Burns Flashcards
thermal burns
exposure to heat sources such as hot metals, scalding liquids, steam, or flames
most common type of burn injury
chemical burns
contact with acids, alkalines, or organic compounds can cause chemical burns through absorption, inhalation, or ingestion
examples: lye, sulfuric acid
electrical burns
intense heat generated from an electric current
cold thermal injury
frostbite
complications of electrical burns
current passing through vital organs such as brain, heart, kidneys have additional manifestations
electric current can cause muscle contractions strong enough to fracture long bones and vertebrae, can propel body and cause spinal/limb fractures
respiratory arrest
metabolic acidosis
myoglobinuria
cardiac arrest
v-fib
partial-thickness burn
involve the epidermis and sometimes part of the dermis
full-thickness burn
epidermis and dermis are destroyed
1st degree burn (superficial partial thickness) manifestations
erythema, blanching on pressure, pain, mild swelling
no vesicles or blisters (may blister/peel after 24 hrs)
2nd degree burn (deep partial thickness) manifestations
fluid-filled vesicles that are red, shiny, wet if ruptured
severe pain caused by nerve injury
mild to moderate edema
3rd and 4th degree burn manifestations (full thickness)
dry, waxy white, brown or charred, leathery, or hard skin
visible thrombosed vessels
insensitivity to pain
possible muscle, tendon, bone involvement
eschar
full-thickness nonviable burn tissue
face, neck, circumferential torso burns may interfere with ____________
gas exchange
full thickness extremity burns can impair ________
perfusion distal to injury
prehospital care for small thermal burns
cover with clean, cool, dampened towel
prehospital care for large thermal burns
if unresponsive, CAB
if responsive, ABC
flush wounds with cool water, wrap pt in dry, clean sheet or blanket
cool burns for no more than 10 min, do not immerse or cover with ice
emergent phase: time frame and priorities
up to 72 hours after initial injury
fluid/electrolyte shifts: hypovolemic shock
gas exchange
fluid and electrolyte shifts are caused by
increased capillary permeability
colloidal osmotic pressure decreases - fluid shifts out of vascular space into interstitial spaces (third spacing)
increased insensible losses
injured cells release K+ into circulation
Na+ moves to interstitial spaces
manifestations of emergent phase
hypovolemic shock
edema
weeping skin
pain
blisters
paralytic ileus
hypo/hyperthermia
AMS
complications of emergent phase
dysrhythmias
impaired circulation
VTE
airway burns/injury - respiratory distress, altered ABGs
HF
pulmonary edema
pneumonia
WBC decrease
AKI
nursing management of emergent phase
2 large bore IVs
central line for burns >20% TBSA
arterial line
Parkland (Baxter) formula for fluid replacement
intubation
O2
high fowler’s
suctioning
chest PT
bronchodilators
monitor I&O
wound care
no pillows, use rolled towel
Parker (Baxter) Formula
2ml LR / weight in kg / TBSA
Given fluid vol to administer in 24 hours:
administer 50% in first 8 hours
25% in second 8 hours
25% in last 8 hours
medications for emergent phase
Lactated Ringers
Heparin (VTE prophylaxis)
Tetanus shot
bronchodilators
morphine
hydromorphone
haldol
lorazepam
silver sufadiazine
IV abx
allograft
from skin donor
autograft
patient’s skin is used
commonly from thigh, abdomen
