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Burns
| Question | Answer |
|---|---|
| Who gets burned? | The young, the old, the unlucky and the uncareful |
| What are the primary considerations for a burn victim? | ABCs, airway, breathing, circulation |
| What is the initial management? | Remove the burning process,ABCs, 100 NRB mask, Remove clothing and jewelry, Examine head to toe front to back |
| What is the major cause of morbidity and mortality in burn PTs? | inhalation injury, 80% |
| What makes PTs at risk for an inhalation injury? | Burned in a closed space, inhaled smoke particles, smoke particles in oropharnyx, impaired consciousness |
| If a Pt has a face burn and singed nasal hairs, is that an indicator for inhalation injury? | No, not necessarily |
| What would make a nurse suspect a PT has an inhalation injury? | hoarseness, stridor, severe wheezing and/or dyspnea, bronchospasm, bronchorrhea, dcreased lung compliance, increased PCO2, cyanosis, |
| What should you anticipate for an inhalation injury? | intubation |
| What part of the body is involved in an inhalation injury? | supra and sub glottic injuries due to carbon monoxide intoxication |
| How is carbon monoxide sneaky? | It's odorless and tasteless |
| What are the effects of CO? | altered judgement, confusion, disoriented, lethargic, respiratory arrest, death |
| When should the ET tube be inserted and why? | Before airway obstruction occurs and for acute swelling of the face and airways |
| How does inhalation injury effect the supraglottis? | Heat produces edema which may cause an obstruction 24 hours post injury |
| How would you describe the time course between internal and external edema? | Parallel |
| What is the treatment for inhalation injury? | 100% NRB mask, oral airway, intubation, elevate HOB, aggressive pulmonary toilet, bronchodilators |
| Why do we want to use aggressive pulmonary toilet after intubation? | To make sure a mucus plug does not develop at the end of the ET tube |
| What size ET tube should be used? | The largest possible, 7-8mm in adults |
| How are ET tubes secured? | Cannot use tape when burn is on face, have to use ties (#1 bandnet), sometimes even suture them in |
| What precautions should be monitored when using bandnet ties on an ET tube? | Ear erosion,re-adjust as swelling increases |
| What does the burn depth and total body surface area burn need to be evaluated? | to determine the amount of fluid resucitaion |
| Are UTIs a frequent problem in burn victims? | Yes |
| What is needed for a burn to heal? | A viable dermis |
| Which burns are the most painful? | The superficial ones/partial thickness |
| Which type of burns are painless? | Full thickness |
| What type of burn is a sunburn? | first degree, unless blistering then can be second degree |
| How are burns estimated? | by the "rules of nines" |
| How does burn edema react? | It is biphasic, rapid edema within the first hour and then increasing burn/non-burn edema 24 hours following |
| Who should be resuscitated? | partial thickness burns >15% and full thickness burns >10%, those who have electrical or inhalation |
| What is burn shock? | Hypovolemic shock |
| What primarily causes edema? | increased capillary permability |
| What formula is used to determine the amount of fluid resuscitation? | parkland formula: 2-4cc x kg x TBSA = ml/24 hr Half of the total is given within the first 8 hours and second half is given over 16 hours |
| What is the fluid of choice for resuscitation? | LR |
| What is started at hour 16 post burn? | Albumin to pull fluid back into vascular space |
| What is the primary parameter to measure resuscitation in a burn pt? | Urine Output: adult:30-50 cc/hr child: 0.5-1cc/kg/hr |
| What other factors help determine adequate fluid resuscitation? | SBP >90, HR 100-140 (adult) |
| What can happen due to over resuscitation? | Compartment syndrome, pulmonary edema, increased abd pressures, decreased perfusion |
| Is eschar painful? | No, but it needs to come off b/c it is a source of infection |
| What is the most common place to take for skin graft? | thighs, for children:scalps |
| What is a good indicator that a burn will heal well? | If it has the hair follicle still (basal cell layer) |
| How often are dressing changed? | once to BID |
| What is the most common type of dressing? | Silver |
| What are common skin substitutes? | transcyte- for partial thickness, and Integra for full thickness |
| Are ATBs given to all burn pts? | No, only used when needed, not for prophylaxis. |
| How are pain meds used now? | Less and less b/c we don't want the pt to later suffer from delirium, instead of over-medicating we keep them medicated enough to not endure the pain |
| What is one of the major factors of the healing process? | Nutrition |
| What type of burn is a tar burn? | thermal |
| What is used to get the tar off? | Mayo, RED, orange sol, medisol |
| What is the initial treatment for chemical burns? | irrigation with water then debridment |
| How is scarring controlled? | with pressure therapy, masks can be worn 23 hours per day for 1 year to 18m |
Created by:
brebre273
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