Week 10 - 12 Flashcards
Who is at greater risk for burn injury?
0-4 years scalding
Males 15-39 are 1 in 5 at work
What are the risk factors for Surgical Complications in burns patients?
Airway compromise due to inflammation response
What is the criteria for admission to a Burn Unit?
Age under 5 years or over 60 years.
Site of injury: face, hands, perineum, any flexure (including neck or axilla) and circumferential dermal burns or a full-thickness burn of the limb, torso, or neck.
Inhalation injury.
Mechanism of injury:
Chemical burns affecting over 5% total body surface area (over 1% for hydrofluoric acid burns).
Exposure to ionising radiation.
High-pressure steam injury.
High-tension electrical injury.
Suspected non-accidental injury in a child.
Large affected area:
Age under 16 years: over 5% total body surface area affected.
Age 16 years or older: over 10% total body surface area affected.
Co-existing conditions, eg serious medical conditions, pregnancy or associated fractures, head injury, or crush injuries.
What is the significance of early detection of Inhalation injury?
risk of airway closure due to inflammation response and potential breathing issues due to burnt alveoli
Direct thermal injury producing upper airway oedema and/or obstruction.
Inhalation of products of combustion (carbon particles) and toxic fumes, leading to chemical tracheobronchitis, oedema, and pneumonia.
Carbon monoxide (CO) poisoning.
What is meant by the rule of nines in a patient with burns?
The adult body is divided into anatomical regions that represent 9%, or multiples of 9%, of the total body surface. Therefore 9% each for the head and each upper limb; 18% each for each lower limb, front of trunk and back of trunk.
The palmar surface of the patient’s hand, including the fingers, represents approximately 1% of the patient’s body surface.
Burns prevention 1 2 3 4 5
Preventing Scalds Contact Burns Flame Burns Explosions Friction
Safety in the workplace.
Safety in the home, including regularly checking smoke alarms.
Good parenting to protect children.
Care of the frail elderly and the socially isolated.
Prevention of sunburn: appropriate duration and timing of sunbathing, sun protection creams, and regulation of tanning booths. See separate article Sunburn.
A 80 kg pt has 25% TBSA burn. The patient is NBM so also include the 2L maintenance fluid requirements . Formula: 2mL/kg/TBSA% + 2000mlWhat are the fluid requirements for the first 24 hours? A 4000 mL B 7380 mL C 6000 mL D 14 760 mL
C 6000 mL
The incidence of burns injuries in Aust/NZ 1999-2004 is
460 admissions
4,600 admissions
46,000 admissions
46,000 admissions
True or False
The Classification of burns injuries is superficial, partial thickness and full thickness
True
Complete the following statement
We use the rule of nines TBSA% to …………….
calculate total body surface area burt
nursing care of a burns patient
airway intubate fluids obs UandE hemodynamics wound care temperature contol
Name three local effects of a burn 1 2 3 Name three systemic effects of a burn 1 2 3
Name three local effects of a burn 1 pain 2 blistering 3 redness and swelling Name three systemic effects of a burn 1 hypovolaemia 2 cardiac arrhythmias 3 thermoregulation
The aim of Pre hospital care in burns patients is ………
reduce heat
Cool with running water for up to 20 minutes
Consider immersion or wet towels if running water unavailable
If water is unavailable consider water gel products (in adults only)
Why do we need to consider certain groups of patients differently when they are critically ill? children
Children
> Surface area to volume ratio Leads to > heat loss and
Insensible fluid loss
>risk of dehydration/hypothermia
Metabolic rate >risk of hypoglycemic events
Airway Newborn’s larynx one third diameter of adults Short maxilla and mandible Large tongue Floppy epiglottis Shorter trachea More acute angle of airway
Breathing
Children compensate for hypovolaemia by vasoconstriction and tachycardia, and may lose up to 30% of blood volume before becoming hypotensive
Tachycardia is also non-specific, and occurs in children who are hypovolaemic, in pain, frightened, hypoxic, hypercapneic, having seizures etc.
Why do we need to consider certain groups of patients differently when they are critically ill? elderly
Integumentry
dry scaly skin, decreased perspiration decreased fat distribution, thinning of hair, decreased growth rate
Gastrointestinal
decreased secretions, making swallowing more difficult, decreased peristalsis, decreased production of digestive enzymes, constipation.
Reproductive system
decreased hormones, decreased testicle/uterine size, decreased
Urinary
decreased renal filtration and renal efficiency - decreased urine output, decreased bladder size, increased incontinence, nocturia
Musculoskeletal
decreased muscle mass, bone demineralisation narrowing of intervertabral space, shrinking, decreased joint mobility, enhanced bony provenances
Neurological
decreased voluntary and automatic reflexes, decreased ability to respond to stimuli, shorter sleeping habits
Pressure ulcers
risk of pressure ulcers from ETT, O2 tubes BP cuff, catheters, central lines, wound drainage, bed rails, o2 masks, spints traction and collars
