Burns Flashcards
Anatomical changes
Infection Pain Loss of vitamin D Evaporation Sweating loss Contractures
Greater risk of death if
Over 60 years old
TBSA 40% or more
Superficial thickness
Only epidermis Peels 2-3 days after Redness Pain Edema
Superficial partial thickness
Epidermis and upper 1/3 of dermis Pink Wet, blistered Good blood supply Intense pain Exposed nerves 10-21 days healing
Deep-partial thickness
Extends into dermis Dry Shiny Decreased pain (destroyed nerves) 2-6 weeks healing Skin graft?
Full thickness
Destruction of epidermis and dermis Skin does not regrow Forms eschar Decreased pain Needs graft
Deep full thickness burns
Destruction of skin, bone, muscle
May require amputation
Skin graft
Resuscitation phase goals
Until diuresis occurs ABC Fluids Infection Body temp Emotional
S/Dx of airway involvement
Source of burn Burns to face, nose area Smoky smell in breath Horse, brassy cough Drooling, dysphagia Wheezing, stridor
What to do for airway
Notify provider
Apply O2
Prepare intubation
ARDS can occur
What to do?
HOB 45
O2
Notify provider
Monitor ABGs, O2 sat
Circulation assessment
Hypovolemia shock
ECG changes
Use invasive monitoring for vitals
Vascular changes
Fluid shift Third spacing (12-36 hours) Profound electrolyte imbalance Diuretics stage begins 48-72 hours after injury Hypokalemia Hyponatremia
Kidney/ urinary changes
Monitor kidney function
Myoglobin (rust color)
Labs
GI assessment
Paralytic ileus Curlings (stress ulcer) Monitor for Absent bowel Blood in emesis or stool NG placement PPIs and H2 blockers Feed a working gut
Metabolic assessment
Increased sympathetic Catecholamines Antidiuretic Aldosterone Cortisol Increased core temp
Parkland formula
4ml/kg/TBSA
1/2 in first 8 hours
Other in 16 hours
Acute phase
36-48 hours
Until wound is closed
