Thermal Injuries Flashcards by Kaitlin Zemanek

What are the four causes of thermal burns?

Flame
Flash
Scald
Contact with hot objects

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What are the three causes of chemical burns?

acids
alkalis
organic compounds

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What are three injuries associated with smoke and inhalation injury?

Metabolic asphyxiation
upper airway injury
lower airway injury

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Contact with electric current can cause ______ ______ strong enough to ____ long bones and vertebrae

muscle contractions; fracture

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Possible complications from an electrical burn

dysrhythmias
severe metabolic acidosis
myoglobinuria

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What are the 5 different types of burns?

Thermal, chemical, smoking/inhalation injury, electrical and cold thermal injury

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How are burn injuries classified?

Depth of burn
Extent of burn
Location of burn

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At the scene of the (burn) injury, priority is given to ______ & _______

removing the person from the source of the burn; stopping the burning process

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Small thermal burns should be ______ for the patient’s comfort and protection until medical care is available

covered with a clean, cool, tap-water dampened towel

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To prevent hypothermia cool large burns for no more than ____ minutes

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What are the three phases of burn management

1) Emergent
2) Acute
3) Rehabilitation

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What are the primary concerns during the emergent phase?

hypovolemic shock

edema formation

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Major electrolyte shifts of ____ & _____ occur during the emergent phase

sodium; potassium

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A _____ shift develops first because injured cells and hemolyzed RBCs release _____ into circulation

potassium; potassium

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What type of burns are painless at first?

full-thickness and deep partial-thickness

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What type of burns are usually painful at first

superficial to moderate partial-thickness

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What can a patient with a larger burn area develop?

paralytic ileus

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What three body systems are most susceptible to complications during the emergent phase?

cardiovascular
respiratory
urinary

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What are cardiovascular complications in the emergent phase?

dysrhythmias
hypovolemic shock
sludging
VTE

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What are complications associated with deep circumferential burns?

ischemia
paresthesia
necrosis

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What is the treatment for a deep circumferential burn?

escharotomy

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What are respiratory complications in the emergent phase?

upper airway distress

airway injury

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True or False. There is a correlation between the percentage TBSA and the severity of inhalation

False

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How soon do patients with burns to the face and neck need to be intubated?

Within 1-2 hours after injury

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At least 2 large-bore IVs must be in place for patients with burns that are ___% TBSA or more

For patients with burns greater than ___ % TBSA consider a central line

Fluid replacement is achieved with ______, _____ solutions or a combination of the two

crystalloid (LR); colloid (albumin)

What is the most common formula used for fluid replacement?

Parkland (Baxter)

Patients with an ______ injury have greater than normal fluid needs

electrical

What is the recommended fluid therapy for the first 24 hours?

2-4 mL LR/kg/% TBSA burned

When are colloids administered after a burn injury?

after the first 12-24 hours

What is the colloid fluid replacement formula?

0.3-0.5 mL/kg/% TBSA burned

Urine output parameters after a burn injury

0.5-1 mL/kg/hr | for ELECTRICAL burns = 75-100 mL/hr

Cardiac parameters after a burn injury

MAP > 65 mmHg SBP > 90 mmHg HR < 120 bpm

What is given priority once a patent airway, effective circulation and adequate fluid replacement have been achieved?

wound care

How do partial-thickness burn wounds appear?

pink to cherry-red; wet, shiny, serous exudate; painful; minor, local sensations

What is the source of infection in burn wounds most likely from?

Patient's own flora; skin, respiratory, GI systems

What should the nurse do if the patient's burn wounds are exposed?

Always wear PPE

What should the nurse do with the room's temperature with a burn patient?

Keep the room warm

What should not be used with patients with ear burns?

Pillows

Early in the post-burn period ___ pain medications should be given

IV opioid

What is given routinely to all burn patients because of the likelihood of anaerobic burn wound contamination?

tetanus

What do many burn antimicrobial creams contain?

