Burns Flashcards
Where do most burns occur?
Home
Patho of burns
• capillary permeability (from vessel damage)
• Pulse
• Cardiac Output
• UO
• Epinephrine and Norepinephrine secreted to what?
• ADH and aldosterone secreted to what?
- ↑capillary permeability (from vessel damage) > plasma leaking into tissues. Mostly within the first 24 hours. Worry about SHOCK!
- Pulse ↑ d/t FVD
- Cardiac Output ↓
- UO ↓ - kidneys either trying to hold on to fluid or they aren’t being perfused adequately
- Epinephrine and Norepinephrine secreted to ↑ BP = vasoconstriction = shunts blood to vital organs
- ADH and aldosterone secreted → Retain Na and water w/ Aldosterone; Retain water w/ ADH = Blood Volume ↑
Client burned over 40%–use what common method to determine the % of the body that is burned?
Rules of Nines
- an estimate of total body surface area affected
Rule of Nines Head and neck = \_\_\_ Trunk front = \_\_\_ Trunk back = \_\_\_ Each arm = \_\_\_ Each leg = \_\_\_ Genitals = \_\_\_
Head and neck = 9% Trunk front = 18% Trunk back = 18% Each arm = 9% Each leg = 18% Genitals = 1%
Partial thickness burns also called ____
Full thickness bruns a.k.a. ____
1st and 2nd degree burns (epidermis, dermis);
3rd and 4th degree burns (muscle, fat, one)
If burn is located on the face, neck, or chest – interfere with what?
BREATHING
*concern w/ airway
Burn of hands, feet, joints, or eyes – concern with what?
compartment syndrome
Risk factors for burns
• anyone w/ heart/lung/kidney disease
• pre-existing diabetes or peripheral vascular disease = delayed healing w/ foot/leg burn
• other injuries that occurred when the client was burned
• high mortality w/ the very old and very young d/t skin very thin and less subcutaneous fat = burn deeper and cause more complications
- also the BSA (body surface area) is LESS in the very young
Emergency management:
Stop burning process
- Wrap the client in a blanket – burning process has not stopped after this
- Cool water for no more than 10 mins to stop burning process
- blanket will help hold in body HEAT and keep out GERMS
- Remove jewelry = cause swelling; metal gets hot
- Remove non-adherent clothing and cover burns w/ clean, dry cloth
Inhalation Injury (Number one cause of death) Usually caused by?
inhaling carbon monoxide or hydrogen cyanide
Carbon Monoxide Poisoning
s/sx, treatment
Carbon monoxide binds Hgb faster than oxygen = Oxygen CANNOT bind
- Client is HYPOXIC
- Tx: Oxygen 100%
Hydrogen Cyanide Treatment
100% Oxygen
It would be important to determine if the burn occurred in an open or closed space because
Closed space → more carbon monoxide and/or hydrogen cyanide inhaled = increased complications
When you see a client with burns to the neck/face/chest focus on what?
AIRWAY
What might the PHP do prophylactically?
INTUBATE w/ ET tube before the airway could close off d/t swelling
Indicators of inhalation injury
singed nose har singed facial hair soot on face coughing up secretions w/ black specks difficult swallowing wheezing blisters found on the oral/pharyngeal mucose hoarseness substernal/intercostal retraction and stridor = BAD SIGNS
more death with ____ body burns
UPPER
Fluid Replacement
important for burn mgmt
• 2 large bore IV’s (for large volumes of fluid)
• Use Crystalloids (LR) and colloids (albumin)
• KNOW what time the burn occurred, why?
Fluid replacement therapy (first 24 hrs) is based on the time the injury occurred, not when tx started
Common rule for fluid replacement
Calculate total amount of fluid needed for first 24 hrs →give HALF the amount during the first 8 hours (if you miss 2 hrs, give over 6 hrs)
Parkland formula fluid resuscitation.
(2-4ml of LR) X (body weight in kg) X (% of TBSA burned) = total fluid requirement for the first 24 hours after burn
1st 8 hours = 1⁄2 of total volume (if you miss 2 hrs, must give over 6 hours)
2nd 8 hours = 1⁄4 of total volume
3rd 8 hours = 1⁄4 of total volume
Which of the following would you select to determine if a client’s fluid volume is adequate in burns?
their weight or their urine output?
Urine output
