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G270 > Burns > Flashcards

Burns Flashcards

1
Q

Strongest predictors for mortality in burn injuries (3)

A
  • Increased percent of TBSA burned
  • Presence of inhalation injury
  • Increased age
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2
Q

Burns Gerontologic Considerations (2)

A

Increased mortality

Delayed wound healing

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3
Q

Zone of Coagulation

A

Innermost, no recovery possible, necrosis, greatest injury

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4
Q

Zone of Stasis

A
  • Has reduced blood flow to vascular damage
  • Injured cells may remain viable
  • If persistent ischemia → necrosis will occur in 24 - 48 hours
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5
Q

Zone of Hyperemia

A
  • Minimal injury, superficial burn

* May fully recover spontaneously

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6
Q

Superficial

A

1st degree
Epidermis intact with erythema
If rubbed, burned tissue does not separate from underlying dermis
Sunburn or superficial scald

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7
Q

Partial thickness

A

2nd degree
• Epidermis & some dermis damage
• Painful and associated with blister formation
• Healing time based on depth of dermal injury : 2-3 wks • Hair follicles & skin appendages intact

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8
Q

Full thickness

A

3rd degree
• Total destruction of epidermis, dermis & underlying tissue
• Wound color : pale white, red, brown, or charred
• Burned area lacks sensation (damaged nerves)
• Skin leathery & dry: destruction of microcirculation, hair follicles & sweat glands
• Severity of burn deceiving: no pain

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9
Q

Deep necrosis

A

4th degree

Injuries extend into deep tissue, muscle or bone

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10
Q

Rule of Nines

A
  • Most common method used to estimate extent of burns in adults
  • Based on anatomic regions, each representing approximately 9% of TBSA
  • Allows clinicians to quickly obtain estimate of burn size
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11
Q

Lund & Browder Method

A
  • More precise reliable estimate of TBSA burned
  • More detailed consideration to % surface area of various body parts
  • Relates to age of patient
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12
Q

Palmer method

A
  • Good for patients with scattered burns

* Patient’s hand, including fingers, is approximately 1% of patient’s TBSA

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13
Q

Physiological response to burns

A
  • Acute inflammation and intravascular coagulation

* Altered vascular permeability: third spacing

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14
Q

Early Priority of Care for burns

A
  • Airway, breathing
  • Fluid and electrolyte balance: massive fluid and lyte loss
  • Acid-base balance: massive fluid and lyte loss, tissue degradation
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15
Q

Cardiovascular Alterations

A 
hypovolemia
edema--> airway
decreased CO
increased O2 demand
decreased BP
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16
Q

Fluid & Electrolyte Alterations

A
  • Deeper: edema up to 18 h post-injury
  • ↑K from massive cell destruction; ↓ K later with fluid shifts
  • ↓ Na+ : resulting from plasma resuscitation
17
Q

Pulmonary Alterations

A

Bronchoconstriction
• Release of histamine, serotonin, & thromboxane &
chest constriction
Catecholamine release alters peripheral blood flow, reduction O2 delivery to tissues
Edema can cause obstruction up to 48 h after burn

18
Q

Renal alterations

A

↓ blood volume

↓ UO : ↓ GFR

19
Q

Thermoregulatory alterations

A

inability to regulate temp

20
Q

GI alterations

A
  • Paralytic ileus
  • Curling’s ulcer
  • Translocation of bacteria
21
Q

3 phases of care

A
  • Emergent/ Resuscitative
  • Acute/Intermediate
  • Rehabilitation
22
Q

Resuscitative phase

A

Remove patient from source & stop burning process
• Immediate primary survey of patient to assess the ABCDEs:
Rescue workers’ priorities
• Establish an airway, administer O2 (100% if carbon monoxide poisoning is suspected)
• Inserting large-bore IV line
• Cover wound with clean, dry cloth or gauze
• Immediate continuous irrigation of chemical injury

23
Q

ABCDE

A 
Airway 
Breathing 
Circulation
Disability
Exposure
24
Q

Fluid Resuscitation

A
  • Under-resuscitation: Shock, MODS
  • Over-resuscitation: HF, pulmonary edema
  • LR is crystalloid of choice
25
Q

Fluid Resuscitation Thermal or Chemical

A

2 ml/kg per % TBSA — V = 2 X kg X %TBSA

26
Q

Fluid Resuscitation Electrical

A

4 ml/kg per % TBSA— V = 4 X kg X % TBSA

27
Q

Fluid Resuscitation Time

A
  • Administer half of total fluids during first 8 hours from time of injury
  • Administer the other half over the next 16 hours from time of injury
28
Q

Acute/intermediate phase

A
  • 48 - 72 h after burn injury

* Assessment & maintenance of respiratory &circulatory status, F&E balance, GI & kidney function

29
Q

Autografts

A

patients own skin
not rejected by immune system
only permanent method of grafting

30
Q

Rehabilitation Phase

A

• Begins immediately after burn has occurred → years after injury

31
Q

fluid of choice

A

LR

G270 (6 decks)

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