Burns Primer Flashcards
1
Q
What is the normal range for Hematocrit?
A
• 36-54%
2
Q
What is the normal range for Hemoglobin?
A
• 12-18
3
Q
In the emergent phase of burn care, what are our goals for BP and HR?
A
- BP: ≥90 systolic
- HR: <120
4
Q
What are the common types of burn injuries?
A
- Thermal
- Inhalation
- Chemical
- Electrical
5
Q
Describe causes of thermal burns.
A
- Fire
- Contact with hot objects
- Scald (wet) burns
- Cold thermal injury: frostbite
6
Q
Describe causes of inhalation burn injury.
A
- Smoke
- CO2
- Hot chemicals
7
Q
Describe partial and full thickness burns.
A
- Partial-thickness burn
- Superficial partial-thickness burn
- Involves the epidermis
- Deep partial-thickness burn
- Involves the epidermis and dermis
- Full-thickness burn
- Involves all dermal layers, fat, muscle, bone
8
Q
Describe 1st degree burns.
A
- Superficial partial thickness
- The burn site is red, painful, dry, and with no blisters
9
Q
Give an example of a 1st degree burn
A
• Mild sunburn
10
Q
Describe 2nd degree burns.
A
- Deep partial thickness
- The burn site looks red, blistered, and may be swollen and painful
11
Q
Describe 3rd degree burns.
A
- May be deep partial thickness to full thickness
- Pain less likely pending amount of nerve damage
- Burn site may look white, blackened and/or charred
12
Q
Describe 4th degree burns.
A
- Full thickness
- There is no feeling in the area since the nerve endings are destroyed
13
Q
What are the 4 stages of burn care?
A
- Prehospital
- Emergent
- Acute
- Rehabilitation
14
Q
Describe the prehospital stage of care.
A
- Immediate care at point of injury
- Stabilization for xport
15
Q
Describe the emergent stage of care.
A
- Resuscitative care and hemodynamic stabilization
- The period time required to resolve the life-threatening problems resulting from the burn
16
Q
How long does the emergent stage last?
A
• Up to 72hrs from time of burn
17
Q
What are the primary life threatening concerns of the emergent phase?
A
• Hypovolemic shock and edema
18
Q
When does the emergent phase end?
A
• When fluid stabilization and diuresis begins
19
Q
What is the goal of the Acute phase of burn care?
A
- Infection control
- Healing and wound care
20
Q
How long does the acute phase last?
A
• Can take weeks/months pending the severity of burns
21
Q
When does the acute phase end?
A
• With wound closure
22
Q
What is the purpose of the Rehabilitation phase of burn care?
A
• Pyschosocial, physical needs.
23
Q
In prehospital care, the rescuer must be protected from becoming…
A
• Part of the incident
24
Q
What are automatic assumptions with electrical burns?
A
- That the victim fell and sustained back/cervical spine injury until ruled out
- There is more tissue damage than what can be seen as the electricity traveled from entry to exit point
25
What is the prehospital care for chemical burns?
* Brush particles off skin
* Remove clothing from burned area/cut around clothing fused to skin
* Use water lavage
26
How are small thermal burns covered in prehospital care?
• Clean, cool, tap water dampened towel
27
What are the priority prehospital actions for large thermal burns?
* ABCs
* Do not immerse in cool water or pack with ice.
* Remove burned clothing.
* Wrap in clean, dry sheet or blanket
28
Why are large thermal burns wrapped in a clean, dry sheet or blanket?
• To prevent contamination and provide warmth
29
Why should large burns be cooled for no longer than 10 minutes?
• To prevent hypothermia
30
What should be the first action when treating a burn victim in the prehospital phase?
• Observe for signs of respiratory distress or compromise
31
What are some key indicators of possible inhalation burn injury?
* Presence of facial burns
* Singed nasal hair
* Hoarseness, painful swallowing
* Darkened oral and nasal membranes
* Carbonaceous sputum
* History of being burned in enclosed space
* Clothing burns around chest and neck
32
Rule of Nines percentage for Head?
• 9%, 4.5 anterior, 4.5 posterior
33
Rule of Nines percentage for Torso?
• 36%, 18 anterior, 18 posterior
34
Rule of Nines percentage for Arms?
• 9%, 4.5 anterior, 4.5 posterior
35
Rule of Nines percentage for Legs?
• 18%, 9 anterior, 9 posterior
36
Rule of Nines percentage for Genitals?
• 1%
37
What is the Parkland formula used for?
• Fluid resuscitation for the first 24hrs after burn injury
38
What is the Parkland formula?
* 4mL/kg/%TBSA
* ½ given w/in first 8hrs from injury
* The other half is split between the following two 8hr periods
39
What fluid is used with the Parkland formula?
• Lactated Ringers isotonic solution
40
What is the pathophysiology of Burn Shock?
* Burn →
* ↑ Vascular permeability →
* ↓ Intravascular volume (due to 3rd spacing of fluids which present as edema) →
* Third spacing of fluids leads to ↓ intravascular blood volume (hemoconcentration) →
* ↑ Hematocrit → ↑ viscosity →
* ↑ Peripheral resistance → Burn Shock
41
What is normal insensible fluid loss?
