lasts for days to weeks
Large increase in body’s need for nutrients as it repairs itself
Need protein
What occurs with stage 4 of burns: resolution phase
Scar formation
General rehabilitation and progression to normal function
Effect of burns on cardiac system
Myocardial depression
Fluid shift causing distributive shock:
- hypovolemia
- decreased CO
- edema
Peripheral ischemia
- burn shock (distributive & hypovolemic)
Burn effects on lungs
Smoke inhalation cause pneumonia = most common cause of death
Effect of burns on GI system
Ileus if > 20% TBSA burn (NG tube needed)
Malabsorption
Ischemia
Curling’s ulcers
Hypercatabolism
Burns effect on the hematopoietic system
RBCs consumed or damaged
Platelets destroyed
Granulocytosis
Huge stimulation of bone marrow to reproduce blood cells
Effect of burns on the renal system
Decreased perfusion (pre renal)
Effect of burns on the immune system
Immune suppression
More susceptible to bacteria, viruses, fungi
Failure to reject cadaver skin or mesh
*Pre hospital treatment of burns
**Occurs out in the field, before pt is in nurses’ care
Extricate pt / stop the burn
Remove clothing/jewelry
Primary survey ABC / brief D-I
Give 100% O2
Cover burn with sterile white sheet
Cover pt to prevent hypothermia
Irrigate chemical burns
Transport to a burn center
*Decontamination prior to transport
*Cool the burn within 30 minutes (to cool down inflammatory response)
What are we assessing for during assessment of airway / breathing on intake of burn patient?
Assess for:
*change in voice
* hoarseness
obstruction
emesis
edema
blood
*facial burns with singed hair
* stridor
Initial treatment for airway of burn patient
100% O2 on all patients
Consider intubation d/t likelihood of impending airway obstruction: *tube them if any question
Initial treatment for circulation of burn patient
- Insert 2 large bore IVs
*LR = fluid of choice b/c extra nutrients
Obtain labs:
- CBC
- BMP
- Mg and phos
- ABG
- CO
- PT/PTT
Initial assessment for disability on burn pt
Check neuro status
What does expose mean for a burn pt?
*Remove all clothing and jewelry
Assess entire body for acute injuries
What does environment mean for a burn pt?
Cover pt to prevent hypothermia
Control family and room
What does estimate mean for a burn pt?
*Estimate the burn injury
3 ways to estimate % of TBSA burned
Rule of palms
Rule of nines
Lund & browder chart
When is rule of nines used to measure area of burn?
*for large surface areas quickly
What are the percentages for each body part when measuring BSA for rule of nines
Head = 9%
Arms = 9%
Anterior torso = 18%
Back = 18%
Legs = 18%
Groin = 1%
Measurement best used when burn is < 10% of BSA
Rule of palms
*What is the rule for fluid resuscitation called?
*Parkland Formula
What need to be in place to be able to use the Parkland Formula?
2 large bore IVs
Foley catheter
Crystalloid of choice for fluid resuscitation
*LR
(Blood administration not recommended for fluid replacement)
Guidelines for fluid resuscitation for UOP
*Goal = 0.5 mL/kg/hr
(No more and no less, to prevent adverse effects)
*Parkland formula
*2-4 mL x weight in kg x % TBSA burned = amt to infuse over 24 hours
*What is are the guidelines for resuscitation using the parkland formula after amt to be infused is determined?
Give 1st half over first 8 hours *from time of incident
Give 2nd half over second 16 hours
Used for 2nd and 3rd degree burns only
Drug of choice for comfort for burns
*Morphine
Treatment of GI after burn
*NPO until transfer to burn center
*NG tube for all pts who have 20 or greater TBSA to prevent ileus
Tules for wound care for a burn *Prior to transfer to a burn center
Transfer in dry sterile sheet or kerlex
Do not use NS
Do not place topical medication
Do not debridement the patient prior to transport
Give morphine
