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50 Cards in this Set
- Front
- Back
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major causes of burns
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cigarettes
hot water cooking accidents space heaters gas, charcoal lighter fluid steam chemicals |
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ages at greatest risk for burns
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< age 4 and > age 55
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types of thermal burns
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flame
flash scald contact (tar, metal) |
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tissue injury & destruction from necrotizing substances
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chemical burn
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most common chemical burn
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acid
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most difficult to manage chemical burn
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alkali - adhere to tissue causing burning even after neutralization
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what to do immediately for a chemical burn
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remove offending agent, clothing and lavage area with water
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tissue destruction from chemical burn can last how many hours
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72 hours
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majority of deaths related to fires are due to what
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carbon monoxide poisoning
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s/s of carbon monoxide poisoning
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lightheaded, dizzy, severe h/a
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what happens in body during carbon monoxide poisoning
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CO displaces O2 on hemoglobin causing hypoxia, carboxyhemoglobinemia
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injuries from inhalation above glottis
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from hot air, steam, smoke
presence of facial burns singed nose hairs hoarseness painful swallowing darken oral/nasal membranes |
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injuries from inhalation below glottis
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chemically produced
pulmonary edema w/in 12-24 hrs can develop ARDS |
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what happens to blood in electrical burns
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coagulation necrosis caused by intense heat from electric current
damage to nerves/vessels causing anoxia & death injury depends on amt of voltage, tissue resistance, current pathways & surface area usually entrance & exit wound at risk for cardiac arrest, arrhythmias, metabolic acidosis, myoglobinuria |
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iceburg effect
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doesn't look bad on surface but most damage occurs underneath
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what other injuries should you look for with electricl burns
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cervical and long bone fractures due to the fact that most times the person falls
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myoglobin released into blood when there is large tissue damage - can block renal tubules and develop acute renal tubular necrosis
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myoglobinuria
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how is myoglobinuria treated
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lactated ringers
UO 75/100 ml/hr IV mannitol can also be given to incr UO s/s - smoky urine |
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2 WAYS BURNS ARE CLASSIFIED
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partial thickness
full thickness |
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TYPES OF PARTIAL THICKNESS BURNS
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superficial/1st degree - sunburn
deep/2nd degree-epidermis and dermis - nerve damage |
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TYPES OF FULL THICKNESS BURNS
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3rd and 4th degree - all depth of skin effected and nerve endings destroyed
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two ways the extent of burns are determined TBSA
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Lund-Brower chart - more accurate
Rule of Nines - easy, initial |
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PRE HOSPITAL TX INCL:
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chemical-flush w/water, never immerse body, no ice
remove burnt clothing remove from electrical source stabilize cervical spine cover burn site w/dry dressing ABCs thermal-stop,drop,roll chemical-remove clothes, showerx20 min electrical-remove from source |
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HOSPITAL MGMT INCL:
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ABC
HOB @30 degrees 100% O2 via face mask intubate if facial edema and inhalation injury check lungs Q2hr check pulses check for arrhythmias IV-check patency and usually is PICC/Triple Lumen cath check UA-myoglobinuria CBC/Lytes/ABG Pulse Oximetry CXR 24-48 hr daily Morphine 3-5mg q5-10 min no demerol-toxicity |
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MANIFESTATIONS DURING EMERGENT PHASE - UP TO 72 HRS
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edema formation
potential for hypovolemic shock due to incr capillary permeability shock decr BP incr HR protein lost from vascular space into interstitial spaces third spacing occurs-fluid in areas that normally has little or no fluid, exudate and blister formation insensible loss by evaporation - normally 30/50 cc/h may go to 200-400 cc/h |
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WHEN DOES EMERGENT PHASE END
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cessation of fluid loss and edema
diuresis occurs |
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OTHER CHAR EMERGENT PHASE
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pain may occur, depending on depth
adynamic ileus-due to trauma and K shifts arrhythmia circulation compromised to extremities-ischemia-escharotomy respiratory problems-edema acute tubular necrosis ATN due to renal ischemia develop cardiogenic shock, bronchospasms scared and concerned for others in fire check 5 P's usually have femoral arterial line for blood samples, ABGs, BP |
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what are the 5 P's
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pain
pallor pulse paresthesia paralysis |
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NSG CARE EMERGENT PHASE
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intubation required
high Fowler's 2 large bore IV Parkland formula UOP 30/50 - 75/100 ml/hr BP>90 sys, P<120, R 16-20 - keep at this level infection greatest complication grafts IV meds TPN, enteral feeds Zantac, Maalox topical antibiotics |
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PARKLAND FORMULA
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4ml/kg/TBSA=total fluid (Lactated Ringers)
1/2 total give 1st 8 hr 1/4 total give 2nd 8 hr 1/4 total give 3rd 8 hr |
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Graft info
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either porcine or cadaveric
permanent-autograft cultured-epithelial autograft problems - will it take,prevent infection sterile procedure |
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ulcer caused by stress of burn
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Curling's Ulcer - give H2-histamine blockers prophylactically to prevent
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debridement info
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tub - no more than 20-30 min
done BID |
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anti-microbial agents used
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Silvadene, Sulfamylin, bactroban
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HOW LONG IS ACUTE PHASE
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from diuresis until grafting and wound heals
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how long til partial thickness eschar separates
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2 weeks
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how long and how does full thickness eschar separate
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longer time than 2 weeks via surgical debridement
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what can occur during hydrotherapy
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hyponatremia - drawing out of Na from burn areas and also GI drainage, diarrhea, excessive water intake
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what to do to prevent excessive water intake
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give pop, juice, popsicles, nutritional supplements instead of water
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what can cause hypernatremia
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improper tube feeding, improper fluid admin
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s/s hypernatremia
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thirsty
dried furry tongue "feels furry" lethargy confusion seizures |
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causes of hyperkalemia
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renal failure, deep muscle injury
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causes of hypokalemia
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hydrotherapy, vomiting, diarrhea, GI suction
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no more than ___% of weight loss should occur in burn patients
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10%
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WHEN DOES REHAB PHASE BEGIN
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begins when wounds heal and pt able to resume self care
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GOALS OF REHAB INCL:
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resume functional roles
begin functional and cosmetic surgeries |
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COMPLICATIONS OF REHAB
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contractures-from inadequate ROM
scarring-discoloration and contour custom fitted pressure garments 24hr/day x 12-18 months Benadryl and moisturizers help protect from direct sunlight |
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PAIN MGMT FOR BURNS - WHAT ROUTE IS BEST AND WHY
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Early in postburn period, IV pain meds give because
1. GI function is slowed or impaired due to shock or paralytic ileus 2. IM injections will not be absorbed adequately in burned or edematous areas, causing pooling of med in tissues. |
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COMMON NARCOTICS FOR BURNS
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morphine
MS Contin Dilaudid fentanyl oxycodone/Percocet methadone NSAIDs Haldol (promotes slee) Ativan (anti-anxiety) Versed (short-acting amnesia properties) |
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DRUG OF CHOICE FOR PAIN CONTROL
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morphine
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