Burns Flashcards
Rule of Nine's Head & Neck Trunk Arm Leg Genitals
Head & Neck - 9% Trunk - Front: 18%, Back: 18% Arm - 9% each Leg - 18% each Genital - 1%
Parkland Formula
Kind of fluid? When to start it? How much fluid for each 8h?
4mL LR x Body weight Kg x TBSA
START FROM INJURY, not when seen
1st 8 hours: ½
2nd 8 hours: 1/4
3rd 8 hours: 1/4
How to determine if fluid volume is adequate
Urine Output! NOT daily weight because they are losing this fluid FAST
Temperature of water to use on burn patient
Cool water
Medication for burn patients because of their fluid shift?
Albumin
Because burn patients are getting fluids fast, what is a good way to determine if we are fluid overloading the patient?
CVP - Right atria pressure
We want to prevent R HF
How do we give pain meds to burn patients
IV
Not PO because they may not be able to swallow and they work slowly
Not IM because they might not have enough muscle perfusion
Type of immunization if they need protection from Tetanus NOW
Immune globulin: Passive immunity
Type of immunization to give to prevent Tetanus
Tetanus Toxoid: Active immunity.
This takes 2-4 weeks for the body to make the antibodies
4 things to a assess circulation
Pulse
Skin color
Skin temperature
Cap refill
NOT TURGOR
Escharatomy vs Fasciotomy
Escharatomy: Cut through eschar to relieve pressure and restore circulation
Fasciotomy: Deeper incision through fascia to restore circulation
Need to assess UO how often in a burn patient
qh
Why might not the burn patient have adequate perfusion to the kidneys?
Kidneys will retain fluid because of fluid loss, or will not be perfused at all
Why are we worried about red/brown urine?
When muscle is damaged, myoglobin is released and needs to be perfused through the kidneys, but if the myoglobin clogs the kidneys, it may lead to Renal failure and we need to call the doctor with this color of urine
Medication to flush out the kidneys
Mannitol - don’t refrigerate
Only diuretic to use on burn patient
When should the patient start to diurese?
Fluid returns to vascular space in 48 hours if the kidneys are working
Is K high or low? Why?
HIGH because K is stored mostly within the cells and injury causes cells to lyse
Reasons for Antacid, H2 Antagonists, PPIs to be ordered?
Magnesium carbonate (Mylanta), pantoprozole, or famotidine
Prevent Stress ulcer (Curlings ulcer)
Why is the burn patient made NPO with NG tube?
When is NG removed?
They could develop a paralytic ileus
This is d/t hypovolemia, decreased GI motility (least perfused with trauma), and hyperkalemia (muscle weakness)
NG is removed with return of bowel sounds
What key diet components would a burn patient need?
Protein and Vitamin C - More calories!! Hyper metabolic state!!
How to assess whether GI feedings are moving through the intestines?
Residual
If there is a lot of residual, you will want to hold the next feed
How to ensure proper nutrition and a positive nitrogen balance in a burn patient?
Pre-albumin - lab that changes first
NOT BUN - BUN is a kidney thing, not nutrition indicator
Any who who is starving has a negative balance
Preventing contractors in hands and neck
Wrap each finger separately and put on a splint
Neck: Head hyperextended without pillows
Does eschar need to be removed?
YES or else new tissue can’t form and bacteria love to grow in eschar
Type of isolation for burn patients
Protective isolation
How does enzymatic debridement work? Where/when can’t we use it?
Sutilains, Collagenase
It eats dead tissue
DO NOT USE on face, over large nerves, if open to a body cavity or if pregnant
Hydrotherapy is used to do what? What do these patients need? What is a risk?
Debridement
PAIN MEDS
Cross contamination
Why do burn patient antibiotics drugs need to be alternated?
Bacteria build up resistance or tolerance
Why kind of antibiotics are best?
Narrow-Spectrum because these will prevent superinfection or 2nd infections
May only use broad spectrum while waiting for wound cultures - must culture before starting
Mycin drugs… when do we worry?
If BUN or creatine increases
If patient complains of hearing loss
These drugs can lead to ototoxicity and nephrotoxicity
How often can harvesting be done to a well nourished site
every 12-14 days
What to do if skin graft becomes cool/blue?
Roll over it with q tips from the center out to remove anything under it (blood, exudate)
What happens if graft comes off?
Put on sterile saline dressing over the graft, then cover with a dry sterile dressing, then call the physician
How long to flush chemical burn
15-30 min water
First thing to do with an electrical burn? Why?
Heart monitor for 24 hours
Hight risk for V FIB
Electrical wounds have what?
Entrance and Exit
Usually blow out exit
what can build up with electrical injuries?
Myoglobin and Hgb… Risk of renal damage
ED electrical burn… How do we position them?
Place on a spine board w/ C Collar… these tend to occur in high places and the force of electricity and cause physical force
Are amputations common in electrical burns?
Yes because circulation is destroyed
What part of the body does electricity destroy?
Nerves –> Risk for cataracts, gait problems
