burns in class Flashcards
which burns might need a referral
- burns to specialty areas or at joints (face, hands, feet, peri area)
- inhalation burns
- chemical
- partial thickness >20 % TBSA
- deep partial thickness
- lightning victim- electrical burn
- circumferential burns ( all the way around that body space)
- frostbite
- SJS
TPA with frostbite
- MICROTHROMBI THAT DEVELOPS BLOCKS CAPILLARIES THAT FEED THE REST OF THE DIGIT
- NEED TO GET WITHIN 24 HOURS TO OPEN UP THE TINY CAPILLARIES and clear the blockage
superficial burn
pink dry itchy self healing
partial thickness
pink blisters and painful
full thickness
leathery dry not painful
myoglobinuria
- from muscle breakdown that releases high amount of myoglobin in blood
- major concern would be renal damage (red urine because clogged up the renal)
what burn injury includes muscle breakdown and causes myoglobinuria, bone fractures, dysrhythmias, and cardiac arrest
-electrical burns
care for electrical burns
- EKG fro 24 hour
what burn is most at risk for compartment syndrome
- circumferential burn (no compliance left- doesn’t stretch and gets tighter and tighter)
3 phases of burn care
- emergent
- acute
- recovery
in emergent phase what happens to plasma proteins water and sodium
- when capillary wall is damaged or they become enlarged cap permeability is increased and plasma proteins and other particles move into the interstitial space which contributes to the accumulation of interstitial fluid
in emergent phase of burn what is expected in the initial lab work
- low albumin
- high hct: elevated relative to the total volume since there is less plasma- high concentration of hct but they didn’t bleed out (7 or less before giving blood)
fluid imbalances that occur in the emergent phase
- plasma in vasculature: decreased
- UOP: decreased- loosing a lot of fluid
- potassium: increased- concentration higher with serum leaving
- Sodium: decreased
- ph: decreased- tissues not getting perfused= lose aerobic metabolism which lowers ph
- hematocrit: increased
- blood pressure: decreased: don’t have the blood return= decreased CO
order of care in ED for burn
- airway
- 2 large bore IV (> 18g)
- assess for other injuries
- ointment to wound
how to protect pt from secondary injury
- fluid resuscitation!!!!!!!
three major complications of a large burn injury
- airway
- infection
- HYPOVOLEMIC SHOCK
what type of pt is at risk for inhalation injury?
- enclosed spaces
what are the signs of Inhalation injury? AND WHAT is the timeline for airway safety?
- soot (black)
- singed facial hair
- coughing out little black stuff
- voice changes (gargle)
- timeline: see need airway within first 24 or even 48-72
best position for inhalation injury
- sitting up
- no pillow (keep airway straight)
- humidified air to prevent mucous plug
what data can use as a reliable indicator of appropriate fluid resuscitation?
- urine output
how to figure out map
- systolic x 1 + diastolic x 2 divided by 3
goals of care in the emergent phase
- FLUIDS
- pain
- prevention of hypothermia
what type of drugs are responsible for SJS
- antibiotics and anti-epileptics
