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Flashcards in burns Deck (24)
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1
Q

Parkland formula

A

4cc X % BSA X Kg of body weight, this i s the amount needed over first 24 hours. Admin 50% in the first 8 hours and the next 50% over 16 hours the goal is GOOD urine output 30-50 ml hour adults. 1-2 ml/kg/hr children

2
Q

Composition of fluid for burns

A

< 30% BSA ringers Lactate
> 30 % BSA ringers lactate with 50ml bicarb (hypertonic) helps to reduce edema)
no fluid bolus

3
Q

resuscitative/emergent phase

A

immediately after bun vascular space becomes permeable allowing plama to leak into interstitium can result in hypovolemic shock get fluids quick. may last 7 days, usually 3-5 days

4
Q

Zone of coagulation

A

heat source worst, full thickness or 3rd degree burn, non viable

5
Q

Zone of stasis

A

surrounds zone of coag, cells may be salvaged, if resuscitation and elevations to reduce edema is not addressed the result will be conversion from partial to full thick ness

6
Q

Zone of hyperemia

A

borders zone of stasis, least affected area, usually heals spontaneously, also know as superficial 2nd degree area or 1st degree

7
Q

Acute phase

A

starts immediately after burn and continues until end of wound closure. determination of burn made and treatment plan.

8
Q

first degree burn

A

sun burn, pain, red. involved outer epidermis.

9
Q

second degree burn

A

wet, pain , swelling, entire epidermis and portions of dermis. can be superficial or deep (partial thickness) usually pink to light red

10
Q

third degree

A

no pain, white, dry, no edema, entire epidermis and dermis destroyed (full thickness) eschar, waxy white color. No swelling b/c skin not elastic

11
Q

Topical antimicrobials

A

1% silver sulfadiazine or silvadene is a combo of sulfadiazine and silver, silver binds with DNA & releases sulfonamide that interferes with metabolic pathways, complications - transient leukopenia , tx by stopping cream, silvaden uses on second degree burns superficial to deep dermal
Bacitracin antimicrobial for minor burns, petrolatum based keeps wound moist and bandage non adherent, you dont need a bazooka silvadene to go rabbit hunting when bacitracin will do, its cost effective
mefenidine acetate or sulfamylon 10% a cream that covers broader spectrum of bacteria, more systemic side effects such as metabolic acidosis, causes burning after application. it is used primarily on ear burns to prevent cartilage from becoming infected.
nystatin, bactroban and silver nitrate helps prevent gauze from sticking. if wound is full of debris an adherent bandage is needed for debridement. if wound is clean adaptic or xerflo on adherent .

12
Q

biological dressings

A

animal hides to fetal membranes, cadaver tissue, most common is pig skin, 0.8 inches thick, best for superficial second degree burns. longer post burn period is before treatment less chance for biological to be applied.

13
Q

To apply biological dressings

A

wash with soap and water abrasive actioin, remove debris, lay pigskin dermal side down apply bandage, a sign pig skin is is doing its job is becomes translucent. once wound healed a thin layer of bacitracin applied to pigskin and pt instructed of its removal

14
Q

Synthetic substances

A

Biobrane, its nylon silicone mesh with porcine peptides bound to mesh used on partial thickness and donor sites. if wound is deep and one part superficial don’t use biobrane.

15
Q

Combined, synthetic and biological dressings

A

used more frequently, promote epithelialization, decrease pain, and amount of time needed for wound care, expensive! integra act like scaffolding for dermis to rebuild upon.

16
Q

tx third degree burn

A

wash with soap and water daily, apply topical cream and bandage, start with pt/ot twice a day and schedule operation to excise and graft burn, strive for 1% bsa per day

17
Q

Rehabilitative phase

A

starts first post burn day, daily exercises, rom, splinting to position of function. done at times of rest.

18
Q

chemical burns

A

remove chemical quickly
dry chemicals brushed away then area flushed with water for 20 minutes
liquid chemicals flushed with water for 20 min or longer

19
Q

smoke inhilation

A

carbon monoxide poisoning (takes 02 off hemoglobin inoxic) tcdb
carboxyhemoglobin test, O2, skin color
Above glottis, breath in hot air-swelling, thermally produces
below glottis, chemicals that were in smoke or toxic fumes
ARDS Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that prevents enough oxygen from getting to the lungs and into the blood
Pulmonary edema

20
Q

classification of burn injury

A

related to depth of burn
extent of burn calculated in percent of total body surface area TBSA
location of burn
patient risk factors

21
Q

classification of burn injury depth

A

superficial (1st degree Red pain
Deep 2nd degree, pain, red, wet, swelling
3rd degree dry waxy white, no pain, no edema

22
Q

emergent phase

A

nursing and collaborative mgmt
inpatient or outpatient care
transfer to burn unit

23
Q

wound care

A

prevention of infection auto contamination/cross contamination
open method/multiple dressing changes/wet to dry
bandages distal to proximal
drug therapy, pain/prophylactic/abx

24
Q

complications

A
contractures
pressure sores
pneumonia
infections
ulcers
psychological