Burns Flashcards
priorities on scene
What are the priorities of urgent care on the scene?
- 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
Problems with cool water?
- 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.
Electrical burns (what to do?)
CPR and EKG
Chemical burns
- Do not apply liquids
- Brush off chemical
- Remove clothes.
- Determine the chemical (call poison control)
Radiation
- Remove the source
- Remove the clothes
- Transport to decon shower
- Assist with decon shower
Resuscitative phase/Emergent Phase
- Secure Airway
- Observe Respirations
- Support circulation + organs (fluids)
- Keep pt comfortable with analgesics (IV morphine, maintain body temp w/ blankets , warm enviroment).
- Prevent infection (wound care +IM tetanus)
- Monitor unrine output (foley catheter)
- Emotional support
Upper Airway Obstruction
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
Lower airway obstruction
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
Carbon monoxide poisoning
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.
Breathing
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.
Circulation
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)
Parkland (Baxter) formula
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.
Debridement
The process of taking away tissue that is no longer healthy to promote a healthy enviroment for tissue healing + prepare for grafting
very painful.
Nursing interventions for infection prevention
- 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
Superficial - 1st degree burn
- pink
-mild edema
-painful/sensitive to heat - no blisters/eschar
- heals in 3-5 days
- sunburn
- flash burns
- external radiation from cancer treatment
Partial - thickness superifcial - 2nd degree burn
- pink
- has blisters
- extremely painful
- takes 2-4 weeks to heal
Deep partial thickness (2nd degree) + full thickness (3rd degree)
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
Deep Full thickness (4th degree)
- 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
escharotomy
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
Major Organs affected from burns
- Cardiovascular = will remain low for 18-36 hrs post burn
- Respiratory
- Renal
- GI
- Immune system
Findings of adequate fluid resuscitation
- urine output of >30mls/hour
- systolic BP > 90 or HR <120bpm
Acute Phase - after 24 hours
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
Rehabilitation phase
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
safe water temperature
120 F is maximum
110 for seniors
lower cost
Classification of burn injuries = MAJOR
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
complications for cardiovascular after burns
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
Respiratory complications
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)
Renal Complications
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.
GI complications
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
interventions for paralytic ileus
NG tube placement
administration of proton pump inhibitor (-prazole)
h2 medications
immune system complications
reduced immune function
open wounds + decreased total body protein increase risk of infection.
Resucitation/Emergent phase
- begins at the time of injury
- ends with restoration of normal capillary permeability
- duration is 48-72 hrs
- includes prehospital care + ED care
Resuscitative phase
- 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
Acute phase
- 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
Rehabilitative Phase
- Overlaps acute phase of care
- extends beyond hospitalization
** designed that the pt can gain independence and achieve maximal function
