Burns

Question 1

What are the priorities of urgent care on the scene?

Answer 1

• 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

Question 2

Problems with cool water?

Answer 2

• 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.

Question 3

Electrical burns (what to do?)

Answer 3

CPR and EKG

Question 4

Chemical burns

Answer 4

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

Question 5

Radiation

Answer 5

• Remove the source
• Remove the clothes
• Transport to decon shower
• Assist with decon shower

Question 6

Resuscitative phase/Emergent Phase

Answer 6

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

Question 7

Upper Airway Obstruction

Answer 7

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

Question 8

Lower airway obstruction

Answer 8

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

Question 9

Carbon monoxide poisoning

Answer 9

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.

Question 10

Breathing

Answer 10

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.

Question 11

Circulation

Answer 11

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)

Question 12

Parkland (Baxter) formula

Answer 12

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.

Question 13

Debridement

Answer 13

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

very painful.

Question 14

Nursing interventions for infection prevention

Answer 14

• 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

Question 15

Superficial - 1st degree burn

Answer 15

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

Question 16

Partial - thickness superifcial - 2nd degree burn

Answer 16

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

Question 17

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

Answer 17

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

Question 18

Deep Full thickness (4th degree)

Answer 18

• 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

Question 19

escharotomy

Answer 19

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

Question 20

Major Organs affected from burns

Answer 20

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

Question 21

Findings of adequate fluid resuscitation

Answer 21

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

Question 22

Acute Phase - after 24 hours

Answer 22

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

Question 23

Rehabilitation phase

Answer 23

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

Question 24

safe water temperature

Answer 24

120 F is maximum
110 for seniors

lower cost

Question 25

Classification of burn injuries = MAJOR

Answer 25

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

Question 26

complications for cardiovascular after burns

Answer 26

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

Question 27

Respiratory complications

Answer 27

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)

Question 28

Renal Complications

Answer 28

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.

Question 29

GI complications

Answer 29

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

Question 30

interventions for paralytic ileus

Answer 30

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

Question 31

immune system complications

Answer 31

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

Question 32

Resucitation/Emergent phase

Answer 32

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

Question 33

Resuscitative phase

Answer 33

- 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

Question 34

Acute phase

Answer 34

- 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

Question 35

Rehabilitative Phase

Answer 35

- Overlaps acute phase of care - extends beyond hospitalization ** designed that the pt can gain independence and achieve maximal function