Burns Flashcards
Emergency management
Stopping burning process:
Wrap with / Cool water
Remove jewelry
Clothing (non adherent vs adherent)
Blanket. But burning is still not done so Cool water is done briefly not more than 10 mins. Blanket helps HOLD body heat and keeps away GERMS
Because metal heats fast and swelling will occur
Clothing must be removed if it is non adherent but dont remove if adhered to skin. We must clothing because it can constrict blood flow if this occurs
Emergency management
Inhalation Injury is the number one cause of death
Carbon monoxide poisoning
Cherry red
Treatment for carbon monoxide
Hydrogen cyanide is the same with
Determine if open or closed spaced
Pulse oximeter not reliable, why
This travels faster (200 times faster) compared to oxygen, therefore it gets hemoglobin and binds. There is no more space for the oxygen.
Client will turn Cherry Red
Treatment for 100 % oxygen
Same with Carbon monoxide poisoning
Hydrogen cyanide poisoning can also happen
To know if they inhaled more carbon monoxide or hydrogen cyanide especially in closed space
Because pulse oximeter cant differentiate carboxy hemoglobin from oxy hemoglobin
Indicators of inhalation injury S/S: Singed Soot Hoarseness,Stridor,Wheezing Coughing up
Nose hair or facial hair
Soot on face
Difficulty in breathing
Coughing up dark specks
Fluid replacement is the primary focus
2 large bore IVs
Hypertonic such as LR
Therapy starts at
Common rule in calculating
Formula is
We need to give large volumes of IV fluid
Is used for replacement
The time the injury happened not the time treatment started
Total amount of fluid needed in 24 hours then Give the half of fluid in the first 8 hours and then give the remaing half for the remaining hours
2-4 LR x weight in kg x % of tbsa burned-( 4 ml is used in electrical burns to prevent renal damage)
3 problems if patient is restless in burns
Nursing priority is
Children urinary output formula
Adult urinary output formula
Not enough fluid replacement
Pain
Hypoxia
HYPOXIA
1mL/kg/hr
.5 to 1 mL/kg/hr
Albumin (colloid)
Increases fluid
Workload of heart
So monitor for
In the vascular space
The workload will increase which could lead to decrease cardiac output
CVP
Pain management for burns
DOC
So monitor the
IV meds preferred or IM?
Opioids
RR closely
IV because it acts faster
Active immunity
Passive immunity
Like tetanus toxoid. The body has to work fot it to develop their immunity
Like Immune globulin. The body does not need to work. Provides immediate protection. Actually injecting antobodies
Infection control
When giving mycin drugs worry about
Broad spectrum antibiotics will be used until
Topical drugs like:
Silver nitrate
Mafenide acetate(Sulfamylon)
Antimicrobial ointments
These topical drugs should be alternated,why
Assess for allergy of
Dressings can be left
In applying meds
Worry about hearing loss or BUN/Creatinine. Because it can lead to Ototoxicity and Nephrotoxicity
Wound cultures have returned, otherwise it is avoided because it could lead to super infections
Silver nitrate dressings must be kept wet and could cause electrolyte imbalance
Can cause acid base problems and it stings
Promotes moist wound and kill bacteria
To prevent build up of resistance to drug
Sulfate because all these drugs contain sulfate
3 to 14 days
Apply thin layer and aseptic technique
Wound care
Sutilains (Travase) or collagenase (Santyl) are
Dont use on:
Face,pregnant,large nerves and area is opened to a body cavity
Hydrotherapy
-cross contamination
Enzymatic debridement drugs to remove dead tissue and promote wound healing
Used to debris
-cross contamination can occur in immersion hydrotherapy. Shower is an alternative
Grafting is done for wound care
Autograft -12 to 14 days Cover graft if Open to air if Blue or cool means Use of Tuberculin syringe by PHC and Qtips prescribed for nurses to -this is done due to
Uses client own skin -same donor site can be harvested in 12 to 14 days If still bleeding If bleeding stopped Poor circulation
Aspirate blood or exudate under graft and to apply gentle pressure from the center of graft to edges using Q tips
-accumulation of air or fluid under graft and promote healing
Nutrition in burn clients
More calories and increase protein and vitamin c to promote wound healing
Circulation complication
4 Circulatory check list are:
-how about skin turgor?
Procedures to help relieve pressure on circulation:
Pulse Skin color Capillary refill Skin temp Skin turgor is for hydration check
Escharotomy and Fasciotomy. Fasciotomy is a much deeper cut
Renal system
Decrease in UO
Brown or red urine?
Doc to flush kidneys
After 48 hours fluid is going
Due to compensatory mechanism of body to hold fluids
Brown pigment can be due to myoglobin present in the bloodstream due to injury
Mannitol(Osmitrol) report when urine is clear. Dont refrigerate.
Back to vascular space which increases UO
Electrolyte imbalance in burns
Hyperkalemia
Hypokalemia
Because potassium lives inside cells. Woth burns the cells rupture and potassium goes out into the vasvular space
Can happen after fluid shifts back usuly after 48 hours
