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109 Ch. 57

Burns

QuestionAnswer
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