Burns part one Flashcards
(58 cards)
1
Q
signs of inflammation
A
-pain, heat, swelling, loss of function
2
Q
patho of a burn injury
A
-burn»_space; pain»_space; inflammatory process»_space; fluid shifts»_space; edema»_space; tissue and organ damage»_space; fluid mobilization diuresis»_space; healing rehab»_space; or shock»_space; tissue organ damage continues
3
Q
inflammatory process
A
- PAIN
- Increased blood flow
- Release of Vasoactive substances
- Increased capillary permeability
4
Q
complications of fluid loss in burns
A
- Edema
- Hypovolemia
- Shock!
- Pain continues!
- Tissue and Organ Damage
- decreased fluid in blood = decreased BP and CO (perfusion)
5
Q
how to classify burns
A
- etiology
- Depth of tissue damage
- total body surface area (TBSA) involved and severity
6
Q
burn etiology
A
- most common: fire/flame and scald
- african amercian children
- elderly
- thermal
- chemical
- electrical
- radiation
7
Q
thermal burns
A
- exposure to heat generating sources
- flame, steam, scald, hot objects/surfaces
- inhalation: heated gases
8
Q
chemical burns
A
-alkaline, acidic agents and organic compounds
9
Q
electrical burns
A
-injury related to voltage
10
Q
radiation burns
A
-usually from radiation therapy or exposure to industrial exposure (nuclear plants)
11
Q
role of the skin
A
- protective barrier
- sensation
- water balance
- temperature regulation
- vitamin production
- cosmetic
12
Q
degree of the burn
A
- superficial partial thickness (1st): epidermis
- deep partial thickness (2nd): dermis
- full thickness (3rd and 4th): fat, muscle, bone
13
Q
how long after the burn can you tell how much damage
A
24 hours
14
Q
how to know the depth of a burn
A
- if you tug on a hair and it comes out then the burn is as deep as the hair follicle (deep partial thickness)
15
Q
deep partial thickness injuries loose the ability to…
A
-thermoregulate
16
Q
classification according to burn depth
A
- epidermis: superficial
- minimally into the dermis: superficial partial thickness
- dermis: deep partial thickness
- SQ: full thickness
- muscle: full thickness
17
Q
superficial burn common cause
A
- sunburn
- minor scalds
18
Q
superficial burn signs
A
- mild erythema, hypersensitivity, blanches, pain
- causes pain and discomfort but no real medical intervention needed
19
Q
superficial burn will heal within
A
a few days (3-5)
20
Q
management of superficial burn
A
- no admit to burn unit or real medical intervention
- heals without scarring
- OTC- relief gel or cream
- Hydration: PO
- NSAIDS
- Acetaminophen/Ibuprofen
- Diphenhydramine (Benadryl)
- Moisturize: No alcohol or perfumes
21
Q
superficial burn injury level
A
- epidermal layer (outermost layer)
22
Q
superficial-partial thickness burn level
A
- epidermis & minimal layers of Dermis
23
Q
superficial-partial thickness burn appearance
A
- Blisters, erythema, shiny, wet , inflamed
- Pain: hypersensitivity r/t nerve injury and nerve exposure
- mild to moderate edema
24
Q
superficial-partial thickness burn healing time
A
1-3 weeks with minimal to zero scar tissue
-(7-21 days)
25
fluids and superficial-partial thickness burn
- without adequate perfusion burn damage Can extend further into the dermis and convert to a deep partial thickness burn
- - this would be secondary injury
- give fluids: small area have them drink, large area (>70%)= IV
26
would you pop or deroof a blister
- leave alone if they are calling
| - in our care: deroof
27
management of partial thickness
- promote self healing
- may need graft
- blisters: deroof > 2cm
- Antimicrobial topical with non adherent dressings = daily wound care with thorough cleansing
- hydration
- abx if infection present
28
deep partial thickness characteristics
- Less moist, Decreased sensation & pain
| - Light pink to cherry red
29
deep partial thickness injury level
- epidermis and bottom layers of dermal tissue
30
deep partial thickness risks
- conversion to full thickness
31
deep partial thickness management
- Systemic fluid support
minimize conversion to deeper tissue injury*
- Pain management : varying levels
- increase Nutritional needs
- May require excision and skin grafting
- Assess and RX for maximum Function
- PT and OT right away (esp. when on joints)
32
full thickness burn injury level
- all layers including portions of subcutaneous tissue
33
full thickness burn signs
- Non blanching
- Non tender
- Dry, white, brown, black, tough & leathery, red , waxy
* wont heal on own
34
full thickness burn management
- May involve fat, muscle &/or bone
- Systemic fluid support
- Nutritional support
- Requires excision and skin grafts
- Functional support/positioning
35
what causes the red urine with burns
- with muscle damage there is release of creatinine kinase and myoglobulin which are products of muscle breakdown that occlude renal tubules and are in urine
36
burn conversion
- area of the burn that is most at risk for conversion if the patient does not receive adequate resuscitation.
