Toddler: Burns Flashcards
What is a thermal burn?
most common, through exposure to flames, or scalds, contact with hot object
What is a chemical burn?
touch or ingest caustic agents
What is an electrical burn?
exposure to direct or alternative current that passess through muscles, organs, nerves, vessels
What is a radiation burn?
exposure to radioactive substances or sunlight
first degree burn = ______ thickness burn
superficial
2nd degree burn = ______ thickness burn
partial
3rd and 4th degree burn = ______ thickness burn
full
Define 1st degree burn
Damages occur only on outer layer of skin, burn is painful and red
Define 2nd degree burn
Partial thickness
involves epidermis and upper layers of dermis
may have soaring of sweat glands and sebaceous glands
heals in 10-14 days
Define 3rd degree burn
Full thickness
involves all of epidermis and dermis
may also involve underlying tissue
nerve endings usually destroyed
requires skin grafting
Characteristics of 1st degree burn
Pain at site
redness on burned area
blanches on pressure
no bullae (blisters)
peeling after a few days due to premature cell death
Characteristics of 2nd degree burn
Blisters or bullae
erythema
blanches on pressure
pain and sensitivity to cold air
minimal scar formation
characteristics of 3rd degree burn
Skin may appear brown, black, deep cherry red, with to gray, waxy or translucent
usually no pain (due to damaged nerve endings),
injured area may appear sunken
What does management for 1st degree burn include?
Pain management moist soaks or cool cloths
antibiotics
dressing changes
increase fluid intake
HPHC (high protein and high calorie) diet
follow up visits
What does management for 2nd degree burn include?
IV fluids
pain management
HPHC diet
wound dressings
antibiotics
What does management for 3rd degree burn include?
IV fluid resuscitation
antibiotics
skin grafts and proper dressing changes
high protein high calorie (HPHC) die
vitamins and mineral supplements
debridement
pain management
What are the 8 body responses to moderate-severe burns?
- Increased capillary permeability (fluid moves from capillaries into cells/tissues)
- Decreased cardiac output due to fluid shift & increased vascular resistance (to improve blood flow/BP)
- Airway inflammation
- Bone marrow Suppression (late response)
- Hypermetabolic state (response to trauma of burn)
- Decreased digestive absorption (due to trauma)
- Inflammatory response
- Immune suppression (due to bone marrow suppression or over-proliferation of WBC)
Why may airway inflammation occur with burns?
not initial response, usually from smoke inhalation
What is a late body response to burns?
bone marrow suppression
What are the clinical manifestations and therapy for increased cap. permeability?
- Edema in burned and unburned skin, hypovolemia, oliguria
- T: Increased IV therapy for 24-48 hours (fluid resuscitate)
What are the clinical manifestations and therapy for dec. cardiac output & inc. vascular resistance?
Hypovolemia, poor cap refill, tachycardic, cool extremities
T: Aggressive fluid resuscitation to maintain urinary output
What are the clinical manifestations and therapy for airway inflammation?
Hoarseness, stridor, hypoxemia (from airway edema or narrowing), soot in mouth
T: Supplemental O2, Intubation and ventilation
What are the clinical manifestations and therapy for bone marrow suppression?
anemia
T: transfusion of packed red blood cells
What are the clinical manifestations and therapy for hypermetabolic state?
Loss of weight and lean body mass, hyperglycemia
T: High protein diet, enteral tube, insulin
What are the clinical manifestations and therapy for decreased digestive absorption?
Food aversion, nausea, vomiting, paralytic ileus
T: IV fluids and electrolytes, nasogastric tube
What are the clinical manifestations and therapy for inflammatory response?
Fever, tachycardia, open wounds
T: Debridement, excision of full thickness burns, wound dressings, protective isolation (to prevent infection)
What are the clinical manifestations and therapy for immune suppression?
infection
T: antibiotics
What is the biggest risk with thermal burns? and why?
risk of hypovolemic shock
A potentially critical condition that results from an extracellular fluid loss, plasma loss due to burn
What are the early signs of hypovolemic shock?
- Signs of dehydration
- Confusion
- Cool, pale skin
- tachycardia
What is included in the assessment of burn severity?
- Depth of the burn
- % of body surface area (BSA): Use rule of nines (one for child and one for adult)
- Involvement of specific body parts: face, hands, genitals, circumferential?
What is the treatment of major burns in order? (7)
- stabilize ABC
- manage fluid shifts and minimize fluid loss
- control pain
- prevent infection and further tissue loss
- promote nutrition
- aid ROM and mobility
- supportive effective coping
When would you switch to oral/enteral feeds?
when theres good bowel sounds
Why do you need a high protein and calorie diet?
- prevent weight loss
- protein good for cell development/growth
What is the parkland formula?
4ml x kg x % body surface area burned + maintenance fluids = 24 hour total fluid replacement
note: do parkland formula and calculate rate for certain amount of hours first
then add maintenance fluid rate
How do you use parkland formula by hours?
- ½ first 8 hours
- ¼ next 8 hours
- ¼ next 8 hours
What is the fluid choice for resuscitation and why?
Lactated ringers: matches biochemical composition of human plasma with balanced electrolyte formulation