Sulfa

What are clinical manifestations of the acute phase?

eschar removed; red/pink scar tissue

How to prevent curling's ulcer?

feeding the patient ASAP after burn injury; H2 blockers; PPIs

What can help speed up the removal of dead tissue from the healthy wound bed?

enzymatic debriding agents (collagen)

What are the complications during the rehabilitation phase?

skin and joint contractures; hypertrophic scarring

What areas are most susceptible to skin and joint contractures?

anterior/lateral neck areas, axillae, antecubital fossae, fingers, groin, popliteal fossae, knees, ankles

What are the three different types of hyperthermia?

heat cramps heat exhaustion heatstroke

When do heat cramps occur?

during rest after exercise or heavy labor

Who is usually affected by heat cramps?

healthy, acclimated athletes with inadequate fluid intake

How are heat cramps resolved?

rest and oral/parenteral replacement of sodium/water; elevation, gentle massage, analgesia

Patient education for heat cramps

avoid strenuous activity for at least 12 hr; salt replacement during strenuous exercise in hot, humid environments; sports drinks/pedialyte

Clinical Manifestations of heat exhaustion

fatigue, nausea, vomiting, extreme thirst, anxiety, hypotension, tachycardia, fever, dilated pupils, confusion, ashen color, profuse sweating

First action of nurse with heat exhaustion?

place patient in cool area and remove restrictive clothing

What do you not use with a patient experiencing heat exhaustion?

salt tablets - potential gastric irritaiton and hypernatremia

True or False. Heatstroke is a medical emergency

True

When does the core temperature increase with a heatstroke?

within 10-15 minutes

Heatstroke nursing interventions

100% O2, BVM or mechanical ventilation; ECG monitoring; correct fluid/electrolytes

What are the cooling methods for heatstroke?

removing clothing, covering with wet sheets, placing patient in front of large fan; immersing patient in a cool water bath; apply ice packs to groin and axillae; peritoneal lavaging with iced fluids

Do you want a patient with hyperthermia to shiver?

What medication can we give to control shivering?

chlorpromazine IV

What complication do we need to monitor for with hyperthermia?

rhabdomyolysis

What body parts are usually affected by superficial frostbite?

ears, nose, fingers, toes

How is the skin affected with superficial frostbite

waxy pale yellow, blue, mottled; feels crunchy, frozen; tingling, numbness, burning sensation

What should be avoided with frostbite?

heavy blankets and clothing

What body parts are affected with deep frostbite?

muscle, bone, tendon

How is the skin affected with deep frostbite?

hard, insensitive to touch; mottling progressing to gangrene

What is the body's first attempt to conserve heat?

Peripheral vasoconstriction

As cold temperatures persist, ____ & ____ are the body's only mechanisms for producing heat

shivering; movement

Clinical Manifestations of mild hypothermia

shivering, lethargy, confusion, rational to irrational behavior, minor heart rate changes

Clinical Manifestations of moderate hypothermia

rigidity, bradycardia, slowed respiratory rate, BP only obtainable by Doppler, metabolic and respiratory acidosis, hypovolemia

At what core temperature does shivering diminish or disappear?

89.6

Cold blood becomes _____ and acts as a _______

thick; thrombus

Severe hypothermia makes the person appear _____

dead

Clinical Manifestations of severe hypothermia

metabolic rate, heart rate, respirations so slow they may be difficult to detect; reflexes absent; pupils fixed and dilated; profound bradycardia, ventricular fibrillation, asystole

True or False. With severe hypothermia every effort must be made to rewarm the patient to at least 86 F before the person is pronounced dead

True

What are some passive or spontaneous rewarming methods for hypothermia?

moving patient to a warm, dry place; removing damp clothing; radiant lights; warm blankets

What are some active external or surface rewarming methods for hypothermia?

fluid- or air-filled warming blankets, warm water immersion

When do you use active internal or core rewarming methods?

moderate to severe hypothermia

Active internal or core rewarming techniques

heated humidified O2; warmed IV fluids; peritoneal lavage with warmed fluids; extracorporeal circulation with cardiopulmonary bypass, rapid fluid infuser, hemodialysis

Which portion of the body do you rewarm first with hypothermia?

Core warmed first before the extremities

When do you discontinue active rewarming?

Once the core temperature reaches 89.6-93.2 F