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62 Cards in this Set
- Front
- Back
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How long does it take to heal a superficial partial thickness burn?
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3-5 days
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What is an example of a superficial partial thickness burn
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sunburn
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What layer of skin is involved in a superficial partial thickness burn?
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epidermis ONLY
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How long do deep partial thickness burns take to heal?
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7-28 days
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What does a deep partial thickness burn look like?
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puffy, blisters, Painful!
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What is true of 40% of burn victims?
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They are on drugs or alcohol
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What layers of skin are involved in a deep partial thickness burn?
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All of the epidermis and some of the dermis (but not all)
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What are major risk factors for becoming a burn victim?
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having difficulty with activities of daily living (old people)
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What types of burns are treated the same?
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deep partial thickness and full thickness burns are treated the same. deep partial thickness burns can turn into full thickness burns
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What happens to burns over time
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They worsen.
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How do full thickness burns appear?
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skin may look dry, have extensive eschers, white patches
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Is a full thickness burn painful?
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No and yes. The area's nerve endings will be destroyed, but wil have pain from varying degress of burns surrounding the worst part of the burn.
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What types of burns are included in a total body surface area burn calculation?
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deep partial thickness and full thickness only
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What types of burns on children are suspicious?
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Straight line burns, because they do not occur in nature and may be indicative of abuse
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What is an escher?
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non-elastic leathery covering that develops on severe burns- not mobile and can cause decreased distal perfusion
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If can be surmised if the area of entrance for an electrical burn is small?
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There is greater internal tissue damage
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What are priority problems for people with hand burns?
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risk for infection and contractures
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What is a circumferential burn bad?
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Causes decrease in distal perfusion, if it is on the abdomen, it may restrict bellow's effect and inhibit lung capacity.
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In addition to tissue burns, what complications can arise from electrical burns?
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cardiac arrthymias, seizures, intracranial hemorrhage
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How do you remove tar from a burn?
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wait until it cools, use mayonnaise or a petroleum product
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What is the priority for a chemical burn?
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Irrigate, irrigate, irrigate.
ensure healthcare worker safety |
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What will the labs of a burn victim look like?
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-Low bicarb
-low pH -elevated lactate level |
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What intervention is appropriate for an elevated lactate level?
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fluid resuscitation until the lactate level goes down
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As the body tries to compensate for extensive burns, what can occur?
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hypovolemic shock (decreased bp, increased hr-unless on betablockers, oliguria, metabolic acidosis)
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What is lost from a burn?
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-protective barrier against infection
-loss of body fluids and temperature control -destruction of sweat and sebacceous glands -destruction of sensory receptors (full thickness) -hypovolemic and diuretic stages |
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What is the path of fluid in the body when a burn occurs?
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Initially, entire body swells and third spaces fluid, then they become hypovolemic. A few days later they will enter a diuretic stage
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How long does the hypovolemic stage last?
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onset to 72 hours
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What are characteristics of the hypovolemic stage?
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-rapid fluid shifts
-implications of edema -vascular compensation (short lived) -possible dehydration -changes in serum electrolytes and protein |
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What are the major electrolytes affected during the hypovolemic stage?
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sodium and chloride
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What can imbalanced chloride cause?
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blisters and edema
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What occurs physiologically immediately post injury?
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vasocontriction occurs to compensate for the burn but only lasts 1-2 hours.
-increased bp -increased hr -"stress response" -decreased UOP |
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How do you treat acidosis in the burn patient?
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volume resuscitation
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How can dysrhythmias occur during the hypovolemic stage?
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Hyperkalemia occurs because cells are leaking K+ and this can eventually lead to V fib. Give Ca+ to stabilize the cell membranes to treat the arrhythmias.
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What causes the diuretic stage?
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18-24 hours after the initial burn there is a return of vascular integrity, this is when the 3rd space fluid returns to the vasculature
The Diuretic stage then begins at 48-72 hours and is characterized by a reversal of the fluid shift. |
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What can creates a potential volume overload?
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During the hypovolemic stage as many as 10-12L of fluid may be infused.
