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56 Cards in this Set
- Front
- Back
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When a pt is burned what aspects of the skin are affected?
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if hair follical is damaged - no hair will grow
damaged blood vessels will dec healing 4th degree burns won't have pain bec nerve endings are dead |
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What are the stages of wound healing?
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Fluid exudate; leukocytes, histocytes, macrophages
2-3days: fibroblasts, and capillary 4th: fibroplasts replace inflammation cells 5-6day: scar tissue Skin develops in no necrosis Elastic tissue appears in months (firm good) Nerves last to regenerate |
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It is important for the person to be healthy to heal, what should you monitor?
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Labs
WBC inc (first signs of infection bec theres no skin) Hct inc RBC - to monitor for internal bleed electrolytes to determine if cells are being broken down |
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What are outcomes of burn care?
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prevention of shock
pain management limit bacterial growth on wound |
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What happens in the emergent phase of burn healing?
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Injured vasculature (fluid shift)
F/E imbalances (K bec of hemolytic RBC) Fluid reabsorption (48hrs later) Diuresis - 50-100mL to 1000mL Myoglobunuria |
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what is myoglobunuria?
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when myoglobin is in the urine because of the muscle break down
urine is burgandy could cause ATN |
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How do you determine the amount of fluid to give to a burn pt?
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TBSA x Kg body weight x 4 = total for first 24hrs
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In what increments is the fluid given during the 24hrs?
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1st 8hrs = 1/2 total
2nd 8hrs = 1/4 total 3rd 8hrs = 1/4 total |
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How do you know when the fluid replacement is working?
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Pulse: <100
CVP: >6 - <10 PCWP: <18 Urine hrly: 30-70ml, if <20 kidneys aren't perfused Sensorium: clear GI Fx: BS present (absence of ileus |
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What occurs in the acute phase of burns?
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maintenance of hemodynamic status
Wound care PT OT |
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What kind of wound care occurs in the acute phase?
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debridement
escharatomy hydrotherapy (pain meds before) skin graft |
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What are PT and OT concerned with in the acute phase?
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starts with admission
contracture concerns keloids hypertrophic scarring ROM during dressing change |
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What is important to know for debridement?
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some wounds are open and some are closed
open all blisters to prevent bacteria wear PPE with open wounds and use a antimicrobial |
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What is the cause and color of a first degree burn?
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Cause:
sun, flash, minor scald Color: dry, minor blister, erythema |
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What is the cause and color of a second degree burn?
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Cause:
scald Color: moist, reddened with blisters, white slough, red mottled |
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What is the cause and color of a third degree burn?
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Cause:
flame, severe scald color: dry, charred, whitish |
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How do electrical burns move through your body?
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bounces off hard tissue (fat and bones) and goes through soft tissue
assess CV status see insertion site and blow out at exit site |
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How do you treat chemical burns?
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flush area with water continuously
alkaline burns are the worst bec they aren't neutralized by the tissues |
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What are the types of smoke burns?
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CO poisoning
Inhalation above the glottis (thermal) Inhalation below the glottis (chemical) |
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What % of burns are on the head and neck total for front and back?
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9%
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What % of burns are on each upper limb total for front and back?
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9%
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What % of burns are on the thorax and abdomen front?
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18%
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What % of burns are on the Perineum?
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1%
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What % of burns are on the thorax and abdomen back?
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18%
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What % of burns are on each lower limb total for front and back?
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18%
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What factors influence wound healing?
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extent of injury
nutrition Oxygen - without it, collagen isn't formed Medications/Chronic Illness (DM) No antibiotics unless nessassary |
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What nutritional aspects are needed for wound healing?
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Protein (albumin for capillary strength)
Vitamins C Minerals - iron Calories |
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What are the steps for burn care?
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stop the burning process
assure adequacy of ventilation and oxygen initiate restoration of hemodynamic stability systemically and locally |
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What should be done to stop the burning process?
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Water for smoldering clothing
Water for chemical burns Remove clothing - keep warm Cool water for small 2° burns only |
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What should be done to assure adequacy of ventilation and oxygenation?
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Provide oxygen for all burns to treat carbon monoxide
Consider early endotracheal intubation with smoke inhalation injury |
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What should be done to initiate restoration of hemodydnamic stability systemically and locally?
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Isotonic crystalloid infusion
Remove any constricting items Consider Escharotomy for circumferential burns LOOK FOR OTHER TRAUMATIC INJURIES BURN WOUND LAST PRIORITY |
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How do you treat shock?
