Burns

Question 1

Pathophysiology

Answer 1

Plasma seeps out into the tissue due to damage from the heat, increasing vessel permeability ( First 24 hours)

Pulse increases because you are in a fluid volume deficit

Cardiac output decreases because there is less volume to pump out

Urine output decreases because kidneys want to hold onto fluid or are not being perfused

Epinephrine is secreted to cause vasoconstriction and shunt blood to vital organs - below 90 systolic, the organs are not being perfused adequately

ADH and aldosterone are secreted in response to blood volume loss - attempt to retain water and water and sodium

Question 2

Burn treatment for >20 -25% TBSA

Answer 2

Fluid replacement. It is important to know when the burn occurred because the first 24 hours of fluid therapy is dependent on that time, not the time that treatment has started

Calculate what is needed for the first 24 hours, and give half the volume calculated during the first 8 hours - this is called the consensus formula.
(4ml of LR) x (kg) x (% of tbsa burned) = total fluid requirement

1st 8 hours : 1/2 of total volume
2nd 8 hours: 1/4 of total volume
3rd 8 hours: 1/4 of total volume

If patient is restless, it could suggest three problems : inadequate fluid replacement, pain or hypoxia. To assess fluid status, check U/O because we are bolusing fluid.

Question 3

Emergency management of Burns

Answer 3

The burning process continues even after the fire. 
Pour cool (NOT COLD) H2O on body. Blanket prevents hypothermia and GERMS. Remove jewellery because swelling will occur - metal also gets vee hot
Remove non-adherent clothing and cover burns with a cool dry cloth.

Assess for upper airway injury - S/s include singed nose and facial hair, soot, coughing up soot or black secretions, blisters on oral/pharyngeal mucosa. Shallow breathing leads to retaining Co2 and subsequently, respiratory acidosis.

Question 4

What medication to manage? why? what considerations do you have to have?

Answer 4

Albumin
Holds onto fluid in the vascular space, increasing the vascular volume, kidney perfusion, blood pressure and cardiac output. It will help correct a fluid volume deficit because we are drawing fluid into the vascular space.

This increases the workload on the heart.

Question 5

Airway injury

Answer 5

Caused by carbon monoxide.
Normally, Oxygen binds with hemoglobin, but then the CM gets to hb first and now O2 can’t bind.

SpO2 will not change to reflect this because it can’t differentiate between O2 and CM

Now client is hypoxic - treat with 100% oxygen.

Determine if client was burned in closed space because they inhale more carbon monoxide that way .
When you see a client with burns to neck, Face, chest, think of airway injury.
They may be intubated prophylactically because swelling can occur

Question 6

Rule of 9’s

Answer 6

Estimated total body surface area affected
Head and Neck - 9

Front and back of trunk - 18 and 18
Arms - 9 each
Genital - 1
Leg - 18 eacj

= 100 in total

Question 7

Consensus formula

Answer 7

(ml of fluid) x (body weight in kg) x % burned = total fluid requirements

1st 8 hours = 1/2 of total volume
2nd and 3rd 8 hours - 1/4 total volume

1kg = 2.2 pounds

Question 8

If you Stress the heart too much when giving Albumin

Answer 8

The client can be thrown into FVE and cardiac output will DECREASE.
Lung sounds are crackles/moist
Take CVP to ensure you are not overloading the client

Question 9

Immunizations

Answer 9

Tetanus Toxoid - Active immunity ( takes 2-4 weeks to develop own immunity)

Immunoglobulin - think IMMEDIATE protection ( passive immunity)

Question 10

Frost Bite

Answer 10

Frostbite involves tissue freezing, resulting in ice crystal formation in intracellular spaces that causes peripheral vasoconstriction, reduced blood flow, vascular stasis, and cell damage. Superficial frostbite can manifest as mottled, blue, or waxy yellow skin. Deeper frostbite may cause skin to appear white and hard and unable to sense touch. This can eventually progress to gangrene.

Treatment of frostbite should include the following:

Remove clothing and jewelry to prevent constriction.
Do not massage, rub, or squeeze the area involved. Injured tissue is easily damaged (Option 3).
Immerse the affected area in water heated to 98.6-102.2 F (37-39 C), preferably in a whirlpool. Higher temperatures do not significantly decrease rewarming time but can intensify pain (Option 5).
Avoid heavy blankets or clothing to prevent tissue sloughing.
Provide analgesia as the rewarming procedure is extremely painful (Option 4).
As thawing occurs, the injured area will become edematous and may blister. Elevate the injured area after rewarming to reduce edema (Option 2).
Keep wounds open immediately after a water bath or whirlpool treatment and allow them to dry before applying loose, nonadherent, sterile dressings (Option 1).
Monitor for signs of compartment syndrome.
Educational objective:
Care of the client with frostbite focuses on preventing further injury and reducing pain. This includes removing items that can cause constriction or sloughing; no massaging or rubbing of the injured area; providing warm water soaks and analgesia; elevating injured areas; applying loose, nonadherent, sterile dressings; and monitoring for compartment syndrome.