- Inadequate resuscitation may cause the burn to become deeper because of limited blood flow, causing the zone of stasis to convert into the zone of coagulation
37
inhalation trauma
- Consider in patients with facial burns, or Injury that occurs in an enclosed spaces
- 25-50% of burn patients will experience this
- Independent predictor of death
- Complications associated with carbon monoxide poisoning, injury above & below glottis
- Inhalation injury: increases incidence: Respiratory complications
38
carbon monoxide poisoning with inhalation injury
1. Inhalation: heated gases/smoke = Carbon monoxide poisoning
2. Asphyxiation
- CO binds selectively to Hgb molecule = hypoxia
- Treat with 100% FiO2
- injury in enclosed space; cherry red face
- Pulse ox considerations
39
above the glottis
- More common
-Protective reflex
Oral mucosa burns
- Lung parenchyma not injured
- Facial/airway edema primary nursing concern
40
below the glottis
- Patient possibly unconscious at the scene
- Injury to airway (intubation?)
- Injury lung parenchyma
41
complications of injury above and below the glottis
Atelectasis; pneumonia ; ARDS ; death
42
inhalation injury causes...
- Loss of cilia
- Respiratory epithelial cells
- Neutrophil infiltration from inflammation process
- Atelectasis: occlusion by debris
- Pseudomembranous CASTS
- Bacterial colonization@72 hr >> pneumonia
- ARDS
- Asphyxiation
43
with inhalation injury primary concern is
- maintaining airway
- intubation
- Airway patency: High Fowlers HOB > 45--No pillow
- Suctioning (✓ carbon in sputum)
44
suspect inhalation injury when
```
Facial burns
Wheezing (47%)
Carbonaceous sputum , Soot
Rales
Dyspnea ; Tachypnea
Hoarseness (voice chnages)
Cough (lots of coughing!)
Singed facial hair, nasal,
Painful swallowing
```
45
inhalation injury and swelling
- greatest 2-96 hours
- Anticipate Intubation *airway care !!
- Early intubation 1-2 hrs post injury
- 6-12 hours bronchoscopy if not intubated Recheck airway
46
electrical injuries
- Electrical energy converts to heat
- Current travels: path of least resistance
- Least: nerves, blood, fluid
- Most: bone, skin
- Majority of tissue destruction is “internal”
47
electrical burns
- Injuries are “hidden”: Small surface injuries or Devastating internal injuries
- Generated heat damages adjacent muscle and tissues
- Deep muscle & nerve injury may occur when superficial muscle appears normal
- Difficult to assess internal injury
48
high voltage injury consequences / risks
- Loss of Consciousness
- Cardiac Arrhythmias
- Muscle contractions: Clenched fists
- Myoglobinuria and CK: Product of Muscle breakdown
- Mummified extremities
49
care for electrical burn pt
-Fluid resuscitation based on TBSA injury
- *EKG-cardiac monitoring for 24 hours
- Assess: compartment syndrome with neurovascular checks q 1hr
- Detailed *Neurological exam q1hr : note changes over time
- Assess for *rhabdomyolysis and myloglobinuria (ATN): if have red urine give fluids Goal: UOP to > 100 – 150 cc/hr
50
compartment syndrome
- Increased pressure within body compartments
- Causing inadequate perfusion and inadequate nerve conduction
- Result is tissue and nerve necrosis beyond site of increased pressures
- Limb threatening and life threatening
* compartments swell and become edematous and compress nerves (NO SENSATION) and arteries (DECREASED PERFUSION)
51
what area of burns are we most worried about compartment syndrome
- electrical (inside)
| - circumfrential bun (all the way around the skin in that area)
52
chemical burn
-Do not look for chemical antidote
-Do not try to neutralize chemical
-Protect yourself!
-Brush off any powder, remove clothing
-Irrigate: copious amounts of water :Irrigation > 20 minutes
-Identify the causative agent
without delaying patient care)
-Chemical burn alone meets referral criteria to a burn center
53
SJS and TENS
-severe cutaneous hypersensitivity reactions
-Rash: exfoliative
skin and mucous membranes
-Cause: Drug Reaction (50%)
54
DIFFERENCE BETWEEN SJS AND TENS
SJS < 10 TBSA & TENS > 30 % TBSA
| - TENS = higher mortality rate
55
similaritites of SJS and TENS
- All Epidermal cells: skin & mucous membranes: eyes, mouth, GI , GU , periareas
- Macules: Red, tender blisters coalesce, into blisters
56
SJS/ TENS common causitive agnets
- Antiepileptics (AED)
- Antibiotics
- sulfa meds
- anti gout meds
57
frostbite
-Tissue destruction from cold is similar to burns
-Depth of tissue damage:
Assessed when extremities are warm and perfused
-cells are destoryed from the lack of 02 and h20
-linning of blood vessels are damaged = blood leaks when re warming
58
frostbite tx
- Topicals: Antimicrobials
- Or allow tissue to desiccate and mummify
- possible amputation
- Some can heal without surgery
* Refer to Burn Center within 24 hrs for tPA
- -Pain management (IV)