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maintain O2 and tissue perfusion
Re-establish and maintain CV fx Provide comfort and reduce anxiety |
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How do you assess shock?
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Non- invasive:
ABC LOC, orientation State of hydration and perfusion Respiratory Assessment Pain level and location Cardiovascular assessment Ecchymosis, contusions, etc. Invasive: CVP, PCWP, Arterial B/P monitoring |
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What are the defenses for shock prevention?
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Epinephrine and Norepinephrine
Mineralcorticoids and Glucocorticoids ADH Bone Marrow Liver and Spleen Kidneys these all est energy and maintain circulatory balance |
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What are the risk factors for near drowning?
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<5 yrs old
teens inability to swim ETOH or drug use trauma seizures hypothermia stroke |
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What is a near drowning?
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surviving the physiologic effects of hypoxemia and acidosis that result from submersion incident
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What are the forms of near drowning?
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Dry
Wet Secondary |
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What is dry near drowning?
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victim doesn't aspirate fluid but suffers RR obstruction or asphyxia from laryngeal spasm
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What is a wet near drowning?
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victim aspirates fluid and suffers asphyxia from it (85%)
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What is secondary near drowning?
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victim suffers a reoccurance of RR distress with in mins or 1-2 days after it
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What are the treatments for near drowning?
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Ongoing head to toe assessment- remove all clothing
IV access: infuse warm fluids ABG – respiratory acidosis is common b/c of inc CO2 100% O2 Vital Signs B/P - monitor for hypotension Pulse- arrythmias Respirations- assess rectal temp. Rewarming interventions |
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What are the classifications of hypothermia?
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<35 or <95
Mild: 89.6-95 Mod: 86-89.6 Severe: 77-86 <82 coma |
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What are the causes of hypothermia?
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cold water drowning,
prolonged exposure to cold temperature impaired thermal regulators increased heat loss decreased heat production administration of large quantities of cold blood |
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What are the s/s of hypothermia?
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1st response- chills/shivering, slurred speech and amnesia
Respirations- slow and shallow Cyanosis Tachycardia- severe bradycardia Confusion, lethargy, loss of deep tendon reflexes Initial diuresis- decreased UOP |
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What is the treatment for hypothermia?
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If wet- get them dry! If extremity is frozen- leave it frozen for now
Continuous monitoring of rectal temp Continuous cardiac monitoring Passive External Rewarming: put in warm environment, take off clothes, warm blanket Active External: hot water bottles, warming blankets, radiant heat, immersion in water, body to body heat |
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When should you stop resuscitative efforts for hypothermia?
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Core temp must be at least 32 C/89.6 F before stopping resuc. efforts (some texts say warm to 95 F before ceasing resuscitation efforts)
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What are the s/s of superficial frostbite?
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white waxy color
tingling and numbness burning sensation crystals form: difficult to warm on nose ears toes and fingertips |
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What are the s/s of deep frostbite?
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white or yellow white color
insensitive to touch edema of entire extremity tingling numbness burning skin cold and stiff blisters with in a few hrs usually a limb |
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What are the interventions for frostbite?
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Remove wet, cold clothing, shoes, etc
Avoid excessive manipulation of the affected area Re-warm affected area by warm moist soaks or immersion in circulating water at 104-110 F IV analgesics Elevate extremity - cradle Place cotton between toes and fingers Avoid friction and weight on affected area - no heavy blankets allow pt to move fingers on own |
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What is mild hyperthermia?
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heat cramp
excessive perspiration - loss of salt contractions thirst |
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What is moderate hyperthermia?
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Heat exhaustion
body is subjected to high T and blood accumulates in the skin to attempts to dec dec in circulating blood volume dec in CBF syncopy pale fatigue sweating AMS Hypotension tachycardia weak pulse |
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What is critical hyperthermia?
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Heat Stroke
body's T cont to rise and internal organs become damaged death hot dry skin AMS Hypotension tachycardia weakness T >104 |
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What is the treatment for hyperthermia?
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cool environment
O IV to replace fluids take off clothes put wet blankets on them put fan on Cath EEG |
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What is the treatment for critical hyperthermia?
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remove clothing- cool water to skin
control shivering with valium and thorazine hyperthermia blankets ice packs to groin or axillae Make sure T <102 Use corticosteroids (no Tylenol or ASA) |
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What are the ongoing assessments for hyperthermia?
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O2
VS neuro hemodynamics renal (rabdomyolysis) |
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Hyperthermia
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>99
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