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