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Third Module 251 > Burns > Flashcards

Burns Flashcards

priorities on scene

1
Q

What are the priorities of urgent care on the scene?

A
  • smother flames on patient
  • secure airway/observe respirations
  • remove clothing UNLESS its is stuck to the burn
  • remove all jewelry: swelling and cuts circulation
  • Keep pt clean, warm, and dry
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2
Q

Problems with cool water?

A
  • Cool water can only be applied on minor burns.
  • Would cause hypothermia on most burns: impaired temp regulation
  • We need to keep the pt clean, wrm and dry.
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3
Q

Electrical burns (what to do?)

A

CPR and EKG

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4
Q

Chemical burns

A
  • Do not apply liquids
  • Brush off chemical
  • Remove clothes.
  • Determine the chemical (call poison control)
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5
Q

Radiation

A
  • Remove the source
  • Remove the clothes
  • Transport to decon shower
  • Assist with decon shower
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6
Q

Resuscitative phase/Emergent Phase

A
  1. Secure Airway
  2. Observe Respirations
  3. Support circulation + organs (fluids)
  4. Keep pt comfortable with analgesics (IV morphine, maintain body temp w/ blankets , warm enviroment).
  5. Prevent infection (wound care +IM tetanus)
  6. Monitor unrine output (foley catheter)
  7. Emotional support
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7
Q

Upper Airway Obstruction

A

related to edema: rapid obstruction which occurs from thermal injury. MOST CONCERNING with burns to the face, lips, ears and neck.

  • Soot in the airway
  • singed eyebrow/nasal hair
  • any black carbon in the nose/mouth/sputum
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8
Q

Lower airway obstruction

A

Involves damage to the lower respiratory system: inhalation of chemicas/byproducts of fire (soot).
Irritation from the checmicals strips away the resp mucosa which leads to an inflammatory response = edema and release of histamines.

** carbon monoxide poisoning is leading cause of death

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9
Q

Carbon monoxide poisoning

A

LEADING CAUSE OF DEATH
binds to the hemoglobins displacing oxygen leading to asphyxiation and systemic toxicity.

  • pts with carbon monoxide poisoning may have a cherry red appearence.
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10
Q

Breathing

A

S/S upon assessment:
- Altered LOC
- Dizziness
- Nausea
- Hoarse voice
- Presence of cough
- Drooling/swallowing issues
- SOB
- Tachypnea
- Accessory muscles
- Rales
- Stridor/wheezes (partial obstruction)

If wheezing stops, pt needs STAT intubation.
Be prepared with intubation kit.

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11
Q

Circulation

A

Hypovolemia from intravascular volume depletion from inflammatory response + histamine relase.

  • capillary leak syndrome = increase of protein leakage
  • increased BP + HR
  • decreased cardiac output + MAP
  • third space shift of fluids (edema + hemoconcentration = elevated levels of H+H)
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12
Q

Parkland (Baxter) formula

A

4mL X kg X BSA%

1/2 to be given in the first 8 hours
1/4 (half again) in each of the next 8 hours.

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13
Q

Debridement

A

The process of taking away tissue that is no longer healthy to promote a healthy enviroment for tissue healing + prepare for grafting

very painful.

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14
Q

Nursing interventions for infection prevention

A
  • providing isolation
  • meticulous handwashing
  • wearing + changing gloves between care of each wound to prevent auto contaminiation (pt’s natural flora overgrows and invades)
  • cleaning equipment daily
  • not sharing equipment between patient rooms
  • No plants/Raw food in pt rooms
  • administer vaccine/antibiotics/topical microbials = silvadene, silver diazene
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15
Q

Superficial - 1st degree burn

A
  • pink
    -mild edema
    -painful/sensitive to heat
  • no blisters/eschar
  • heals in 3-5 days
  • sunburn
  • flash burns
  • external radiation from cancer treatment
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16
Q

Partial - thickness superifcial - 2nd degree burn

A
  • pink
  • has blisters
  • extremely painful
  • takes 2-4 weeks to heal
17
Q

Deep partial thickness (2nd degree) + full thickness (3rd degree)

A

both similar
- red to white in color w/ moderate edema. Usually no blisters.
- Eschar is present.
- results from scalds, flames, tar grease, chemicals, and prolonged contact with hot objects.

