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109 Ch. 57
Burns
| Question | Answer |
|---|---|
| How many people die and need tx for burns q year | 4500 die/1.1 million need medical attention/ 1/3 need burn centers, 5th most common cause of death |
| Where do most burns occur | home in kitchen and bathroom, 75% bring on self |
| what is highest fatality rate of burn victims | children under 4, adults over 65 60yrs & 60% surface burn = 96% die |
| 4 goals for burns | prevention, lifesaving measures, prevention of disability, rehabilitation |
| Types of burns | chemical: acids/alkalines(h2o activates it) thermal: flames/hot liquid/steam smoke inhalation, electrical, cold thermal(frostbite), radiation(sunburn) |
| how tx chemical burns | rinse 15 min with water |
| what is a major predictor of mortality in burn vicitms | smoke inhalation |
| three types of smoke inhalation | carbon monoxide poisoning (cherry red skin) inhalation above glottis - heat(hot air, steam, smoke) inhalation below glottis - toxic fumes |
| smoke inhalation above the glottis | true medical emergency |
| what are s/s of smoke inhalation above the glottis | facial burns, singed nose hair, hoarseness or difficulty swallowing, darkened oral membranes, carbon in sputnum, clothing burns @ neck/chest, cough, SOB, dyspnea tx: nasotracheal/endotracheal intubation |
| s/s smoke inhalation below the glottis | related to length of exposure, pulmonary edema in 12-24 hrs, then move to ARDS acute resp distress syndrome(chest xray looks "white out") tx: early intubation and mechanical ventilation of 100% O2 |
| what is the iceberg effect wtih electrical burns | what you see is just tip of iceberg, risk for dysrhythmias, severe metabolic acidosis, myoglobinuria |
| what are three classifications of burns | (1st) superficial partial thickness (2nd) deep partial thickness (3rd) full thickness |
| what involved superficial partial thickness burns | epidermis, painful, sunburn, blistering, no scarring |
| what involved in deep partial thickness burns | dermis, very painful(air), possible scarring |
| what involved full thickness burns | fat, muscle, bone, no pain, scarring, skin grafts |
| what classifies minor burns | 2nd degree of <15% TBSA, cause local reaction. 3rd degree of <10% not include electrical, inhalation, poor risk pts |
| tx for minor burns | wound care, pain mgmnt, tetanus immunization, education |
| what classifies moderate burns | 2nd degree of 15-20%, 3rd of 10%, more local reaction excludes electrical, inhalation |
| what classifies major burns | 2nd degree >25%, all 3rd degree >10%, eyes, ears, face, hands, perineum, joints, all inhalation, electrical, concurrent trauma, at risk pts |
| Zones of burn injury on electrical burns | hyperemia - some fx stasis - low fluid mvmt, no O2, may b necrotic coagulation - cooked meat, never fx again |
| extent of burns is measured by | Rule of Nines, Lund Browder method (more accurate), Palmer method(for scattered burns) |
| what is rule of nines | body divided in multiples of 9 head, each arm: 9% upper torso, lower torso, each leg: 18% private area: 1% |
| severity of burn is determined by these factors | age, depth of burn, amt of surface area, presence of inhalation, other injuries |
| burns <20% TBSA produce | primarily local response |
| burns more than 20% | produce local and systemic response, major |
| what are effects of major burn injury | F&E shifts, cardio effects, pulmonary injury, renal/GI/immune alterations |
| what is greatest fluid volume leakage | first 24-36 hours after burn, peaking by 6 - 8 hours |
| how can you avoid edema in major burns | avoid excessive fluid adm |
| what is a escharotomy | surgical incision into eschar to relieve constricting effect of burned tissue |
| evaporative fluid loss can reach how much | 3-5L or more over 24hr period |
| hyponatremia is common during first week of burn as water shifts how | from interstitial to vascular |
| what also is seen right after burn injury, and then reveerses with fluid shifts | hyperkalemia first with cell destruction, then hypokalemia with fluid shifts |
| Burn care is categorized into three phases | Phase 1: emergent/resuscitative: onset of injury to completion of fluid resuscitation, 24-48 hrs ABC, not pack with ice, cover with cool tap water, remove burned clothing |
| what is 2nd phase | acute/intermediate phase: from beginning of diuresis to wound closure |
| what are tx for 2nd phase | fluid resuscitation, foley, NG inserted b/c of ileus, ECG(electrical), pain IV med(not demoral) |
| F&E shifts in emergent phase | hyperkalemia with cell destruction, NA traps in edema fluid and shifts into cells as K released, metabolic acidosis, |
| what is hypovolemic shock in burn victims | massive shift of fluids out of blood vessels, incr capillary permeability = intravascular volume depletion. Albumin, NA, H2O out of vascular all in first 24-48 hours |
| what is normal insensible loss Severely burned pt: | 30-50ml/hr 200-400ml/hr |
| what are clinical manifestations of emergent phase | shock from pain/hypovolemia, blisters, adynamic ileus(paralytic), shivering, altered mental status(key) |
| Management of Shock | maintain BP 90, urine output of 30-50, if electrical want 75-100 to flush myoglobin thru kidneys |
| what type of fluids will be given in shock | isotonic, hypertonic, colloid |
| How do you take blood cultures | 2 different sites: one anaerobic, one aerobic |
| how many calories are needed by burn victims for nutritional therapy | 5000kcal/d |
| when is acute period ended | when burn area is covered by skin grafts or wounds healed, 48-72hrs, fluid re-shifts back, NA lost(hyponatremia), K back in(hypo), |
| what is ICU psychosis syndrome | lose orientation |
| which germ is most prevalent with burn victims | psuedamonas |
| what are two kinds of pain in burns | continuous background pain, treatment induced pain |
| burn wounds heal by two ways | primary intention of grafting, healed areas protected from sun for 1 year |
| what is most common complication during rehap phase | skin/joint contractures |
Created by:
palmerag
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