Burns
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| 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
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| Where do most burns occur | home in kitchen and bathroom, 75% bring on self
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| what is highest fatality rate of burn victims | children under 4, adults over 65
60yrs & 60% surface burn = 96% die
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| 4 goals for burns | prevention, lifesaving measures, prevention of disability, rehabilitation
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| Types of burns | chemical: acids/alkalines(h2o activates it)
thermal: flames/hot liquid/steam
smoke inhalation, electrical, cold thermal(frostbite), radiation(sunburn)
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| how tx chemical burns | rinse 15 min with water
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| what is a major predictor of mortality in burn vicitms | smoke inhalation
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| three types of smoke inhalation | carbon monoxide poisoning (cherry red skin)
inhalation above glottis - heat(hot air, steam, smoke)
inhalation below glottis - toxic fumes
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| smoke inhalation above the glottis | true medical emergency
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| 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
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| 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
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| what is the iceberg effect wtih electrical burns | what you see is just tip of iceberg, risk for dysrhythmias, severe metabolic acidosis, myoglobinuria
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| what are three classifications of burns | (1st) superficial partial thickness
(2nd) deep partial thickness
(3rd) full thickness
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| what involved superficial partial thickness burns | epidermis, painful, sunburn, blistering, no scarring
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| what involved in deep partial thickness burns | dermis, very painful(air), possible scarring
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| what involved full thickness burns | fat, muscle, bone, no pain, scarring, skin grafts
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| what classifies minor burns | 2nd degree of <15% TBSA, cause local reaction.
3rd degree of <10%
not include electrical, inhalation, poor risk pts
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| tx for minor burns | wound care, pain mgmnt, tetanus immunization, education
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| what classifies moderate burns | 2nd degree of 15-20%, 3rd of 10%, more local reaction
excludes electrical, inhalation
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| 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
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| 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
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| extent of burns is measured by | Rule of Nines, Lund Browder method (more accurate), Palmer method(for scattered burns)
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| 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%
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| severity of burn is determined by these factors | age, depth of burn, amt of surface area, presence of inhalation, other injuries
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| burns <20% TBSA produce | primarily local response
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| burns more than 20% | produce local and systemic response, major
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| what are effects of major burn injury | F&E shifts, cardio effects, pulmonary injury, renal/GI/immune alterations
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| what is greatest fluid volume leakage | first 24-36 hours after burn, peaking by 6 - 8 hours
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| how can you avoid edema in major burns | avoid excessive fluid adm
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| what is a escharotomy | surgical incision into eschar to relieve constricting effect of burned tissue
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| evaporative fluid loss can reach how much | 3-5L or more over 24hr period
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| hyponatremia is common during first week of burn as water shifts how | from interstitial to vascular
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| what also is seen right after burn injury, and then reveerses with fluid shifts | hyperkalemia first with cell destruction, then hypokalemia with fluid shifts
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| 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
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| what is 2nd phase | acute/intermediate phase: from beginning of diuresis to wound closure
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| what are tx for 2nd phase | fluid resuscitation, foley, NG inserted b/c of ileus, ECG(electrical), pain IV med(not demoral)
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| F&E shifts in emergent phase | hyperkalemia with cell destruction, NA traps in edema fluid and shifts into cells as K released, metabolic acidosis,
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| 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
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| what is normal insensible loss Severely burned pt: | 30-50ml/hr
200-400ml/hr
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| what are clinical manifestations of emergent phase | shock from pain/hypovolemia, blisters, adynamic ileus(paralytic), shivering, altered mental status(key)
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| Management of Shock | maintain BP 90, urine output of 30-50, if electrical want 75-100 to flush myoglobin thru kidneys
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| what type of fluids will be given in shock | isotonic, hypertonic, colloid
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| How do you take blood cultures | 2 different sites: one anaerobic, one aerobic
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| how many calories are needed by burn victims for nutritional therapy | 5000kcal/d
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| 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),
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| what is ICU psychosis syndrome | lose orientation
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| which germ is most prevalent with burn victims | psuedamonas
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| what are two kinds of pain in burns | continuous background pain, treatment induced pain
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| burn wounds heal by two ways | primary intention of grafting, healed areas protected from sun for 1 year
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| what is most common complication during rehap phase | skin/joint contractures
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palmerag
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