Flashcards in Burn Notes Deck (81)
Superficial partial-thickness burn signs & symptoms
blanching on pressure (whitens with applied pressure)
can blister and peel after 24 hours
Superficial partial-thickness burn involved structures
Epithelization (Skin growth) can occur
Deep partial-thickness burn signs & symptoms
severe pain due to nerve damage or death
mild to moderate edema
Deep partial-thickness burn involved structure
Epidermis and dermis
Full-thickness burn signs & symptoms
Leathery skin that can be dry or waxy
You can see burst vessels
Visible tendons, fat, muscles and bones
No pain due to nerve death
Possible skin necrosis
Full-thickness burn involved structures
Destroyed skin & local nerves
Who are the high risk factors of burns?
Children younger than 4 and adults over 65.
What are the types of burn injuries?
Thermal - most common
Smoke inhalation - most deadly
How do you determine the severity of burns?
Rule of Nines - initial assessment
Lund-Browder chart - more accurate
Rule of Nine: Give the parts and their percentage
Head - 9%, 4.5 each for front and back
Trunk (includes chest, back, and butt) - 36%, 18 each for front and back
Arm - 9%, 4.5 each for front and back
Perineal - 1%
Leg - 18%, 9 each for front and back
Lund-Browder: Give the parts and percentage
Back of head - 3.5
Front Neck - 1
Back of Neck - 1
Shoulder & Upper Arm- 2
Lower Arm- 1.5
Wrist and Palm- 1.5
Butt- 2.5 each buttcheek
Upper leg- 4.75
Lower leg- 3.5
Ankle and feet - 1.75
How do you prevent hypothermia for large burns?
Do not cool for more than 10 min.
Do not soak
Do not cover with ice
How do you care for a patient with burns for prehospitalization?
Provide 100% Humidified O2
Remove clothing gently
Wash chemical burns with water for 20 min to 2 hours
Wrap burned area with clean sheet or dry blanket to prevent infection
Tissue destruction can occur for how many hours after burn exposure?
What are the phases of burn management?
Acute (Wound Healing)
What are the main concerns in emergent phase?
Hypovolemic shock and edema formation
Fluid & Electrolyte shifts in Emergent phase
Water, Electrolyte and proteins move into interstitial spaces due to increased capillary permeability.
Protein pressure within blood stream (Colloidal osmotic pressure) decreases.
Third spacing occurs
RBCs are depleted but high Hct is shown due to hemoconcentration
Potassium shifts first, then sodium
Hypovolemic shock signs & symptoms
Decreased BP and increased HR
What signifies the end of emergent phase?
Diuresis and urine has low specific gravity
C/M of Emergent phase
Evidence of partial or full thickness burns (pain, blister formation, etc.)
Paralytic ileus (absent bowel sounds)
Unconsciousness or altered mental status due to hypoxia
What three major organ systems are susceptible for complications during the Emergent phase?
Cardiovascular complications in Emergent phase
Impaired circulation - sludging (poor circulation in capillaries)
Venous thromboembolism (VTE)
Respiratory complications in Emergent phase
Pneumonia (PNA) - leading cause of death
Upper Airway injury
Lower Airway injury
Sputum has carbon
Signs & Symptoms of Respiratory Distress
Abnormal breathing patterns: tachypnea or bradypnea
Urinary complications in Emergent phase
Acute Kidney Injury (AKI)
Acute Tubular Necrosis (ATN)
What is the "Iceberg effect" of electrical burns?
More damage in the skin than what is shown.
List in order of priority for Nursing management in Emergent phase.
Rehab with PT or OT
How do you manage airway?
Intubate- especially with facial and neck burn
Escharotomy of chest wall - especially with neck and chest burns
Fiberoptic bronchoscopy - 6-12 hours after injury to check lower airway
Humidified air 100% oxygen - CO posioning
High Fowlers - reposition every 2 hours
deep breathing and coughing
PEEP (positive end-expiratory pressure)
Monitor CO with SpCO2 device
It is used for fluid replacement therapy for first 24 hours.
4ml LR x wt in kg x TBSA (%body burn)