Burns Flashcards
Safety Measure
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
Pathophysiology of burns
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
Classification of Burns
9% head, 9% arms, 18% trunk/back
1% genital, 18% legs
Depth
Partial - 1st degree/2nd degree
Full - 3/4 degree
Risk factors
Kidney, heart, lungs
Diabetics and PVD
Children and Older adults
Treatment in Emergency - For Initial Burn and Inhalation Injury
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
Signs of Inhalation Injury
Singed hair nose Soot Difficulty breathing/ wheezing/ stridor/ coughing Intercostal space Blisters on mouth
Treatment in Emergency pt 2 - IV fluids
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
Immunization
Tetanus toxoid - acquired 2-4 wks
Immune globlin - passive immediate
Infection Control
Broad Abx - Broad spectrum, 2nd infections super infection
MYCIN - OTOTOXICITY, Nephrotoxicity
BUN *
Topical Medications
Sulfate silver, watch allergies
Dressings redone 3-14 days
Tolerance
Thin layer, sterile
Wound Care
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
Grafting
Reharvest 12-14 days Open to air poor circulation check with qtip If site removes, put saline call MD
Nutrition
Increase intake
protein and vitamin C
Blood work - Prealbumin to see positive nitrogen
Complications - Circumferential
Circumferential Burn - all around s/s : temp, color, pulse, cap refill tx: elevate - escharotomy, - Fasciotomy - more deeper why? these two?
Complications - Renal System
Catheter
u/O Down FVD
Provide with mannitol till clear, then watch from FVE (Osmotic Diuretic- pulls fluid from intercellular compartments)
Complications - Electrolyte Imbalance
Potassium cell leak Vas Space , Hyperkalemia
Complications - GI system
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
Conplications - Contractures
Wrap fingers/ splints
Hyperextend
Infections
#1 complaint Eschar bacteria, must be removed
Chemical Burns
Brush Powder off
Rinse water 15-30 minutes
Electrical Burn
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
What are we worried about in hydrotherapy?
Contamination and Infection
What meds would you need for hydrotherapy?
Abx and Pain meds
