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37 Cards in this Set
- Front
- Back
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What are the five mechanisms and types of burns?
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heat exposure- thermal burns
chemicals- chemical burns electrical current- electrical burns radiation- radiation burns extreme cold- frostbite injuries |
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What are thermal burns?
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caused by exposure to flames or hot objects. damaged cells release substances that increase vascular permeability- and cause a fluid/electrolyte shift. There is a high risk here for hypovolemic/burn shock.
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What is a chemical burn?
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tissue damage continues until the agent is completely removed or neutralized. Also, be aware of pulmonary inhalation.
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What is an electrical burn?
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high or low voltage. The greatest heat is at the point of entry. Injury is usually greater than it initially appears- deep tissue necrosis is caused. Lightening strikes!
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What are the stages of burns?
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superficial- first degree
superficial partial thickness- second degree deep partial thickenss- second degree full thickness- third degree subdermal- fourth degree |
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What layers of skin are involved, the characteristics of, and the healing time for superfiscial burns?
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epidermis only
Skin is pink/red with mild edema healing time- without scarring in 3-6 days |
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What layers of skin are involved, the characteristics of, and the healing time for superficial partial thickenss burns?
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epidermis and a portion of the dermis
healing time- within 21 days blisters form, skin is pink or mottled red, pain caused by scald, flash flame *complications are rare with no scarring (unless it gets infected) |
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What layers of skin are involved, the characteristics of, and the healing time for deep partial thickness burns?
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epidermis and dermis
healing time- 3-6 weeks pale, mottled, insensate, white/waxy *can convert to full thickness by bacteria, scarring is common skin grafting can improve quality of life and appearance |
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What layers of skin are involved, the characteristics of, and the healing time for full thickness burns?
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epidermis, dermis, and underlying sq tissue
they range in color from pale to bright red. there is little to no capillary refill. leathery eschar, white or charred black tissue that is insensate. there is no potential for re-epithelialization, so skin grafting is required for wound closure. |
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What is a fourth degree burn?
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it goes down into muscle, bone, tendons
results from prolonged contact with flames, hot objcts, or electricity. amputation is usually required. |
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What is the lund and brower chart?
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a special chart for determining body surface area
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what is the palm method?
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1 palm = 1% of body surface area
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What is the rule of nines?
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bsa is determined in multiples o 9
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What is the cardiovascular response in acute burn injury?
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burn shock: decrease in blood volume, blood pressure, cardiac output, and tissue perfusion. Increase HR, SVR, and vasoconstriction.
Capillary integrity is restored within 24-36 hours, fluid returns to the vascular compartment. A loss of the capillary seal causes vasodilation with increased capillary permeability (which causes hypovolemia) fluid resuscitation is critical! |
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What is the gold standard for urine output after acute burn injury?
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0.5-1.0mL/kg of urine output per hour
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What is the parkland formula for fluid resuscitation?
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In the first 24 hours post-burn give 2-4mL/kg/%TBSA of Lactated Ringers
Give: 1/2 in the first 8 hrs 1/2 over next 16 hours BP/HR are not as reliable.. |
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What is the general pulmonary response in acute burn injury?
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Increased SVR leads to pulmonary hypertension. Full thickness burns to the chest lead to eschar formation. There can also be inhalation injuries.
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What are upper airway injuries sustained in burns?
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-supraglottic injury from heat or chemicals. assess for facial burns, singed nasal hair, erythema, swelling, tachypnea, dyspnea, hoarseness, brassy cough, and stridor.
treat- give 100% humidified O2 via face mask. perform a careful assessment! upper airway edema peaks at 24-48 hours post injury |
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What are lower airway injuries sustained in burns?
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lower airway injuries result from toxic gases and chemicals being inhaled from smoke. when they contact pulmonary tissue they cause irritation (an inflammatory reaction resulting in edema, secretions, decreased ciliary action, bronchospasm, inactivation of surfactant, and atelectasis).
treat- supportive. give humidified O2 at 100% |
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What is carbon monoxide poisoning?
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CO is inhaled as a by-product of the combustion of organic material. it is 200x more likely to bind to hemoglobin than oxygen- hypoxemia results. Always suspect CO in an enclosed area! the pulse ox is unreliable. check the carboxyhemoglobin levels. use hyperbaric O2 to treat.
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What is the renal response in acute burns?
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lower blood volume leads to a lower GFR
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What should you check the urine for in electrical injuries and why?
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myoglobin, because of the risk for acute tubular necrosis
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What is the peripheral vascular response in burn injuries?
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each extremity is assessed initially, and then every hour during resuscitation. monitor vascular status hourly- elevate extrremeties!
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What are the considerations for pain in burn injuries?
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full thickness burns are insensate except for around the edges. partial thickness burns are exceptionally sensitive.
pain/anxiety relief can be crucial, so use morphine and fentanyl |
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What is the acute phase of burns?
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Begins with the onset of diuresis until wound closure
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What is the goal of the acute phase?
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prevent infection!
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How long does the inflammatory phase last?
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up to two weeks
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How long does the proliferative phase last?
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up to one month
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How long does the maturation phase last?
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up to 18 months
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What is involved in initial wound care of burns?
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-stop the burning process
-go to burn center -cleanse with sterile saline |
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What is wound cleansing?
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hydrotherapy and wound debridement
-irrrigation, biological (maggots), chemicals (enzymes), surgery |
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What are the two antimicrobial agents used to cleanse burns?
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silver sulfadiazine- a broad spectrum antimicrobial with a cooling application. do not use with sulfer allergies, facial burns, or pregnant women
mafenide acetate- broad spectrum that can penetrate eschar and cartilage, but it has a very painful application that can last up to 30 minutes |
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Where do allografts and autografts come from?
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allograft- human cadaver
autograft- from patient, or synthetic |
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What are the nutritional needs of burn victims?
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metabolic rate can be 100x normal. use the GI tract early!
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What happens during the rehabilitation phase of burns?
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this is from major wound closure until the victims optimal level of functioning and return to their established role.
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what is the main goal of the rehabilitaiton phase?
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prevent scars and contractures
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how many hours a day should pressure garments be worn?
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23 hrs a day!
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