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The Acutely Ill Adult > Burns > Flashcards

Burns Flashcards

1
Q

What are some of the causes of burns ?

A

Heat eg. Liquid/steam\
Radiation eg. Sun, radiotherapy
Electricity - electric current
Chemicals - alkaline vs acidic
Cold eg.frostbite
Friction eg road rash during car accident

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2
Q

What is TBSA

A

Total body surface area

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3
Q

What are the types of burns

A

Superficial
Partial thickness
Deep partial thickness
Full thickness

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4
Q

What layers of the skin did superficial burns affect ?

A

Epidermis

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5
Q

What layers of the skin do partial thickness burns affect ?

A

Epidermis and dermis

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6
Q

What layers of the skin do deep partial thickness burns affect?

A

Epidermis, dermis, hair follicles, sub cut glands, sweat glands

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7
Q

What layers do full thickness burns affect?

A

All layers of the skin including tissue, muscle and bone

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8
Q

What does burn severity depend on?

A

Depth of burn
% of TBSA burned
Age
Med hx - diabetes, HF
Location - face, neck, head etc
Inhalation injury

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9
Q

What layers of the skin are burnt in a 1st degree burn?

A

Epidermis (superficial)

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10
Q

What are the characteristics of a 1st degree burn ?

A
  • v red/pink
  • warm 2 touch
  • no blisters/scars
  • v quick cap refill
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11
Q

What layers of the skin are burned in a 2nd degree burn ?

A

Epidermis and dermis (partial thickness)

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12
Q

What are the characteristics of a 2nd degree burn?

A
  • v painful
    -shiny & moist
  • red/pink
  • will blister/scar
    -+/- skin graft
    -blanches
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13
Q

What layers of the skin are burned in a 3rd degree burn ?

A

Epidermis, dermis, hypodermis
( hair follicles, sweat glands and nerves destroyed)

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14
Q

What are the characteristics of a 3rd degree burn?

A
  • no pain
    -skin will not heal - skin graft
  • black, yellow, red
    -hard areas - Eschar
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15
Q

What is Eschar?

A

Burned dead tissue

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16
Q

What must be done in a 3rd degree burn to promote healing?

A

Eschar must be removed

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17
Q

What layers of the skin are burned in a 4th degree burn?

A

Epidermis, dermis, hypodermis, bones, muscle, ligaments etc
V deep

18
Q

What are the characteristics of a 4th degree burn ?

A
  • all layers destroyed
  • black w Eschar
  • all sensation gone
  • ++ skin grafting
19
Q

What is inhalation injury ?

A

Damage to respiratory system due to breathing in smoke - carbon monoxide, chemicals, thermal etc

20
Q

What are the S+S of someone who has suffered inhalation injury ?

A
  • burns on nose/mouth
  • carbonaceous sputum (black)
  • sooty nose/mouth
  • hairs singeing
  • ++ red lips
  • probs w talking
  • confusion/anxiety
21
Q

What are the phases of burn Mgt

A

Emergent
Acute
Rehabilitative

22
Q

When does the emergent phase begin and end ?

A

Starts @ onset of burn injury
Ends @ restoration of cap permeability
First 24-48 hrs

23
Q

What is the ot at risk of during the emergent phase ?

A

Hypovolemic shock
Resp distress
Compartment syndrome

24
Q

When have we entered the acute phase ?

A

Cap permeability stabilised until wound closure
( 48-72 hrs until wound heals )

25
Q

What are our main focuses during the acute phase ?

A
  • continue fluid replacement & monitor response - U/O, I&O, vitals, bloods
    -wound care
  • resp function
  • pain assessment + mgt
  • physio & OT- maintain ROM
  • nutritional care (dietician)
  • psych care
26
Q

When does the rehabilitation phase begin?

A

From when burn is healed until pt is able 2 function again

27
Q

What is our main focus during the rehabilitation phase?

A
  • psychological support
  • ADLs
  • physio
  • OT
  • cosmetic correction if needed
28
Q

What are the priorities of burns treatment ?

A
  • prevention of infection
  • prevention of hypovolemia
  • maintain norm body temp
29
Q

What is the emergency mgt pathway for burn wounds ?

A
  • stop burning process
  • remove jewellery or hot clothing
    -cool burn- place under cool tap 4 20 mins/ apply hydro gel
  • pain relief (analgesia)
  • check for trauma + life threatening injuries
  • check tetanus status and provide immunisation if needed
  • assess burn size
    -assess burn depth
  • assess if pt required admission to burns unit
30
Q

What are the tools used to determine TBSA?

A
  • Lund & Browler chart - 2x collegues
  • Rule of 9 Chart
31
Q

What does TBSA of <30% result in

A

Local response

32
Q

What does a TBSA of >30% result in ?

A

Local &. Systemtic response

33
Q

How are minor burns treated (1st nd 2nd degree)

A
  • no hospitalisation
    -treated out-patient with wound care and dressing changes
34
Q

What are the 3 C’s for prehospital care for minor burns

A

-cool water : briefly soak area + no ice, creams or antibiotic ointment to open ski
- cover the area : w a clean dry cloth
- clothing removal : remove clothing and jewellery that is not adhered to the burned skin

35
Q

What is the no.1 intervention for major burns

A
  • IV normal saline (0.9% NaCl)
  • IV Compound Sodium Lactate (Hartman’s)
36
Q

What are the S&S of major burns in the 1st 24hrs

A
  • hyperkalemia : Tall, peaked T Waves on ECG (1st priority to correct)
  • low sodium (hyponatremia) <135 ( electrolyte imbalances)
  • ^ haemoglobin & haematocrit (H&H)
37
Q

What is the treatment for major burns in the 1st 24hrs ?

A
  • fluid resuscitation : IV norm saline + IV lactated Ringer’s
  • nutrition but only after fluid resus- admin feeding once bowel sounds return
  • infection prevention esp w open burns
38
Q

How do you know if fluid resuscitation is working ?

A

-U/O > 30mls/hr
- BP >/= 90 systolic
- HR <120bpm

39
Q

What is the patient education given for the rehabilitation phase ?

A
  • water based lotions (minimises itching + scaring )
  • wear pressure garments (minimise scarring + keeps skin nd tissues tight whilst promoting circulation)
  • exercise daily (ROM)
  • sunscreen = protective clothing when going out in open sun
40
Q

What is the wound care mgt for burns ?

A
  • keep wound clean &moist
  • clean + remove foreign bodies (prevention of infection)
  • Irrigate wound - norm saline, tap H2O,
  • debridement if Eschar
  • analgesia b4 dressing change
  • take photos of wound
  • remove loose skin + keep small blisters
  • covered with non-adhesive dressing
  • if infection- daily dressing nd antibiotics
41
Q

What are the diff type of dressings for wounds?

A

Hydrogels, honey dressings, foams, anti-microbials

42
Q

What’s is the NI for burn care ?

A
  • Fluid resus (based on TBSA)
  • monitor IV
  • record + docu I&O
  • high carbo diet (avoid fats)
  • antimicrobial dressings (reduce infection)
  • admin meds- antibiotics, analgesics, sedatives
  • comp burns- rev by plastics
  • psych support
  • rehab programme

The Acutely Ill Adult (10 decks)

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