3 Burns Flashcards
(24 cards)
Burns (mechanism of injury)
Thermal vs chemical
Thermal:
-contact w/ heat source (fire/explosion)
Chemical:
-contact W/ chemicals (cleaners/ pool clearers)
Burns (mechanism of injury)
Electrical vs inhalation
Electrical:
-risk for cardiac dysrhythmias
Inhalation:
-supreglottic and subglottic
(See suet need intubation)
Carbon monoxide binds to what?
Has a greater affinity to Hgb than what?
Binds to Hgb
-stronger affinity for Hgb then oxygen
Burn classifications
-which has most pain vs least
-which doesnt bleed alot?
-Superficial (1st degree)
-Superficial partial thickness (2nd degree)
-Deep partial thickness (2nd degree)
-Full thickness (3rd and 4th)
1st degree is most painful
3/4th least painfull (burnt nerves)
3/4th least bleeding
Burn zones (NOT ON EXAM)
Zone of hyperemia:
-outer area (minimal cell injury)
Zone of stasis:
-vascular damage
Zone of coagulation:
-greatest injury
-core of wound
TBSA
Rule of Nines
Which classification of burns to add/ which not to add
Palms are what %
TBSA (measures amount of burn/ tells us how much fluid resuscitation needed)
Rule of nines (everything is 9%)
Add all areas of partial and full thickness
Do not add superficial burns
Palms = 1%
-Inflammatory response from burn
-fluid shifts leads to what?
-burns greater than 20% TBSA = what?
-maximum edema at what 2 times post burn?
Cell mediators released = increased capillary permeability
Fluid shifts leads to 3rd spacing
Burn greater than 20% TBSA = edema in burned and unburned area
Maximum edema at 24-48hrs post burn
Cardiovascular response to burn injury
-decrease vs increase in what
-tx
Decreased CO/SV/O2 delivery
Increased HR/SVR
Tx: fluid resuscitation
(Be careful with cardiac patients)
Pulmonary vs renal response to burn injury.
Pulmonary:
-pulmonary edema
-pneumonia
-ARDS
Renal: AKI
-decreased GFR
-RAAS d/t decreased BP
-Na and H2O retention = oliguria
(Diuresis if adequate resuscitation)
Primary survery pre-hospital
-what we want to do first (how)
-ABCs
Pre-hospital second survey:
-assess for what
-transport where
Primary:
-stop burning (remove clothes/cover pt to prevent hypothermia)
-ABCs: O2/pulse or no pulse CPR/ IV LR
Pre-hospital second survey:
-assess other injury
-transport to burn center
Resuscitative phase: hospital
ABC
Rapid what?
Airway: assess for inhalation injury
-what symptoms we may see
-what tx
Rapid head to toe
Wheezing
Stridor
Singed facial hair
Edema
Tx:
O2/intubation/bronchoscopy
Resuscitative phase: hospital
Breathing
-what to check
-tx
-GOALS PaO2/PaCO2/SaO2/RR
COHbg levels
ABG
Chest wall burns (look for restriction)
Tx: escharatomy
(cut segments to prevent chest restriction)
Goals:
PaO2 > 90
PaCO2 <45
SaO2 >95%
RR 16-20
Resuscitative phase: hospital
Circulation
(IV needs)
(Fluid we administer)
Burn shock is similar to hypovolemic shock
2 large bore IV (14-16G) or central line
LR (crystalloids)
advance burn life support for 1st 24hrs
Parkland formula (for burn fluid resuscitation)
4mL/kg/%TBSA
1/2 given in 1st 8hrs
1/2 given over next 16hrs
Circulation (hemodynamic support)
-check VS how often
-everyone gets a foley
-med we give after fluid resuscitation
-may add what type of fluids after 24hrs?
VS Q15min to 1hrs
Diuretics after fluid resuscitation
Add colloids/dextrose/electrolytes after 24hrs
Burn pt Goals
-UOP
-BP
-MAP
-HR
-CVP
UOP: 30-50ml/hr or more if electrical burn
BP: >90/60
MAP: >70
HR: <120
CVP: 8-12
Compartment syndrome:
Assess what?
Important to perform what?
Tx
6Ps
(Pain/pallor/pressure/paralysis/paresthsia/pulselessness)
Perform ROM
Tx: fasciotomy or escharotomy
Rhabdomyolysis
-what is going on
-what lab is bad
-s/s(3)
-tx (3)
Skeletal muscle breakdown leads to AKI and electrolyte disturbance
Hyperkalemia
S/s:
-tea colored urine
-increased CK total
-positive myoglobin
Tx:
-aggressive fluids
-UOP 75-100ml/hr (flush out K+)
-correct electrolytes
GI with burns
2 tx
Monitor what
Start what when?
NG tube to LWS
PPI/H2 blocker
Monitor abd compartment syndrome
Enteral feeding start within 24 hrs of burn
Metabolic with burns
Issue from beginning
2 things to do
Metaboliuc need increases immediately and hard to recover from (need caloric needs)
-keep pt warm
-daily wt/labs
Burn pain control
2 types
When to give extra meds
3 interventions you can do
Continuous infusion/PRN
Extra meds during dressing changes
Keep wounds covered
Do ROM
Elevate extremities
Burn infection control
- temp isnt always a good indicator
3 things to get instead
Lactic acid
WBC
Cultures
Bacitracin
Good for:
Face
Hands
All minor burns
Holistic care
Coping
Body image
Impaired mobility
