Burns

Question 1

Safety Measure

Answer 1

Burn occur at home

• Dryers, lint
• change batteries 6-12 months
• Cooking stoves should be mounted to the wall
• Have a fire plan
• Cooking pots and handles
• Degree of temperature within the household

Question 2

Pathophysiology of burns

Answer 2

Plasma leaks - permeability
24hrs shock 
S/s : c/o down, p up
Save vital organs, kidney perfusion down? 
ADH - retain h20 
Aldosterone - retain h20 and sodium

Question 3

Classification of Burns

Answer 3

9% head, 9% arms, 18% trunk/back

1% genital, 18% legs

Question 4

Depth

Answer 4

Partial - 1st degree/2nd degree

Full - 3/4 degree

Question 5

Risk factors

Answer 5

Kidney, heart, lungs
Diabetics and PVD
Children and Older adults

Question 6

Treatment in Emergency - For Initial Burn and Inhalation Injury

Answer 6

Warm blanket - Why?
Cold water - 10 minutes only no Ice
Remove jewelry

*Inhalation Injury*
CO2, Hydrogen cyanide 
- binds to O2, Red 
- Hypoxia 
Txt: Oxygen 
Pulse oximetry 

H. Cynanide
Tx: Oxygen
Both depend whether is an open/closed area

Least invasive first ENDOTRACH

Question 7

Signs of Inhalation Injury

Answer 7

Singed hair nose
Soot
Difficulty breathing/ wheezing/ stridor/ coughing 
Intercostal space 
Blisters on mouth

Question 8

Treatment in Emergency pt 2 - IV fluids

Answer 8

IV fluids
Crystalloids L/R , Colliods Albumin within first 24hrs
2 large IV bores, IV not IM Why?
First 24hrs from the burn - Total Volume - 1/2 within 8 hrs. weight in KG
*Albumin given 24hrs AFTER
increases everything worry about FVE - CVP overload, wheezes crackles , more volume more pressure

Restlessness - hypoxia, inade fluids, pain
Tx: hypoxia first!
Pain: narcotics, respirations
Fluids: watch via, u/o should be 30-50, electrical 75-100, children 1ml/hr

Question 9

Immunization

Answer 9

Tetanus toxoid - acquired 2-4 wks

Immune globlin - passive immediate

Question 10

Infection Control

Answer 10

Broad Abx - Broad spectrum, 2nd infections super infection
MYCIN - OTOTOXICITY, Nephrotoxicity
BUN *

Question 11

Topical Medications

Answer 11

Sulfate silver, watch allergies
Dressings redone 3-14 days
Tolerance
Thin layer, sterile

Question 12

Wound Care

Answer 12

Debridement  ONLY 48-72 HRS LATER
Removal of necrotic 
Enzymes Suitlan(sp?) and collagenase 
No for 
- pregnancies 
- face 
- large veins 
- open cavities
Hydrotherapy 
*Pain 
-cross contamination

Question 13

Grafting

Answer 13

Reharvest 12-14 days 
Open to air 
poor circulation 
check with qtip 
If site removes, put saline call MD

Question 14

Nutrition

Answer 14

Increase intake
protein and vitamin C
Blood work - Prealbumin to see positive nitrogen

Question 15

Complications - Circumferential

Answer 15

Circumferential Burn - all around 
s/s : temp, color, pulse, cap refill 
tx: elevate 
- escharotomy, 
- Fasciotomy - more deeper  
why? these two?

Question 16

Complications - Renal System

Answer 16

Catheter
u/O Down FVD
Provide with mannitol till clear, then watch from FVE (Osmotic Diuretic- pulls fluid from intercellular compartments)

Question 17

Complications - Electrolyte Imbalance

Answer 17

Potassium cell leak Vas Space , Hyperkalemia

Question 18

Complications - GI system

Answer 18

Watch for 
Curling ulcer, stress ulcer  
s/s : Coffee ground emesis 
Antacid - Mag HYDROXIDE
H2 Blocking receptors  - DINE
Proton Pump inhibitors - RAZOLE

Need to watch for Parlytic Ileus 
Decrease motility
Hyperkalemia 
Decrease in volume 
Can lead to increase in abdominal girth, NG tube not remove till bowel sounds are heard 

Residuals

Question 19

Conplications - Contractures

Answer 19

Wrap fingers/ splints

Hyperextend

Question 20

Infections

Answer 20

#1 complaint 
Eschar bacteria, must be removed

Question 21

Chemical Burns

Answer 21

Brush Powder off

Rinse water 15-30 minutes

Question 22

Electrical Burn

Answer 22

Entrance and Exit
Think neuro problems 
Heart monitor for 24hrs why?
Spine board and C-collar cause electrical burns can occur in high places 
Amputation 
Muscle contractures

Question 23

What are we worried about in hydrotherapy?

Answer 23

Contamination and Infection

Question 24

What meds would you need for hydrotherapy?

Answer 24

Abx and Pain meds