Burns part one Flashcards
signs of inflammation
-pain, heat, swelling, loss of function
patho of a burn injury
-burn»_space; pain»_space; inflammatory process»_space; fluid shifts»_space; edema»_space; tissue and organ damage»_space; fluid mobilization diuresis»_space; healing rehab»_space; or shock»_space; tissue organ damage continues
inflammatory process
- PAIN
- Increased blood flow
- Release of Vasoactive substances
- Increased capillary permeability
complications of fluid loss in burns
- Edema
- Hypovolemia
- Shock!
- Pain continues!
- Tissue and Organ Damage
- decreased fluid in blood = decreased BP and CO (perfusion)
how to classify burns
- etiology
- Depth of tissue damage
- total body surface area (TBSA) involved and severity
burn etiology
- most common: fire/flame and scald
- african amercian children
- elderly
- thermal
- chemical
- electrical
- radiation
thermal burns
- exposure to heat generating sources
- flame, steam, scald, hot objects/surfaces
- inhalation: heated gases
chemical burns
-alkaline, acidic agents and organic compounds
electrical burns
-injury related to voltage
radiation burns
-usually from radiation therapy or exposure to industrial exposure (nuclear plants)
role of the skin
- protective barrier
- sensation
- water balance
- temperature regulation
- vitamin production
- cosmetic
degree of the burn
- superficial partial thickness (1st): epidermis
- deep partial thickness (2nd): dermis
- full thickness (3rd and 4th): fat, muscle, bone
how long after the burn can you tell how much damage
24 hours
how to know the depth of a burn
- if you tug on a hair and it comes out then the burn is as deep as the hair follicle (deep partial thickness)
deep partial thickness injuries loose the ability to…
-thermoregulate
classification according to burn depth
- epidermis: superficial
- minimally into the dermis: superficial partial thickness
- dermis: deep partial thickness
- SQ: full thickness
- muscle: full thickness
superficial burn common cause
- sunburn
- minor scalds
superficial burn signs
- mild erythema, hypersensitivity, blanches, pain
- causes pain and discomfort but no real medical intervention needed
superficial burn will heal within
a few days (3-5)
management of superficial burn
- no admit to burn unit or real medical intervention
- heals without scarring
- OTC- relief gel or cream
- Hydration: PO
- NSAIDS
- Acetaminophen/Ibuprofen
- Diphenhydramine (Benadryl)
- Moisturize: No alcohol or perfumes
superficial burn injury level
- epidermal layer (outermost layer)
superficial-partial thickness burn level
- epidermis & minimal layers of Dermis
superficial-partial thickness burn appearance
- Blisters, erythema, shiny, wet , inflamed
- Pain: hypersensitivity r/t nerve injury and nerve exposure
- mild to moderate edema
superficial-partial thickness burn healing time
1-3 weeks with minimal to zero scar tissue
-(7-21 days)
fluids and superficial-partial thickness burn
- without adequate perfusion burn damage Can extend further into the dermis and convert to a deep partial thickness burn
- this would be secondary injury
- give fluids: small area have them drink, large area (>70%)= IV
would you pop or deroof a blister
- leave alone if they are calling
- in our care: deroof
management of partial thickness
- promote self healing
- may need graft
- blisters: deroof > 2cm
- Antimicrobial topical with non adherent dressings = daily wound care with thorough cleansing
- hydration
- abx if infection present
deep partial thickness characteristics
- Less moist, Decreased sensation & pain
- Light pink to cherry red
deep partial thickness injury level
- epidermis and bottom layers of dermal tissue
deep partial thickness risks
- conversion to full thickness
deep partial thickness management
- Systemic fluid support
minimize conversion to deeper tissue injury* - Pain management : varying levels
- increase Nutritional needs
- May require excision and skin grafting
- Assess and RX for maximum Function
- PT and OT right away (esp. when on joints)
full thickness burn injury level
- all layers including portions of subcutaneous tissue
full thickness burn signs
- Non blanching
- Non tender
- Dry, white, brown, black, tough & leathery, red , waxy
- wont heal on own
full thickness burn management
- May involve fat, muscle &/or bone
- Systemic fluid support
- Nutritional support
- Requires excision and skin grafts
- Functional support/positioning
what causes the red urine with burns
- with muscle damage there is release of creatinine kinase and myoglobulin which are products of muscle breakdown that occlude renal tubules and are in urine
burn conversion
- area of the burn that is most at risk for conversion if the patient does not receive adequate resuscitation.
