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MS_Primers for Exam 3 Content > Burns Primer > Flashcards

Burns Primer Flashcards

1
Q

What is the normal range for Hematocrit?

A

• 36-54%

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2
Q

What is the normal range for Hemoglobin?

A

• 12-18

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3
Q

In the emergent phase of burn care, what are our goals for BP and HR?

A
  • BP: ≥90 systolic
  • HR: <120
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4
Q

What are the common types of burn injuries?

A
  • Thermal
  • Inhalation
  • Chemical
  • Electrical
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5
Q

Describe causes of thermal burns.

A
  • Fire
  • Contact with hot objects
  • Scald (wet) burns
  • Cold thermal injury: frostbite
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6
Q

Describe causes of inhalation burn injury.

A
  • Smoke
  • CO2
  • Hot chemicals
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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
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8
Q

Describe 1st degree burns.

A
  • Superficial partial thickness
  • The burn site is red, painful, dry, and with no blisters
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9
Q

Give an example of a 1st degree burn

A

• Mild sunburn

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10
Q

Describe 2nd degree burns.

A
  • Deep partial thickness
  • The burn site looks red, blistered, and may be swollen and painful
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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
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12
Q

Describe 4th degree burns.

A
  • Full thickness
  • There is no feeling in the area since the nerve endings are destroyed
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13
Q

What are the 4 stages of burn care?

A
  • Prehospital
  • Emergent
  • Acute
  • Rehabilitation
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14
Q

Describe the prehospital stage of care.

A
  • Immediate care at point of injury
  • Stabilization for xport
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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
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16
Q

How long does the emergent stage last?

A

• Up to 72hrs from time of burn

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17
Q

What are the primary life threatening concerns of the emergent phase?

A

• Hypovolemic shock and edema

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18
Q

When does the emergent phase end?

A

• When fluid stabilization and diuresis begins

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19
Q

What is the goal of the Acute phase of burn care?

A
  • Infection control
  • Healing and wound care
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20
Q

How long does the acute phase last?

A

• Can take weeks/months pending the severity of burns

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21
Q

When does the acute phase end?

A

• With wound closure

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22
Q

What is the purpose of the Rehabilitation phase of burn care?

A

• Pyschosocial, physical needs.

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23
Q

In prehospital care, the rescuer must be protected from becoming…

A

• Part of the incident

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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
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25
Q

What is the prehospital care for chemical burns?

A
  • Brush particles off skin
  • Remove clothing from burned area/cut around clothing fused to skin
  • Use water lavage
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26
Q

How are small thermal burns covered in prehospital care?

A

• Clean, cool, tap water dampened towel

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27
Q

What are the priority prehospital actions for large thermal burns?

A
  • ABCs
  • Do not immerse in cool water or pack with ice.
  • Remove burned clothing.
  • Wrap in clean, dry sheet or blanket
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28
Q

Why are large thermal burns wrapped in a clean, dry sheet or blanket?

A

• To prevent contamination and provide warmth

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29
Q

Why should large burns be cooled for no longer than 10 minutes?

A

• To prevent hypothermia

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30
Q

What should be the first action when treating a burn victim in the prehospital phase?

A

• Observe for signs of respiratory distress or compromise

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31
Q

What are some key indicators of possible inhalation burn injury?

A
  • 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
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32
Q

Rule of Nines percentage for Head?

A

• 9%, 4.5 anterior, 4.5 posterior

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33
Q

Rule of Nines percentage for Torso?

A

• 36%, 18 anterior, 18 posterior

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34
Q

Rule of Nines percentage for Arms?

A

• 9%, 4.5 anterior, 4.5 posterior

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35
Q

Rule of Nines percentage for Legs?

A

• 18%, 9 anterior, 9 posterior

36
Q

Rule of Nines percentage for Genitals?

A

• 1%

37
Q

What is the Parkland formula used for?

A

• Fluid resuscitation for the first 24hrs after burn injury

38
Q

What is the Parkland formula?

A
  • 4mL/kg/%TBSA
  • ½ given w/in first 8hrs from injury
  • The other half is split between the following two 8hr periods
39
Q

What fluid is used with the Parkland formula?

A

• Lactated Ringers isotonic solution

40
Q

What is the pathophysiology of Burn Shock?

A
  • 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
Q

What is normal insensible fluid loss?

A

• 30-50mL/hr

42
Q

What is the estimated fluid loss/hr for a severely burnt patient?

A

• 200-400mL/hr

43
Q

What is key to monitor for results of fluid resuscitation?

A

• Urine OP

44
Q

RBCs are hemolyzed by a circulating factor released at the time of the burn. Why is this of concern?

A

• It can result in thrombosis in the capillaries and affect blood flow

45
Q

What causes elevated HCT and HGB in burn victims?

A

• Third spacing pulls fluids out of vascular system leaving the RBCs behind resulting in hemoconcentration?

46
Q

How is elevated Hct and Hgb resolved in a burn patient?

A

• Administration of fluids will dilute the blood and restore levels

47
Q

What happens to the levels of Sodium (Na) and Potassium (K+) in the first 24hrs of a burn patient?

