Burns

Question 1

Phases

Answer 1

1. Emergent Phase
   - Begins with the injury and continues for 24-48hrs.
   - Priorities include securing the airway, supporting circulation and organ perfusion by fluid replacement, managing pain, preventing infection through wound care, maintaining body temperature and providing emotional support
   - Lab values:
   
   • Increased Hemoglobin, Hematocrit, and Potassium
   • Decreased or normal sodium.
   • Metabolic or respiratory acidosis
   • low platelets, low fibrinogen, increase PTT, PT
   • hypovolemia and signs of shock = high HR, low BP
   • respiratory failure = edema to airway = increased RR
   • HYPOthermia
2. Acute Phase
   - Begins 36-48hrs after injury when the fluid shift resolves.
   - Ends with closure of the wound.
   - Priorities include assessment and maintenance of cardiovascular, respiratory and GI systems including nutrition; wound care, pain control and psychosocial interventions
3. Rehabilitative Phase
   - Begins when most of the burn area has healed.
   - Ends when the client achieves the highest level of functioning possible.
   - Priorities include psychosocial support; prevention of scars and contractors; resumption of activities, including work family and social roles. This phase can last for years.
   - Curling’s Ulcer (develops 72 hours after the burn)

Question 2

Parkland Formula for fluid resusitation

Answer 2

• 4mL X kg X %TBSA
• ½ in first 8 hours; ½ in the next 16 hours
• Example: if patient (88kg) has a TBSA of 18%, what is the amount of fluid given in total 24 hours, first 8 hours, and remaining 16 hours?
  4 X 64 X 18 =
  total 24 hours: 4,608mL of fluid
  first 8 hours: 2,304
  second 16 hours: 2,304