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Burns

QuestionAnswer
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