This can cause volume overload when vascular integrity returns during the diuretic stage |
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What causes metabolic acidosis during the diuretic stage?
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The breakdown of protein in the body due to a lack of carbohydrates because they haven't been eating. Give nutrition to correct/prevent.
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What are some assessment findings of the diuretic stage?
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bounding pulses
increased UOP crackles in lungs hemodilution |
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What is the serum electrolyte profile during the diuretic stage?
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-Hypokalemia, because potassium is being dumped form the kidneys
-hyponatremia, d/t excretion by kidneys and leaking out of wound -hypoproteinemia, lost from wounds -hemodilution- fluid volume overload |
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What is the serum electrolyte profile during the hypovolemic stage?
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-hyperkalemia- cells are leaking K+
-hyponatremia- leaking from vessels into insterstitial spaces -hypoproteinemia -hemoconcentration, fluid has left vasculature |
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What is the main electrolyte difference between the hypovolemic stage and the diuretic stage?
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POTASSIUM
hyper in hypovolemic stage hypo in diuretic stage |
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What is considered to constitute 1% of body surface area?
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palm of hand including fingers=1%
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What is the rule of nines?
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used to estimate burned area in the field, not very accurate. body is divided into multiples of 9% (eg, posterior thigh is 9%, anterior chest is 18%, etc).
Lund-Browder and Burkow methods are more accurate |
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What is the priority concern for a burn on the perineum?
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contamination
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What are indicators of possible inhalation burns/injuries?
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soot around nose and mouth, singed eyebrows
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What is the o2 sat of someone with carbon monoxide poisoning?
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Normal or high. Hemoglobin is full, but of carbon monoxide, not oxygen
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What do you do for someone with carbon monoxide poisoning?
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O2 at 12-14 L with a non-rebreather. The oxygen decreases the 1/2 life of the carbon monoxide
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When do you begin fluid resuscitation and why?
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Ideally, begin within 1 hour of injury. This stays ahead of the impending failed compensation. It is given to maintain circulating blood volume.
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What is the preferred IV fluid for resuscitation?
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Ringer's because it has potassium and sodium and lactate (which turns to bicarb in the body and addresses acisosis)
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What is the parkland formula?
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A formula for determining how much fluid someone needs:
4ml Lactated Ringers X weight in Kg X TBSA burned= total ml to be given in 1st 24 hours. Half this volume must be given in the first 8 hours!!! (remember this) |
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How should fluid status be determined after the first 24 hours?
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by looking at electrolytes. look for lactate, and don't use UOP alone.
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What is an advantage in using fentanyl for pain?
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It does not drop BP
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When are systemic antibiotics given?
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Only if signs of an infection are present
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Wound care for burns includes:
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Open wounds- keep moist for healing
semi-open: apply layer of ointment with a layer of gauze Closed: ointment with antibiotic gauze and curlex |
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Where is Silvadene never used?
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on the face, it leaves a shiny appearance
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What do we no longer use when there is no eschar present (medication wise)?
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Silvadene, don't use when eschar is no longer present , then we want the burn to epithelialize(sorry about the spelling) and have new growth
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What is a side effect of sulfamylon (mafenide acetate)?
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Painful when applied. It inhibits epithelial tissue development
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What does silvadene (silver sulfadiazine) do?
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bacteriocidal
anti-fungal applied QD-BID less penetrating and less painful than sulfamylon |
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What is acticote?
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an expensive enzymatic debriedment shealth that stays on for weeks.
It decreases electrolyte losses and keeps it moist. Needs to be remoistened q6h |
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How long does the hypermetabolic state continue?
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Until burns are 90% healed. May require an additional 3500-5000 calories per day, mostly protein to heal.
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What is the best indicator of current nutritional status?
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pre-albumin
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When do we need tight glucose control for burn patients?
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when they are on TPN because of risk for infection
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What is rhabdomyolysis?
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extensive muscle breakdown, myoglobin is broken down and leads to decreased kidney function.
Results in super dark urine, give fluids |
