Miscellaneous topics 2 Flashcards
Patients with extensive burn injuries require
aggressive fluid resuscitation as well as surgery for debridement and skin grafting to prevent bacterial sepsis
What are the four classes of burn injury?
superficial
partial-thickness
full-thickness 3rd degree
full-thickness 4th degree
Describe a superficial burn
epidermis only
Describe a partial-thickness burn.
extends to the dermis
Describe a full thickness 3rd degree burn.
complete destruction of the epidermis and dermis
Describe a full thickness 4th degree burn
Extends to muscle and bone
We can use _________________ to assist with fluid replacement calculations
“rule of nines”
Complications of burns include
hypovolemic shock
inhalation injury
sepsis
contractures
scarring
What is the patient experience with a 1st degree burn?
stinging, tender and sore
What does the patient experience with a 2nd degree burn?
very painful
What does the patient experience with a 3rd degree full thickness burn?
no sensation
What does the patient experience with a 4th degree burn?
no sensation
For children 1-4, the rule of nine’s looks a little different in that
more percentage is given to the child’s head (19%) and slightly less to the legs (15%) and torso (16%)
What is the BEST IV fluid to administer in the initial 24 hours after a major burn?
a. D5W
b. 3% NaCl
c. 5% albumin
d. Lactated ringers
d. Lactated ringer’s
Immediately after a burn, microvascular permeability
increases and this creates a capillary leak
Capillary leak leads to
edema formation
hypovolemia
shock
Fluid shifts and edema formation are greatest in the first ______________ and begin to stabilize by _____________
12 hours; 24 hours
________________- should be avoided during the first 24 hours because it’s lost to the interstitial space
Albumin
What are the two commonly used fluid resuscitation formulas used for the acutely burned patient?
Parkland and Modified Brooke
-both use LR in the 1st 24 hrs. and then use D5W
Additional considerations for burn injuries include
abdominal compartment syndrome
carbon monoxide poisoning
airway complications
up-regulation of extrajunctional receptors after 24 hours
impaired temperature regulation
increased oxygen consumption
A rising hemoglobin in the first few days following a burn suggests
inadequate volume resuscitation
Describe the Parkland fluid resuscitation goals.
4 mL LR x %TBSA burned x kg
1/2 in first 8 hours
1/2 in next 16 hours