BURNS Flashcards
BURNS
The risk of death increases in the very___ and the very__
Old. why?
Young. why?
Old; young
-Old. Because when you’re old, you don’t have have as much subQ fat, therefore, the burn can go deeper
-A child has very little body surface area
(The greater of surface area affected, the greater the chance of death)
Where do most burn occur?
At home
- Cover electrical sockets
- make sure the hot water heater is not set too high
- Turn pot handles inwardly on the stove
- not putting hot things on the table with a table cloth because the toddler can pull on it
Plasma seeps out into the tissues due to increased ____ permeability. How?
Are they at increased risk for shock? why?
When does the majority of “leaking”/ 3rd spacing occur?
capillary
- The heat has damaged the vessel, so fluid is leaking from the vascular space and into the tissue.
- Yes; because the volume of fluid inside of the vascular space is decreasing because it is going to the interstitial space.
- 1st 24 hours
During 3rd spacing, or the 1st 24 hours of a burn, the patient becomes very edematous:
___ pulse
___ cardiac output
___ urinary output
increased
decreased
decreased
Why is epinephrine secreted?
It will make you vasoconstrict in order to reserve volume & shunt blood to vital organs
Why are ADH & Aldosterone?
ADH= to retain water
Aldosterone= retain sodium & water
(therefore, your blood volume will go up)
What is the most common airway injury?
Carbon monoxide poisoning
What’s the treatment for carbon monoxide poisoning?
100% Oxygen
T OR F?
A patient with carbon monoxide poisoning can get their o2 stats checked with a pulse-oximeter
F!
It will not let you know that this patient has no O2 in their blood stream. It will pick up whatever is bound to the hemoglobin and you’ll get a normal reading even though it is the carbon monoxide that is bound to the hemoglobin
What is the name of the test that is used to determine the level of carbon monoxide poisoning?
Caborxyhemoglobin
Why is it important to determine if the burn happened in an open or closed space?
closed space= more carbon monoxide inhalation
When you see a patient with burns to the neck, head, face, chest, YOU HAD BETTER THINK____
Airway
one of the most important aspects of burn management is____ ___
fluid replacement
Why is albumin NOT given during the 1st 24hrs of a burn?
T OR F?
it is not uncommon for albumin to be given after a major burn
What does albumin hold on to in the vascular space?
What will happen to the workload of the heart?
It will just leak out too because the vessel walls are too weak
T!
Fluid
workload will increase because albumin will increase the fluid volume in the vascular space which will increase the workload of the heart because there’ll be more to pump.
on any patient who is getting fluids rapidly, what is the measurement you can take hourly to make sure you’re not overloading them?
What does it mean when you see the CVP number go up too fast? what can it cause?
- CVP (central veinous pressure—- right atrial pressure)
- all you’ve done is filled up the right atrium with fluid
- right sided heart failure
Why is it important to know that the burn injury occured at 11pm?
because fluid therapy for the 1st 24hrs is based on the time the injury occured, NOT WHEN TREATMENT WAS STARTED!
When burned, what are 2 vaccines given to the patient? why?
Tetanus toxoid plus the immunoglobulin
Because tetanus toxoid takes 2-4 weeks to produces antibodies naturally (active immunity), so the immunoglobulin is already a form of antibodies because this patient needs it now. (Immediate protection/ passive immunity)
Is there more Death with upper or lower body burns?
Upper due to airway/ respiratory system
What’s a circumferential burn?
Burn that goes all the way around body part, and has the potential to cut off circulation because the damaged tissue can form a tourniquet.
The 4 MAJOR check marks when doing a circulatory checks of an extremity.
- Skin color
- temperature
- cap refill
- pulse (priority assessment)
NEVER PUT___ ON A BURN! why?
ICE; it causes too much vasoconstriction
Why should all jewelry be removed?
- Swelling
- Metal gets really hot
Singed facial hair
dark sputum
soot all over face (due to smoke inhalation)
all indicate
indicate probable airway injury
T OR F?
A patient comes to the E.R and the nurse inserts a foley and sees dark red/ brown urine. The nurse quickly calls the doctor to notify him. The doc says that this is normal after a major burn
T!
True due to a lot of cellular destruction and they can only excrete through the kidneys.
What’s the number one concern with cellular destruction?
Broken down cells can clog up your kidneys & you gotta worry about renal failure
what are 2 drugs that may be ordered to perfuse the kidneys after a burn?
Lasix
Dobutamine (increase cardiac output which will increase kidney perfusion)
After 48 hours from a burn, the fluid will start going back into the vascular space, and begin to ___
diurese
What’s the relationship between burns and potassium?
burns= cell destruction= K+ released to serum= increased K+ levels
Why would this patient be prescribed an antacid?
stress ulcers can occur (curling’s ulcer)
Why does the doctor want this burn patient to be NPO or have an NGT hooked to suction?
When will the NG tube be DC’d?
Paralytic illeus
What do you need in your diet to promote wound healing?
Protein and vitamin C
When you start GI/ Tube feedings, what can be measured to make sure that the food is moving through the GI tract ok?
gastric Residuals (always push the fluid back into the patient)
What are some lab work you can check to ensure proper nutrition and a positive nitrogen balance?
Total protein or ALBUMIN
What are some way to prevent contractures from burns? examples… a burned hand.
Splint the hand to prevent contractures & wrap each fingers individually/ separately. if they are not wrapped individually, the skin will grow on them together.
What do you wanna do to a neck burn during the healing process?
Hyperextend the neck because that skin will pull it down if now hyperextended & DO NOT use pillows
If the patient has a perineal burn, THE #1 COMPLICATION WILL BE____
Infection
What’s eschar?
does it need to be removed?
what likes to grow on it?
isolation type?
burned dead tissue
yes
bacteria
protective/reverse isolation
Travase or collagenase are____
enzymatic drugs that eat dead tissue/debriding drugs
What’s another way to debride the skin?
whirlpool or hydrotherapy
What MUST be done before ANY debridement?
pain medication
The MOST Important things to know about obtaining wound cultures & starting antibiotics.
YOU NEVER start antibiotics until the cultures have been obtained.
If a patient has a chemical burn, what should you do?
Powdered chemical burn?
If a electrical burn, there will be 2 wounds. what are they?
flush it with water
brush it off
entrance & exit wounds
If a patient comes in with an electrical injury, what’ s they first thing you should do?
Put them on a heart monitor for 24 hours; at risk for v.fib
with electrical burns, toxins can build up and cause___ damage.
With electrical injuries, it is not uncommon for this patient to be placed on a ____ board with a ___ collar. Because electrical injuries tend to occur in high places.
kidney
spine; Cervical
(C.spine injuries tend to occur)
Why are amputations common in electrical injuries?
other common complications are_____
Electricity kills vascularity
neuro deficits
