Final - 7 Tissue Integrity/Burns Flashcards
(27 cards)
Use the Parkland formula to calculate the resuscitation fluids: Lactated Ringer’s at 4 mL x weight in kg x TBSA burn (use number not percentage) (TBSA = 27%). The patient is 176 pounds. How many mLs will be infused in the first 8 hours? What is the amount for each hour? The Parkland formula will tell you how much of the total resuscitation fluid should be used for your starting rate.
4320 mL first 8 hours
2160 mL 2nd 8 hrs
2160 mL 3rd 8 hrs
Best crystalloid solution for burns
LR
amt. of fluid required to resuscitate the pt
TBSA%
how are fourth degree burns treated
surgical amputation
explain TBSA Rule of 9’s
Head: 9% Anterior: 18% Posterior: 18% R arm: 9% L arm: 9% Genitals: 1% R leg: 18% L leg 18%
Lund & Browder:
- palm of pt’s hand =
1% TBSA
s/s of injury above glottis
- singed hair
- facial burn
- carbonaceous sputum
injury below gottis…
may not be immediate
- superficial burn of epidermis (ex. sunburn)
- epidermis
- not include in TBSA%
First degree (superficial)
- bright red moist surface
- Tense, fluid-filled blisters
- Tactile & pain sensors intact VERY painful
- Heals in 10-14 days
- Bacetracin covers gram+ agents
second degree (partial/superficial)
- Dermis & epidermis
- dry waxy-white or dull red
- dry skin slough
Second degree (deeper partial)
- Full Thickness Injury
- all layers of skin
- dry surface
- often leathery
- Tight swelling
- relatively painless
- color is unreliable
Third Degree
- all structures are unable to be healed or grafted:
- blood vessels
- bone
- Tendons
- Muscles
Fourth Degree
priorities of burns
- airway & circulation (fluid status/imbalances)
- pain
3 steps to healing process of burn
- inflammation: begins immediately when burn occurs
- proliferations: beings 2-3 days post burn
- remodeling: may last for years
burns less than _____ TBSA produce primarily a local response
20%
burns more than _____ TBSA may produce a local and systemic response and are considered major burns
20%
the greatest fluid volume leak occurs in the first _____-_____ hours
24-36 hrs
Parkland Baxter Formula
2-4 mL X TBSA% pt’s wt
- 1/2 given in 1st 8 hrs from time of injury
- 1/4 given in 2nd 8 hrs
- 1/4 given in 3rd 8 hrs
urine output:
- adults
- children
adults: 20-30 ml/hr
children: 1 mL/kg/hr
Formulas are only a guide for burn care fluid resuscitation. How often must the patient’ s response to fluid therapy (urine output, heart rate, and blood pressure) be evaluated?
every 1 hr
3 phases of burn injury
- emergent/resuscitative
- acute/intermediate
- rehabilitation
emergent or resuscitative phase
onset of injury to completion of fluid resuscitation
acute or intermediate phase
48-72 hrs after injury occurs
specifically at the beginning of diuresis and ends with wound closure
