wk 12 flash Flashcards
what are the three types of burn
thermal, chemical and electrical
what are the characteristic of a first degree burn
- red, minimal swelling, moderate to severe tenderness
what are the characteristics of a deep partial thickness (second degree) `
miderate to severe pain
no debridement if its small enough
what are the characteristics of a third degree (full thickness) burn
leathery, white and dark brown
no pain in area, only in the edges
if not derided within 24 hours they’ll be septic
how long does a third degree burn have to be derided before the patient goes septic
24 hours
how do we calculate TBSA
rule of 9s
only for people who have average height and weight proportions
how can you tell if a burn patient needs a respiratory assessment
- burned hair, soot on face, wheezing, SOB
or any burns on the face, neck and chest
what do we have to focus on if a patient has a burn on their bum or perineum
- worry about BM, diarrhoea, and infection from diarrhoea
what is a circumferential burn
skin around the trunk
its bad because skin will get so tight you won’t be able to breathe
what is an escharotomy and why would one need it
- basically you cut through burn tissue and let the skin expand
you need it for a bad circumferential burn
what constitutes a minor burn
<10% TBSA partial thickness
<2% full thickness
no burns on face, eyes, hands, ears, or perineum
no electrical or chemical burns
no inhalation injury
< 60 years of age with no chronic disorders
what constitutes a moderate burn
partial thickness less than 10 % TBSA
full thickness 2-10% TBSA
what constitutes a severe burn
partial thickness> 10% TBSA
3 degree burn
inhalation burn
electric/ chemical burn
burn on the face, hands, feet, perineum, joints, etc.
children in hospitals where they dont have supplies for pets
what is the Manitoba burn unit
HSC H5
in the emergency phase of smoke inhalation, what are your 3 main priorities
Airway: protect the airway, intubate early
Breathing: stand beside patient with 15L of oxygen ready
C: give IV fluid because the patient will be hypovolemic (NS or ringers usually)
should you prioritise wound care in the emergent phase of a burn?
no, wait until airway is protected and BP is stable
what are signs that there is a burn in the upper airway
- hoarseness/stridor
- difficulty swallowing
- lots of secretions
what is the main focus of the acute phase of a burn
- patient will be hypervolemic and diuressing a lot
- mainly focus on wounds and preventing sepsis
what is a patients metabolism like in the acute phase of a burn
patients will be hyper metabolic, they’ll likely need a tube feed
what do you give for antianxiety in a burn patient
Ativan
what do you give for pruritis in a burn patient
Benadryl
what type of infusion should you give during burn dressing change
ketamine continuous
what is the main thing with silver/acticoat
it kills bacteria, activate it by getting it wet
what is an autograft
patients own skin
what is a cultured epithelial autograft
take skin and grow in lab (fragile)
what is an allgraft/homograft
another persons skin
what is a heterosexual/xenograft
different species skin graft
what is biobrane
manufactured skin (product)
how long do people need to wear compression garments during the recovery phase of a burn
- 1-2 years
- 24 hours a day
why do you need to wear compression garments after a burn
to prevent hypertrophic scar
which grades of frostbite need to be hospitalised
grades 3 and 4
how long does it take to demarcate
2 weeks - 5 months
what is demarcation
divides between injured and normal skin, you can see the full extent of the damage
what are the main things we do for frostbite care
handle area carefully
soak with warm water
take off jewellery
do NOT squeeze
what does a grade 1 frostbite look like
decreased blood flow (hyperaemia) and edema
what does a grade 2 frostbite look like
large, clear milky blisters
what does a grade 3 frostbite look like
small, dark blisters
cool dumb and blue non-blandkking
what does a grade 4 frostbite look like
blisters all over, part is cold and bloodless
necrosis extends to bone
what is the treatment for a grade 3 frostbite
debridement
what is the treatment for a grade 4 frostbite
amputaiton
what is the priority for sepsis
early identification and antibiotics
what is the priority for septic shock
treat BP
what will lactic acid levels look like for a patient with sepsis
they will be high
what will BUN and Cr levels look like for a patient with sepsis
they will be high
what are the main early shock symptoms
- change in VS
- low BP, high HR
- narrow pulse pressure
- warm and flushed skin
what do late shock symptoms look like with sepsis
- cold and clammy
very low BP
narrow pulse pressure
mottled skin
increase in lactic acid
what are the 6 main priorities for sepsis
- give O2
- IV fluid to raise BP
- draw cultures
- give IV abx (broad spectrum until culture comes back
- baseline bloodworm
- put foley in for accurate i/o
what are three types of opportunistic infection someone who is HIV positive could have
thrush, shingles, pneumonia, yeast
what do pupils look like in late stage shock
unreactive and dilated
what are the main 2 reasons someone dies in the emergent phase of a burn
airway obstruction
CV collapse (high pulse, low BP)
what is the main big thing we should monitor for if a patient has stridor from an inhalation burn
if the stridor stops that’s BAD
what are the four main priorities in a patient with a possible inhalation burn in the emergent phase in ER
1) High fowlers
2) O2 mask on
3) constant oxygen sat probe
4) continually listen to chest sounds (nurse will be assigned to monitor breathing)
what vital signs indicate hypovolemic shock
SBP < 90
HR > 120
