Unit 7: Burns and Angina Flashcards
What is the classification of a superficial (1st degree) burn?
Redness
Pain
Mild swelling
No blisters
Doesn’t break the skin
Who are most at risk for burns?
Young and older generation
Watch for abuse
Keep water heater at 120 degrees
What are causes of burns?
Thermal - fire, steam, hot liquids, or hot objects
Chemical - acids (hydrochloric acid) and alkalis (fertilizer, lye, or drain cleaners)
Radiation - chemotherapy, sunburns
Electrical - watch for iceberg effect
Smoke inhalation
What to check for smoke inhalation? Treatment?
Watch for a hoarse cough and soot in the airways.
Tx includes a NRB at 100% O2 for 40-60 minutes to displace CO from hemoglobin
What are the different degrees of burns? Any specifics about them?
Superficial - 1st degree: sweat glands still intact, no blisters
Partial thickness - 2nd degree: epidermis and part of the dermis - blisters, pain, redness
Deep Dermal Partial Thickness - 2nd degree: affects deeper layers of the dermis - white/charred tissue, non-blanching
Full-thickness - 3rd degree: appears white, leathery, or charred, and there is no pain in the area due to nerve destruction.
Deep Full-Thickness - 4th degree: Edges may not be as severe as underneath; maintain airway
What is the rule of nines and palm method?
The palm method is used as a quick tool. 1% per palm area
Rule of nines:
arms and head = 9% as a whole
legs = 18% as a whole
chest = 18%
back = 18%
groin = 1%
Things to know for burns!
Prevention is key! prevent contractures, prevent worsening symptoms
Watch for HYPOTHERMIA AND INFECTION
Watch for rhabdo with electrical burns
Hypermetabolic state for about 1 year after serious burn
Intubate before swelling
What percentage is considered a major burn?
20%
What are the s/s of emergent phase?
hypovolemia - GREATEST FLUID VOLUME LEAK OCCURS WITHIN THE FIRST 24-48HRS
Dehydration
Decreased urine output
Hyperkalemia
Hyponatremia
Managing burn shock
Maintain fluid status though consensus formula or PARKLAND BAXTER FORMULA
Maintain heart rate less than 110
Maintain urine output
Maintain sodium lvls
What is the equation to know how much fluid to replace?
2-4m/kg*TBSA divided by 2
The first half within first 8 hours
The second half over the rest of 16 hours.
Emergency procedures at the burn scene
Make sure scene is safe
Extinguish burn source, Cool burn
ABCDEs - Intubate before swelling occurs
Remove restrictive objects
Cover the wound
Irrigate chemical burns
O2 and IV placement
What are the phases of burn injury?
Resuscitation (emergent) - onset of injury to completion of fluid restoration
Acute - completion of fluid restoration to start of wound closure; wound care, nutritional support, infection prevention, pain management, prevention of complications
Rehabilitation - begins with wound closure to return to optimal physical and psychosocial adjustment
What to know about the acute phase
hemodilution
Edema could occlude the airway could occur up to 2+ days after burn
What to know about burn wound care
Hydrotherapy for cleaning
Prevent infection
Use topical agents
Types of debridement: natural, mechanical, chemical (silver), or surgical (wound dressing, dressing changes, and skin grafting)
What nutritional support is needed?
Hypermetabolic for about a year after
Initiate feedings ASAP
nurtitional support is based upon pre-burn status and total burn surface area
What is ischemia and infarction?
Ischemia: insufficient oxygen supply to meet requirements of myocardium
Infarction: necrosis or cell death that occurs when severe ischemia is prolonged and decreased perfusion causes irreversible damage to tissue
What is the patho of burn shock?
Significant fluid and protein loss into the interstitial space due to increased capillary permeability following burns, leading to hypovolemia, impaired tissue perfusion, and potential organ dysfunction.
What is chronic stable angina?
The temporary imbalance between the coronary artery’s ability to supply O2 and cardiac muscle’s demand for O2.
Ischemia is limited in duration and doesn’t cause permanent damage to myocardial tissue.
What is new-onset, variant, and pre-infarction angina?
New-onset: first chest pain
Variant: occurs after rest, repeating chest pain
Pre-infarction: chest pain right before MI
What is a STEMI?
The ST segment is elevated
Fully occluded coronary artery
What is a NSTEMI?
The ST segment is depressed (U-waves indicate previous heart damage)
Partial occluded coronary artery
What are risk factors for ACS?
Women
Obese
Old
Diabetic
What is ACS? Treatment?
O2
Give aspirin
Start IV (one with NS and another with IV, Nitro, and fentanyl)
Cath Lab within 90 minutes
What is a cardiac diet?
Sodium <2g
Less red meat
Increase fish, fresh fruits and veggies
What is the sexuality following a Post-MI?
Walk one block or climbing two flights of stairs can resume sexual activity
Wait for 1 1/2 hours after exercise or a heavy meal. Better after a period of rest.
What are diagnostic/labs test for MI?
12-lead
Echo
Exercise Stress Test (EST)
CK-MB - measures damage of heart muscle
Troponin - rises in 3-6 hours post-MI (I isn’t affected by skeletal muscle damage or kidneys, while T is)
PT/INR, PTT, CBC, BMP, BNP (used to test if it is the heart or lungs), UA, CMP
What is FONA?
Fentanyl
Oxygen
Nitroglycerin
Aspirin
What is a CABG, PTCA, and stent?
PTCA (percutaneous transluminal coronary angioplasty) - a balloon is passed into the artery and blown up pushing apart a clot.
Stents - able to constrict and dilate, keep the artery open
CABG - keep MAP lower
T/F: Patients will present with ST changes on 12-lead, but will not have changes in troponin or CK levels
True - this is because the troponin levels won’t change until damage is done to the heart, meaning the only real indication for unstable angina is the ECG.
What does an abnormal Q wave indicate?
History of MI and ischemia of the heart (the Q wave is very noticable)
What are the abnormal signs of MI?
Women - chest discomfort, indigestion not relieved with antacids, upper abdomen pain, jaw pain, arm/shoulder pain, fatigue, N/V
Diabetics - wont have pain
Elderly - jaw, fainting, no pain
What is thrombolytic therapy?
Used to break down clots when cath labs aren’t available.
