Burns

Question 1

Thermal burns are caused by

Answer 1

Flame, flash, scald, or contact burns

Question 2

In the case of thermal burn, what should a client do

Answer 2

1. Stop, drop, and roll to shut off o2 supply to oxygen, flush with cold water
2. Cover with clean cover
   * do not remove clothes (cut if possible) you may tear off skin

Question 3

Chemical burns are the result of

Answer 3

Contact with acids, alkalis and organic compounds

Question 4

Why do alkalis burn more difficult than acid burns

Answer 4

Alkalis burns adhere to tissue causing protein hydrolysis and liquefaction

Question 5

What should a client do if they are experiencing a chemical burn

Answer 5

Remove self from agent
Flush with water
Remove clothes if possible

Question 6

How are electrical burns caused

Answer 6

Result from intense heat generated from electrical current. They damage vessels, nerves, and can cause anoxic and death

Question 7

Describe 1st degree burns

Answer 7

Superficial partial thickness only epidermis, pink-red, slight edema and mild pain

Question 8

Describe 2nd degree burn

Answer 8

Deep partial thickness includes epidermis and dermis, painful, red blisters

Question 9

Describe 3rd

Answer 9

Full thickness, includes epidermis, dermis, subcutaneous, nerve endings
Little to no pain

Question 10

Describe 4th degree burns

Answer 10

All parts from 3rd plus down to bone and organs. Dry, waxy, leathery, hard skin, no pain

Question 11

What is the rule of nines

Answer 11

Is a tool used to assess the total body surface area % in pt with burns.

1. Head & neck= 9%
2. Upper extremity= 9%
3. Lower Extremity= 18%
4. Anterior trunk= 18%
5. Posterior Trunk= 18%
6. Genitalia= 1%

Question 12

What are the vascular changes that occur in burn pt

Answer 12

1. Decrease in blood flow (occluded blood vessels)
2. Damage to macrophages in tissue (these cause constriction of vessel)
3. Circulatory disruption at burn site
4. Blood vessel thrombosis (can cause necrosis)

Question 13

What contributes to the massive fluid shift in burn pt

Answer 13

Fluids shift out of blood vessels as a result of increased capillary permeability the fluid shifts in the interstitial spaces

Question 14

Are superficial burns included in the TBSA calculation

Answer 14

No

Question 15

The fluid shift has what effect on blood volume and pressure

Answer 15

It causes them to decrease

Question 16

What are the complications that occur due to the fluid shift

Answer 16

Hypovolemia, metabolic acidosis, hyperkalemia, hyponatremia, hemoconcentration

Question 17

Describe the steps in fluid demobilization

Answer 17

1. Occurs 24hrs after capillary leakage stops
2. Diuretic stage; edema fluid shifts to vascular space
3. Blood volume increases, increase renal blood flow and diuresis
4. Body weight returns to normal
5. Develop hypokalemia

Question 18

What is Curling Ulcer

Answer 18

Acute ulcerative gastroduodenal disease that occurs 24hrs after burn.

Question 19

What causes Curling ulcer

Answer 19

Reduced GI blood flow and mucosal damage

Question 20

How is Curling ulcer managed

Answer 20

H2 blockers, mucoprotectants and early enteral nutrition. Watch for sudden drop in hemoglobin

Question 21

What are the three phases of burn injuries

Answer 21

Emergent, Acute, Rehabilitative

Question 22

Describe the emergent phase of burn injuries

Answer 22

resuscitative phase; time required to resolve the immediate ice threatening problems

Question 23

How long does the emergent phase of burns last

Answer 23

From the onset of burn to the beginning of fluid demobilization and diuresis. Usually 24-48hrs

Question 24

What are the primary goals of the emergent phase

Answer 24

1. Secure airway
2. Fluid replacement (support circulation)
3. Analgesics (comfort)
4. Prevent infection (wound care)
5. Maintain body temperature
6. Provides emotional support

Question 25

What is the fluid replacement used during the emergent phase

Answer 25

Lactated ringers w/o destrose

Question 26

T/F CO position is the most immediate cause of death from the fire

Answer 26

True

Question 27

What are the signs and symptoms of Carbon Monoxide poisoning

Answer 27

``` Edema in airway Hoarseness Dysphagia Strider Copies secretions black tinged Substernal retractions ```

Question 28

What intervention need to be performed if CO poisoning is suspected

Answer 28

``` High fowler position Assess degree of poisoning Humidifier O2 100% via face mask Turn, cough, deep breath Incubation & ventilation Bronchodilators for bronchospasm ```

Question 29

What are the clinical manifestations of the emergent phase in a pt who has an inhalation injury

Answer 29

1.May have severe respiratory problems. Upper airway edema. auscultate for wheezes if they disappear this indicates impending airway obstruction and demands immediate incubation

Question 30

What is the purpose of IV fluid therapy during the emergent phase

Answer 30

To prevent shock by maintaining adequate circulating blood flow volume, severe burns require large fluid loads in a short time to maintain blood flow to vital organs.

Question 31

What are the interventions for a pt who has impaired gas exchange

Answer 31

``` Early incubation Ventilation Humidifier O2 ABG's Bronchodilators ```