• 30-50mL/hr
42
What is the estimated fluid loss/hr for a severely burnt patient?
• 200-400mL/hr
43
What is key to monitor for results of fluid resuscitation?
• Urine OP
44
RBCs are hemolyzed by a circulating factor released at the time of the burn. Why is this of concern?
• It can result in thrombosis in the capillaries and affect blood flow
45
What causes elevated HCT and HGB in burn victims?
• Third spacing pulls fluids out of vascular system leaving the RBCs behind resulting in hemoconcentration?
46
How is elevated Hct and Hgb resolved in a burn patient?
• Administration of fluids will dilute the blood and restore levels
47
What happens to the levels of Sodium (Na) and Potassium (K+) in the first 24hrs of a burn patient?
• They can become hyponatremic or hyperkalemic due to fluid shifts
48
What are the normal level ranges for sodium and potassium?
* Sodium: 135-145
* Potassium: 3.5-5
49
How is CO poisoning treated?
• 100% O2 via non-rebreather
50
What kind of drugs are used for pain management of the burn pt?
• Opioids
51
What is asepsis?
• State of being free from disease-causing micro-organisms
52
How is body temp regulated with burn victims?
• Typically via room temperature w/ thermostat set to 85°
53
Why do we assess bowel sounds in the burn patient?
• To check for paralytic ileus
54
What is Curling’s Ulcer and how is it treated?
* Gastric stress ulcers
* Treated with H2 Blockers
55
What is the open method of burn wound care?
• Burn is covered with a topical antibiotic with no dressing over the wound.
56
When open burns wounds are exposed, staff should wear…
* Disposable hats
* Masks
* Gowns
* Gloves
57
What is the closed method of burn wound care?
• Sterilized gauze dressings are laid over a topical antibiotic.
58
When are closed method burn dressings changed?
• Dressings may be changed from every 12 to 24 hours to once every 14 days.
59
What method of burn wound care is used for facial burns?
• Open
60
Corneal burns are treated with…
• Antibiotic ointment
61
The emergent phase ends with?
• Diuresis (and Fluid stabilization)
62
What is done prior to wound debridement?
• Medicate pt with opioids as it is PAINFUL
63
Explain excision and grafting.
* Eschar is removed down to the subcutaneous tissue or fascia
* Skin graft is placed on clean, viable tissue.
64
What are circumferential burns?
• Burns that completely surround a limb or part of the body (arm, leg, etc)
65
What is the inherent danger of circumferential burns?
• Compartment syndrome
66
How do we test for oxygenation/tissue perfusion when circumferential burns are present?
* Assess breathing
* Assess distal pulses
* Assess for successful pain relief with medication
67
What is done to treat compartment syndrome as a result of a burn injury?
• Escharotomy to relieve pressure
68
When treating burn patients, how often are blood labs run?
• Every 4-6hrs
69
Besides fluid shifts, how else may a burn patient develop hyponatremia?
* Excessive GI suction
* Diarrhea
70
What are the s/s of hyponatremia?
* Weakness/fatigue
* Dizziness, HA
* Confusion
* Muscle cramps
* Tachycardia
71
The burn patient may also develop a dilutional hyponatremia called water intoxication. To avoid this condition, the patient should…
• Drink fluids other than water, such as juice, soft drinks, or nutritional supplements
72
In the burn patient, Hypernatremia may develop following
* Successful fluid resuscitation if copious amounts of hypertonic solutions were required
* Improper tube feedings
* Inappropriate fluid administration
73
What are the s/s of hypernatremia?
* Patient will present with thirst; dried, furry tongue;
* Lethargy; confusion
* Possibly seizures
74
Hyperkalemia can cause
* Cardiac dysrhythmias & ventricular failure
* Muscle weakness
* ECG changes
75
Hyperkalemia will be noted if patient has what physiological conditions?
* Renal failure
* Adrenocortical insufficiency
* Massive deep muscle injury
76
Hypokalemia with the burn patient can be caused by
* Lengthy IV therapy without potassium
* Vomiting, diarrhea
* Prolonged gastrointestinal suction
77
What kind of diet is required for the recovering burn patient?
• ↑ calories & ↑ protein
78
Acute phase of burn care ends with…
* Wound closure (healing) or
* Skin graft
79
What are Cultured epithelial autographs (CEAs)?
* Cultured epithelial autograft (CEA) is a method of obtaining permanent skin from a person with limited available skin for harvesting
* Grown from biopsies obtained from the patient’s own skin
80
How long does it take for a burn wound to become raised and hyperemic (good blood flow)?
• 4-6 weeks
81
Mature healing is reached in…
• 6 months to 2 years
82
True or False
Burnt skin never completely regains its original color.
• True
83
True or False
Burn scar discoloration deepens over time
• False, it fades w/ time
84
True or False
Pressure can help keep scar flat.
• True
85
True or False
Newly healed areas can be hypersensitive or hyposensitive to cold, heat, and touch.
• True
86
True or False
Healed areas must be protected from direct sunlight for 6 months
• False, they need to be protected for 1 year
87
Gerontologic Considerations
Normal aging puts the patient at risk for injury because of:
* Unsteady gait
* Failing eyesight
* Diminished hearing
* The fact that wounds take longer to heal
