Burns Flashcards
When someone has an electrical burn injury, what other injuries should be assumed?
C-spine (always assume this)
Limb fractures
Spinal fractures
What is a partial thickness burn?
Both 1st and 2nd degree burns (not called this anymore)
What is a full thickness burn?
What will be the appearance?
3rd and 4th degree burns (not called this anymore)
Can look dry, waxy, brown, charred, leathery, hard
Possible muscle, tendon, bone involvement
Will require surgery
1st thing done when burn patient presents to ER?
Cooling shower
Cover with dry, clean sheet
What are the priority nursing concerns in the emergent phase of burn care?
Fluid and electrolyte shifts
Gas exchange
What is burn shock?
S/sx:
Identifying labs?
Combo of distributive (from 3rd spacing) and hypovolemic shock
S/sx: hypotension, tachycardia, tachypnea
High hematocrit levels will be the identifier
Will also have Na+ and K+ imbalances
May have low WBCs
Leading cause of death in patients with inhalation injury?
Pneumonia
Danger associated with circumferential burns?
May impair blood flow to distal sites
If around chest, may prevent normal chest rise and fall
Surgery performed to incise eschar tissue and allow blood to flow to distal sites?
Escharotomy
What is the most common complication in emergent phase of burn?
AKI
Hypovolemia + RBC breakdown dumped into system + myoglobin (from muscle breakdown) = high blood viscosity and blocked renal tubules
Classic sign of CO poisoning?
How is CO detected in blood?
Cherry red skin
Pulse ox will not read correctly. It can’t differentiate between oxygen and carbon monoxide in blood. Will read normally.
Must use pulse CO monitor.
Airway management in emergent phase of burn?
High fowlers
100% O2 with NRB
Deep breathing and coughing hourly
Reposition frequently
Emergency measures needed in burn patient.
ABCs
2 Large bore IVs (the more the better)
Aggressive fluid resuscitation
Foley (will monitor urine output carefully)
Shower and wound care
Tetanus toxoid shot
Nutrition ASAP
Fluid resuscitation formula
2ml/kg/%TBSA
Will be LACTATED RINGERS
This will give you the total ml needed IN 24 HOURS.
Take that number and divide it out as follows:
1/2 over first 8 hours
1/4 over second 8 hours
1/4 over third 8 hours
EX: 70 kg patient with 50% burns
2 x 70 x 50=7,000 ml
7000 divided by 2= 3500
1st 8=3500
2nd 8=1750
3rd 8=1750
You will watch for signs of fluid overload and carefully monitor urine output.
Urine output goals in fluid resuscitation post burn
Adults: 0.5—1 ml/kg/hour
Children: 1—1.5 ml/kg/hour
Which type of burn is at greater than normal risk for AKI?
Electrical (this is because of all the muscle damage)
They sometimes require additional osmotic diuresis using Mannitol
Need urine output of 75–100 ml/hour.
Why is nutrition important in burn patients?
Body will be in hyper metabolic state.
Needs high protein and carb diet to heal and prevent weight loss
Rule of 9’s:
Arms (each, front and back)=9
Anterior leg=9
Posterior leg=9
Anterior torso=18
Posterior torso=18
Front head/face=4.5
Back head/face=4.5
Genital=1
