Burns Primer Flashcards
What is the normal range for Hematocrit?
• 36-54%
What is the normal range for Hemoglobin?
• 12-18
In the emergent phase of burn care, what are our goals for BP and HR?
- BP: ≥90 systolic
- HR: <120
What are the common types of burn injuries?
- Thermal
- Inhalation
- Chemical
- Electrical
Describe causes of thermal burns.
- Fire
- Contact with hot objects
- Scald (wet) burns
- Cold thermal injury: frostbite
Describe causes of inhalation burn injury.
- Smoke
- CO2
- Hot chemicals
Describe partial and full thickness burns.
- 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
Describe 1st degree burns.
- Superficial partial thickness
- The burn site is red, painful, dry, and with no blisters
Give an example of a 1st degree burn
• Mild sunburn
Describe 2nd degree burns.
- Deep partial thickness
- The burn site looks red, blistered, and may be swollen and painful
Describe 3rd degree burns.
- 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
Describe 4th degree burns.
- Full thickness
- There is no feeling in the area since the nerve endings are destroyed
What are the 4 stages of burn care?
- Prehospital
- Emergent
- Acute
- Rehabilitation
Describe the prehospital stage of care.
- Immediate care at point of injury
- Stabilization for xport
Describe the emergent stage of care.
- Resuscitative care and hemodynamic stabilization
- The period time required to resolve the life-threatening problems resulting from the burn
How long does the emergent stage last?
• Up to 72hrs from time of burn
What are the primary life threatening concerns of the emergent phase?
• Hypovolemic shock and edema
When does the emergent phase end?
• When fluid stabilization and diuresis begins
What is the goal of the Acute phase of burn care?
- Infection control
- Healing and wound care
How long does the acute phase last?
• Can take weeks/months pending the severity of burns
When does the acute phase end?
• With wound closure
What is the purpose of the Rehabilitation phase of burn care?
• Pyschosocial, physical needs.
In prehospital care, the rescuer must be protected from becoming…
• Part of the incident
What are automatic assumptions with electrical burns?
- 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
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
How are small thermal burns covered in prehospital care?
• Clean, cool, tap water dampened towel
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
Why are large thermal burns wrapped in a clean, dry sheet or blanket?
• To prevent contamination and provide warmth
Why should large burns be cooled for no longer than 10 minutes?
• To prevent hypothermia
What should be the first action when treating a burn victim in the prehospital phase?
• Observe for signs of respiratory distress or compromise
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
Rule of Nines percentage for Head?
• 9%, 4.5 anterior, 4.5 posterior
Rule of Nines percentage for Torso?
• 36%, 18 anterior, 18 posterior
Rule of Nines percentage for Arms?
• 9%, 4.5 anterior, 4.5 posterior
Rule of Nines percentage for Legs?
• 18%, 9 anterior, 9 posterior
Rule of Nines percentage for Genitals?
• 1%
What is the Parkland formula used for?
• Fluid resuscitation for the first 24hrs after burn injury
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
What fluid is used with the Parkland formula?
• Lactated Ringers isotonic solution
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
What is normal insensible fluid loss?
• 30-50mL/hr
What is the estimated fluid loss/hr for a severely burnt patient?
• 200-400mL/hr
What is key to monitor for results of fluid resuscitation?
• Urine OP
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
What causes elevated HCT and HGB in burn victims?
• Third spacing pulls fluids out of vascular system leaving the RBCs behind resulting in hemoconcentration?
How is elevated Hct and Hgb resolved in a burn patient?
• Administration of fluids will dilute the blood and restore levels
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
What are the normal level ranges for sodium and potassium?
- Sodium: 135-145
- Potassium: 3.5-5
How is CO poisoning treated?
• 100% O2 via non-rebreather
What kind of drugs are used for pain management of the burn pt?
• Opioids
What is asepsis?
• State of being free from disease-causing micro-organisms
How is body temp regulated with burn victims?
• Typically via room temperature w/ thermostat set to 85°
Why do we assess bowel sounds in the burn patient?
• To check for paralytic ileus
What is Curling’s Ulcer and how is it treated?
- Gastric stress ulcers
- Treated with H2 Blockers
What is the open method of burn wound care?
• Burn is covered with a topical antibiotic with no dressing over the wound.
When open burns wounds are exposed, staff should wear…
- Disposable hats
- Masks
- Gowns
- Gloves
What is the closed method of burn wound care?
• Sterilized gauze dressings are laid over a topical antibiotic.
When are closed method burn dressings changed?
• Dressings may be changed from every 12 to 24 hours to once every 14 days.
What method of burn wound care is used for facial burns?
• Open
Corneal burns are treated with…
• Antibiotic ointment
The emergent phase ends with?
• Diuresis (and Fluid stabilization)
What is done prior to wound debridement?
• Medicate pt with opioids as it is PAINFUL
Explain excision and grafting.
- Eschar is removed down to the subcutaneous tissue or fascia
- Skin graft is placed on clean, viable tissue.
What are circumferential burns?
• Burns that completely surround a limb or part of the body (arm, leg, etc)
What is the inherent danger of circumferential burns?
• Compartment syndrome
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
What is done to treat compartment syndrome as a result of a burn injury?
• Escharotomy to relieve pressure
When treating burn patients, how often are blood labs run?
• Every 4-6hrs
Besides fluid shifts, how else may a burn patient develop hyponatremia?
- Excessive GI suction
- Diarrhea
What are the s/s of hyponatremia?
- Weakness/fatigue
- Dizziness, HA
- Confusion
- Muscle cramps
- Tachycardia
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
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
What are the s/s of hypernatremia?
- Patient will present with thirst; dried, furry tongue;
- Lethargy; confusion
- Possibly seizures
Hyperkalemia can cause
- Cardiac dysrhythmias & ventricular failure
- Muscle weakness
- ECG changes
Hyperkalemia will be noted if patient has what physiological conditions?
- Renal failure
- Adrenocortical insufficiency
- Massive deep muscle injury
Hypokalemia with the burn patient can be caused by
- Lengthy IV therapy without potassium
- Vomiting, diarrhea
- Prolonged gastrointestinal suction
What kind of diet is required for the recovering burn patient?
• ↑ calories & ↑ protein
Acute phase of burn care ends with…
- Wound closure (healing) or
- Skin graft
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
How long does it take for a burn wound to become raised and hyperemic (good blood flow)?
• 4-6 weeks
Mature healing is reached in…
• 6 months to 2 years
True or False
Burnt skin never completely regains its original color.
• True
True or False
Burn scar discoloration deepens over time
• False, it fades w/ time
True or False
Pressure can help keep scar flat.
• True
True or False
Newly healed areas can be hypersensitive or hyposensitive to cold, heat, and touch.
• True
True or False
Healed areas must be protected from direct sunlight for 6 months
• False, they need to be protected for 1 year
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