- Inadequate resuscitation may cause the burn to become deeper because of limited blood flow, causing the zone of stasis to convert into the zone of coagulation
inhalation trauma
- Consider in patients with facial burns, or Injury that occurs in an enclosed spaces
- 25-50% of burn patients will experience this
- Independent predictor of death
- Complications associated with carbon monoxide poisoning, injury above & below glottis
- Inhalation injury: increases incidence: Respiratory complications
carbon monoxide poisoning with inhalation injury
- Inhalation: heated gases/smoke = Carbon monoxide poisoning
- Asphyxiation
- CO binds selectively to Hgb molecule = hypoxia
- Treat with 100% FiO2
- injury in enclosed space; cherry red face
- Pulse ox considerations
above the glottis
- More common
-Protective reflex
Oral mucosa burns
- Lung parenchyma not injured
- Facial/airway edema primary nursing concern
below the glottis
- Patient possibly unconscious at the scene
- Injury to airway (intubation?)
- Injury lung parenchyma
complications of injury above and below the glottis
Atelectasis; pneumonia ; ARDS ; death
inhalation injury causes…
- Loss of cilia
- Respiratory epithelial cells
- Neutrophil infiltration from inflammation process
- Atelectasis: occlusion by debris
- Pseudomembranous CASTS
- Bacterial colonization@72 hr»_space; pneumonia
- ARDS
- Asphyxiation
with inhalation injury primary concern is
- maintaining airway
- intubation
- Airway patency: High Fowlers HOB > 45–No pillow
- Suctioning (✓ carbon in sputum)
suspect inhalation injury when
Facial burns Wheezing (47%) Carbonaceous sputum , Soot Rales Dyspnea ; Tachypnea Hoarseness (voice chnages) Cough (lots of coughing!) Singed facial hair, nasal, Painful swallowing
inhalation injury and swelling
- greatest 2-96 hours
- Anticipate Intubation *airway care !!
- Early intubation 1-2 hrs post injury
- 6-12 hours bronchoscopy if not intubated Recheck airway
electrical injuries
- Electrical energy converts to heat
- Current travels: path of least resistance
- Least: nerves, blood, fluid
- Most: bone, skin
- Majority of tissue destruction is “internal”
electrical burns
- Injuries are “hidden”: Small surface injuries or Devastating internal injuries
- Generated heat damages adjacent muscle and tissues
- Deep muscle & nerve injury may occur when superficial muscle appears normal
- Difficult to assess internal injury
high voltage injury consequences / risks
- Loss of Consciousness
- Cardiac Arrhythmias
- Muscle contractions: Clenched fists
- Myoglobinuria and CK: Product of Muscle breakdown
- Mummified extremities
care for electrical burn pt
-Fluid resuscitation based on TBSA injury
- *EKG-cardiac monitoring for 24 hours
- Assess: compartment syndrome with neurovascular checks q 1hr
- Detailed *Neurological exam q1hr : note changes over time
- Assess for *rhabdomyolysis and myloglobinuria (ATN): if have red urine give fluids Goal: UOP to > 100 – 150 cc/hr
compartment syndrome
- Increased pressure within body compartments
- Causing inadequate perfusion and inadequate nerve conduction
- Result is tissue and nerve necrosis beyond site of increased pressures
- Limb threatening and life threatening
- compartments swell and become edematous and compress nerves (NO SENSATION) and arteries (DECREASED PERFUSION)
what area of burns are we most worried about compartment syndrome
- electrical (inside)
- circumfrential bun (all the way around the skin in that area)
chemical burn
-Do not look for chemical antidote
-Do not try to neutralize chemical
-Protect yourself!
-Brush off any powder, remove clothing
-Irrigate: copious amounts of water :Irrigation > 20 minutes
-Identify the causative agent
without delaying patient care)
-Chemical burn alone meets referral criteria to a burn center
SJS and TENS
-severe cutaneous hypersensitivity reactions
-Rash: exfoliative
skin and mucous membranes
-Cause: Drug Reaction (50%)
DIFFERENCE BETWEEN SJS AND TENS
SJS < 10 TBSA & TENS > 30 % TBSA
- TENS = higher mortality rate
similaritites of SJS and TENS
- All Epidermal cells: skin & mucous membranes: eyes, mouth, GI , GU , periareas
- Macules: Red, tender blisters coalesce, into blisters
SJS/ TENS common causitive agnets
- Antiepileptics (AED)
- Antibiotics
- sulfa meds
- anti gout meds
frostbite
-Tissue destruction from cold is similar to burns
-Depth of tissue damage:
Assessed when extremities are warm and perfused
-cells are destoryed from the lack of 02 and h20
-linning of blood vessels are damaged = blood leaks when re warming
frostbite tx
- Topicals: Antimicrobials
- Or allow tissue to desiccate and mummify
- possible amputation
- Some can heal without surgery
- Refer to Burn Center within 24 hrs for tPA
- -Pain management (IV)