A

• They can become hyponatremic or hyperkalemic due to fluid shifts

48
Q

What are the normal level ranges for sodium and potassium?

A
  • Sodium: 135-145
  • Potassium: 3.5-5
49
Q

How is CO poisoning treated?

A

• 100% O2 via non-rebreather

50
Q

What kind of drugs are used for pain management of the burn pt?

A

• Opioids

51
Q

What is asepsis?

A

• State of being free from disease-causing micro-organisms

52
Q

How is body temp regulated with burn victims?

A

• Typically via room temperature w/ thermostat set to 85°

53
Q

Why do we assess bowel sounds in the burn patient?

A

• To check for paralytic ileus

54
Q

What is Curling’s Ulcer and how is it treated?

A
  • Gastric stress ulcers
  • Treated with H2 Blockers
55
Q

What is the open method of burn wound care?

A

• Burn is covered with a topical antibiotic with no dressing over the wound.

56
Q

When open burns wounds are exposed, staff should wear…

A
  • Disposable hats
  • Masks
  • Gowns
  • Gloves
57
Q

What is the closed method of burn wound care?

A

• Sterilized gauze dressings are laid over a topical antibiotic.

58
Q

When are closed method burn dressings changed?

A

• Dressings may be changed from every 12 to 24 hours to once every 14 days.

59
Q

What method of burn wound care is used for facial burns?

A

• Open

60
Q

Corneal burns are treated with…

A

• Antibiotic ointment

61
Q

The emergent phase ends with?

A

• Diuresis (and Fluid stabilization)

62
Q

What is done prior to wound debridement?

A

• Medicate pt with opioids as it is PAINFUL

63
Q

Explain excision and grafting.

A
  • Eschar is removed down to the subcutaneous tissue or fascia
  • Skin graft is placed on clean, viable tissue.
64
Q

What are circumferential burns?

A

• Burns that completely surround a limb or part of the body (arm, leg, etc)

65
Q

What is the inherent danger of circumferential burns?

A

• Compartment syndrome

66
Q

How do we test for oxygenation/tissue perfusion when circumferential burns are present?

A
  • Assess breathing
  • Assess distal pulses
  • Assess for successful pain relief with medication
67
Q

What is done to treat compartment syndrome as a result of a burn injury?

A

• Escharotomy to relieve pressure

68
Q

When treating burn patients, how often are blood labs run?

A

• Every 4-6hrs

69
Q

Besides fluid shifts, how else may a burn patient develop hyponatremia?

A
  • Excessive GI suction
  • Diarrhea
70
Q

What are the s/s of hyponatremia?

A
  • Weakness/fatigue
  • Dizziness, HA
  • Confusion
  • Muscle cramps
  • Tachycardia
71
Q

The burn patient may also develop a dilutional hyponatremia called water intoxication. To avoid this condition, the patient should…

A

• Drink fluids other than water, such as juice, soft drinks, or nutritional supplements

72
Q

In the burn patient, Hypernatremia may develop following

A
  • Successful fluid resuscitation if copious amounts of hypertonic solutions were required
  • Improper tube feedings
  • Inappropriate fluid administration
73
Q

What are the s/s of hypernatremia?

A
  • Patient will present with thirst; dried, furry tongue;
  • Lethargy; confusion
  • Possibly seizures
74
Q

Hyperkalemia can cause

A
  • Cardiac dysrhythmias & ventricular failure
  • Muscle weakness
  • ECG changes
75
Q

Hyperkalemia will be noted if patient has what physiological conditions?

A
  • Renal failure
  • Adrenocortical insufficiency
  • Massive deep muscle injury
76
Q

Hypokalemia with the burn patient can be caused by

A
  • Lengthy IV therapy without potassium
  • Vomiting, diarrhea
  • Prolonged gastrointestinal suction
77
Q

What kind of diet is required for the recovering burn patient?

A

• ↑ calories & ↑ protein

78
Q

Acute phase of burn care ends with…

A
  • Wound closure (healing) or
  • Skin graft
79
Q

What are Cultured epithelial autographs (CEAs)?

A
  • 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
Q

How long does it take for a burn wound to become raised and hyperemic (good blood flow)?

A

• 4-6 weeks

81
Q

Mature healing is reached in…

A

• 6 months to 2 years

82
Q

True or False
Burnt skin never completely regains its original color.

A

• True

83
Q

True or False
Burn scar discoloration deepens over time

A

• False, it fades w/ time

84
Q

True or False
Pressure can help keep scar flat.

A

• True

85
Q

True or False
Newly healed areas can be hypersensitive or hyposensitive to cold, heat, and touch.

A

• True

86
Q

True or False
Healed areas must be protected from direct sunlight for 6 months

A

• False, they need to be protected for 1 year

87
Q

Gerontologic Considerations
Normal aging puts the patient at risk for injury because of:

A
  • Unsteady gait
  • Failing eyesight
  • Diminished hearing
  • The fact that wounds take longer to heal

MS_Primers for Exam 3 Content (13 decks)

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