Ch. 25 Burns Flashcards
What determines the extent of the burn?
temperature of agent, duration of contact, type of tissue, depth of burn, surface area, risk factors
Who is at highest risk for burns?
children under 4 and adults over 65; and those with low socioeconomic status
What is the focus of burn prevention programs?
making legislative changes and collecting global burn data
What are thermal burns?
burns caused by flame, flash, scald, or contact with hot objects; most common type of burn
What are chemical burns?
burns caused by contact with acids, alkalis, or organic compounds
Where are alkalis found?
oven and drain cleaners, fertilizers, and industrial cleansers
Where are organic compounds found?
chemical disinfectants (phenols) and petroleum products
What type of chemical burn is hardest to treat and why?
alkali burns because they cause protein hydrolysis and liquefaction by adhering to tissues; cause damage even after neutralized
What is a major predictor of mortality in burn patients?
smoke inhalation
What is metabolic aspiration?
causes majority of fire deaths, inhalation of CO or hydrogen cyanide, hypoxia when carboxyhemoglobin serum is greater than 20%; can occur without burns to skin
What is an upper airway injury (burns ch.)?
injury to mouth, oropharynx, or larynx; may be caused by thermal burns or smoke inhalation
What are the manifestations of mucosal burns of oropharynx and larynx?
redness, blistering, and edema
How do you assess for upper airway injury?
facial burns, singed nasal hair, hoarseness, painful swallowing, darkened oral or nasal mucosa, carbonaceous sputum, history of burns in enclosed spaces, burns to clothing around chest or neck
What are the manifestations of upper airway burns?
blisters, edema, hoarseness, difficulty swallowing, copious secretions, stridor, retractions, airway obstruction
What is a lower airway injury (burns ch.)?
inhalation injury to trachea, bronchioles, and alveoli by breathing in toxic chemicals or smoke; can cause pulmonary edema that does’t appear until 12-24 hours after, then manifesting as ARDS
What is an electrical burn?
burn caused by intense heat from an electric current; severity depends on voltage, tissue resistance, current pathways, surface area in contact with current, length of time; indication for transfer to burn unit
What are the manifestations of lower airway injuries?
trapped in enclosed space during fire, facial burns or singed hair, dyspnea, carbonaceous sputum, wheezing, hoarseness, altered mental status
What tissues are resistant to electric current?
bones and fat are most resistant while nerves and vessels are least resistant
What is the iceberg effect?
more damage is done under the surface of an electrical burn than to the surface
Why are electric burn patients at risk for broken bones?
muscle contractions caused by electric currents and fall resulting from electric shock; pts spine should be immobilized immediately
What are patients with electric burns at risk for?
dysrhythmias(may occur within 24 hours), cardiac arrest, severe metabolic acidosis, and myoglobinuria (can block renal tubules, red urine)
What is an example of a cold thermal injury?
frostbite
What are the indications for transfer to a burn center?
more than 10% partial thickness, burns on face, hands, feet, genitals, perineum, or major joints, third degree burns, electrical or chemical burns, inhalation injury, heart kidney or resp. disease, concurrent trauma, and in children
What is a superficial partial thickness burn?
burn to the epidermis; 1st degree burn; arrhythmia, blanching, pain with mild swelling, no blisters or vesicles
What is a deep partial thickness burn?
burn to the dermis; 2nd degree burn; fluid-filled vesicles that are red shiny and wet(moist blebs); every pain caused by injury to nerve, mild-moderate edema; blanching; sensitivity
What is a full thickness burn?
burn to fat, muscle and bone; 3rd or 4th degree burn; dry, waxy white, leathery hard skin; no pain due to nerve damage; strong burn odor; impaired sensation when healed; nonblanchable
What is the rule of nines?
method used to initially assess a burn; the patients hand (including fingers) is 1%
What is the Lund-Browder Chart?
method of estimating size of burn; more accurate than rule of nines because it takes into account body area and age
What types of burns would affect the respiratory system?
burns to face and neck; circumferential burns to chest or back that interfere by obstruction caused by edema or eschar
What types of burns would impact self-care deficit?
hands, feet, joints, and eyes; hands and feet cause problems because of the superficial vascular and nerve systems that are damaged healing time is slowed
What types of burns are most susceptible to infection?
ears and nose due to poor vascularity; buttocks or perineum due to urine or feces
Why are circumferential burns on extremities a problem?
compartment syndrome
What are patient risk factors for mortality with burns?
cardiovascular, respiratory, or renal disease have poor prognosis due to bodies demands; DM or PVD are at risk for poor healing; complications such as fractures also impede healing
What causes a superficial partial thickness burn?
sunburn, quick heat flash
What causes deep partial thickness burn?
flames, flash, scald, contact burns, chemical, tar, or electric current
What causes a full thickness burn?
flame, scald, chemical, tar, and electric current
What initial interventions are conducted for thermal burn patients?
ABCs, stabilize spine, assess for inhalation injury, give O2, be prepared for intubation, monitor vitals and rhythm and LOC, remove clothing and jewelry, cover burns with dry dressings, establish 2 large bore IVs, fluid replacement, foley if greater than 15%, elevated burned extremities, give pain meds, treat other injuries
What is the priority intervention during the prehospital phase?
removing patient from the source of the burn; then remember there could be other injuries that take priority over the burn
What should be done with thermal burns less than 10%?
clean, cool, tap water damp towel to minimize depth of burn; do not leave on longer than ten minutes for risk of hypothermia
When should you use ice on a burn?
NEVER- this can cause hypothermia and vasoconstriction reducing blood flow to the area
What should be done if the burn is greater than 10% of the body surface area?
ABCs; also done for electrical or inhalation burns
What are the interventions during prehospital phase for chemical burns?
remove any chemical particles with water for 20m-2h; destruction can occur for up to 72 hours
What is the emergent phase?
up to 72 hours after the burn, primary concern is hypovolemic shock and edema formation; ends when fluid mobilization and diuresis occurs
What happens to F&E when a burn occurs?
risk for hypovolemic shock; massive shift due to increased cap permeability; water moves into second and third spacing (blisters), insensible loss is increased, hemolysis of RBCs, increased hematocrit