Second degree:
- minimal pain (sense of pressure)

Third degree:
- painless = destruction of epidermis + dermis

18
Q

Deep Full thickness (4th degree)

A
  • involves muscles tendons and bone
  • black, hard inelastic eschar
  • no blisters, edema, pain
  • skin grafting required
  • takes weeks to months for smaller areas to heal
19
Q

escharotomy

A

performed on circumferential burns restricting circulations
a surgical incision using a cauterization laser is done to relieve pressure adn allow blood flow
usually performed with 2-6 hours of burn injury

20
Q

Major Organs affected from burns

A
  • Cardiovascular = will remain low for 18-36 hrs post burn
  • Respiratory
  • Renal
  • GI
  • Immune system
21
Q

Findings of adequate fluid resuscitation

A
  1. urine output of >30mls/hour
  2. systolic BP > 90 or HR <120bpm
22
Q

Acute Phase - after 24 hours

A

Frequent wound care to prevent infection
Debridement of necrotic tissue
Surgical interventions like skin grafts or debridement may be required
Nutritional support to promote healing

23
Q

Rehabilitation phase

A

Physical therapy to regain range of motion
Scar management with pressure garments or silicone gel sheeting
Psychological support to address emotional impact of the burn

24
Q

safe water temperature

A

120 F is maximum
110 for seniors

lower cost

25
Q

Classification of burn injuries = MAJOR

A

MAJOR burn injury
25% TBSA <40 years
20% TBSA >40 years
20% TBSA <10 years
burn to the face, eyes, ears, hands feet or perineum
high voltage/contaminant inhalation/major trauma

26
Q

complications for cardiovascular after burns

A

cardiac output remains low for 18-36 hours then improves as capillary leak stops and fluid shifts back into the intravascular space.
monitor for:
- Edema
- BP
- Central + peripheral pulses
- Cap refill
- O2 Saturation
EKG - arrythmias/cardiac damage

27
Q

Respiratory complications

A

cues would be related to airway edema from super heated air, steam, toxcic fumes, and chemicals

  • difficulty swallowing
  • drooling
  • hoarseness in voice
  • bronchospasm
  • mucosal congestion
  • adventitious sounds: ronchi/stridor/wheezes
  • evidence of infection/pneumonia
  • hypoxemia
  • Acute Respiratory Distress Syndrome (ARDS)
28
Q

Renal Complications

A

AKI - circulating volumes are low resulting in decreased blood flow to the kidneys, GFR declines

muscle damage from burn injury causes protein myoglobulin to be released in the blood creating a sludge which will need to be filtered out in the kidneys FURTHER injurying the kindeys

  • ensure adequate fluid resuscitation of 5mls/kg
  • Monitor BUN, creatinine, GFR, and spec gravtity.
29
Q

GI complications

A

decreased cardiac output = decreased blood flow to the GI tract
- impairing gastric motility + integrity
-decreases nutrient absorption
-increases abdominal pressure
increased mucosal permeability, mucosal ulceration, and GI hemorrhage
Monitor:
- F+E balance
- Anemia
- nutritional status
- decreased bowel sounds
- abdominal distention
- N/V

30
Q

interventions for paralytic ileus

A

NG tube placement
administration of proton pump inhibitor (-prazole)
h2 medications

31
Q

immune system complications

A

reduced immune function
open wounds + decreased total body protein increase risk of infection.

32
Q

Resucitation/Emergent phase

A
  • begins at the time of injury
  • ends with restoration of normal capillary permeability
  • duration is 48-72 hrs
  • includes prehospital care + ED care
33
Q

Resuscitative phase

A
  • begins with the initiation of fluids
  • ends w/ capillary integrity returns to near normal levels and large fluid shifts have decreased
  • amount of fluid is administered based on pt weight, and extent of injury
    -most fluid replacement formula are calculated from the time of injury (not when they arrive from hospital)

**prevent shock by maintaining adequate circulating blood volume + maintaining vital organ perfusion

34
Q

Acute phase

A
  • begins when the pt is hemodynamicallty stable, cap permeability is restored, and diureses has begun
    -usually begins in 48-72 hrs after time of injury
    -FOCUS: infection control, woudn care, wound closure, nutritional support, pain management and PT
35
Q

Rehabilitative Phase

A
  • Overlaps acute phase of care
  • extends beyond hospitalization

** designed that the pt can gain independence and achieve maximal function

Third Module 251 (3 decks)

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