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Precept: Burns
Burns
| Question | Answer |
|---|---|
| Partial | (1st or 2nd degree) (heals 7-21 days)Superficial - involves the upper layers, no break in skin, blistersmild to moderate edema presentwet & painful, pink/redheals 7-12 daysex: scolds, flames, brief contact with hot objects(1st or 2nd degree |
| Deep | extend deeper into the dermis (1/2- 2/3 thru)moderate edema presentwet & painful, red/waxy whitesoft & dry eschar may be presentheals 14-21 daysex: prolonged contact with hot objects, tar, grease, chemicals |
| Full Thickness | (3rd degree) (never heals completely)involves the entire epidermal and dermal layer of the skinno epidermal cells present for re-epithelializationsevere edema presentsome pain may be presentblack, brown, yellow , white, redhard and inelastic e |
| Total Body surface Area (TBSA) | used to measure the size of injury for diagnosis and prognosis and for calculating specific therapeutic parameters, such as drug dose, fluid replacement volumes, and calorie needs |
| The rule of nines | a formula for estimating the percentage of adult body surface covered by burns by assigning 9% to the head and each arm, twice 9% (18%) to each leg and the anterior and posterior trunk, and 1% to the perineum. This is modified in infants and children beca |
| The palmar method | uses the hand as 1% of TBSA to measure the size. |
| Minor | no involvement of hands, face, or genitalia; toral partial thicknes burn area does |
| Moderate | partial-thickness involvement of 15% to 25 % of body; but full-thickness burns |
| Major | involvement exceeds 25% (if partial-thickness or 10% (if full-thickness) of body |
| Vascular System: Fluid Shift | Initially vasoconstriction occurs at the burn site as macrophages release chemical substances. Next adjacent vessels to the burn injury dilate leading to increased capillary hydrostatic pressure, accompained by an increased capillary permaeability (thir |
| Vascular System: Fluid Remobilization | 24 to 36 hours after injury fluid lead ceases, fluid shifts back intot he intravascular compartment, restorin fluid and elctrolyte levels and renal blood flow, resulting in increased urine formation and diuresis.hyponatremia, hypokalemia, hemodilution, |
| Vascular System: Burn Shock can occur due to hyperpermeability | Fluid resuscitiation is necessary to correct hypovolemia, reduce hypothermia and improve organ perfusion, and to correct hemoconcentration and avoid renal failure |
| Cardiac System | Cardiac output decreases in spite of an increased heart rate, it will increase with adequate fluid resuscitiation ,Dysrhythmias/arrest may occur, monitor EKG for abnormalities |
| Pulmonary System | Usually caused by superheated air, steam, toxic fumes, or smoke , major airway injury results from chemicals and toxic gases, rather than heat.Initially Respiratory rate is increased and shallow. Hoarseness may be present. Rales, rhonchi, secretions us |
| Gastrointestinal System | Because of fluid shifts and decreased cardiac output, blood flow is shifted to brain, heart, and liver. Therefore The GI tract has decreased perfusion leading to impaired gastric motility, peristalsis ceases, and a paralytic ileus is present, this leads |
| Immune System | Loss of protective barrier, skin, increases chance for infection, all immune responses are supressed |
| Metabolism | The pt is in a hypermetabolic state, increase secretion of cateholameins, antidiuretic hormone, aldosterone, and cortisol to maintain homeostasis results in hypermetabolism, oxygen and clorie requrements are high.Core body temp increases, the pt loses h |
| Dry Heat | open flame, house fires, explosions |
| Moist Heat | scald injuries |
| Contact Burns | frequent, generally minor, circumferential (An escharcotomy incision may be necessary to to release circumferential burn eschar and improve circulation to a distal extremity) |
| Chemical injury | |
| Electrical Injury | nonthermally induced burn, entrance/exit site, deep tissue destruction may not be apparent |
| Radiation | |
| Emergent and Resuscitation Phase (first 24-48 hours) | Immediate problems include: fluid loss, edema formation, and potential for peripheral cirucuatory impairmentStop the burning process: Immediately cool with water for 10 minutes, regardless of depthor degree, do not use ice, cover with clean dry clot |
| Acute Phase (48-72 hours) | Begins 48 hours after injury and last until wound closure is completed.Care is focused on continued assessment and maintenance of the cardiovascularand respiratory systems, as well as GI, and nutritional status, burn wound care, pain controland psy |
| Rehabilitation Phase | Technically begins with wound closure and ends when the pt returns to the hightest level of functioning possible. Emphasis is placed on psychosocial adjustments of the pt, the px of scars and contractures, and the resumption of pre-burn activity, includi |
| Parkland method | Infuse Lactaed Ringers solution via 1 or 2 large bore IV lines2-4ml's /Kg X %TBSASet rate to deliver 1/2 the total amount in the first 8 hours from time of injurySecond 1/2 given in the next 16 hoursmonitor urinary output hourly via foley cath, |
| Antimcrobials | Silvadene ( silver sulfadiazine) |
| Topical enzymatic debriding agent | Collagenase |
| hydortherapy | clean debride, promote healing |
| dressings | fine mesh, occlusive DSD, pressure dressings |
| homograft | obtained from a cadaver |
| heterograft | obtained from another species, pigskin |
| autograft | form the burned person, meshing allow a small graft to cover a large |
| cultured skin | grown from a small biopsy specimen of epidermal cells |
| antimcrobials | Silvadene ( silver sulfadiazine) |
| position | to px contractures, ROM |
| Deep | dry painless |
| Primary Survey | ABC's |
| Airway/Breathing | Assess for airway patency, intubate if necessaryAdminister O2 an needed, 100% humidified NRBM |
| Circulation | Initiate an IV line and begin fluid replacementInfuse Lactared Ringers solution via 1 or 2 lareg bore IV lines (parkland method)2-4ml's /Kg X %TBSASet rate to deliver 1/2 the total amount in the first 8 hours from time of injurySecond 1/2 given |
| Secondary Survey | Perform a head-to-toe assessmentdetermine depth and extent of burnrecord a complete historyMorphin Sulfate is preferred for pain 1mg/10kg IVKeep the pt on NPO statusAdminister tetanus toxoid for prophylaxis |
Created by:
littlemina
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