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Karteikarten von brittny beauford, aktualisiert more than 1 year ago
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Erstellt von brittny beauford
vor fast 8 Jahre
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| Frage | Antworten |
| A burn occurs when there is injury to the tissues of the body caused by ____, _____, _______ or _______. | heat chemicals electric current radiation |
| Burns have both a _____ and _________ inflammatory reaction, the end result of which is an almost immediate shift of intravascular fluid into the surrounding interstitial space. | local and systemic |
| 5 types of burns | Thermal burns Chemical Burns Smoke and Inhalation Burns Electrical Burns Cold Thermal Injury |
| What is the most common type of burn? | Thermal Can be caused by flame, flash, scald, or contact with hot objects |
| What causes chemical burns? | acids, alkalis and organic compounds. household cleaners and fertilizers |
| Are alkali or acid burns more difficult to treat and why? | Alkali Damage can continue even when neutralized |
| ____________ burns can cause respiratory problems, eye injuries, liver and kidney problems | Chemical |
| How to treat chemical burns | remove the chemical from the skin, remove clothing with chemical on it then flush with lots of water |
| With chemical burns tissue destruction may continue for up to ____ hours | 72 |
| Result from inhalation of hot air or noxious chemicals and can cause damage to the tissues of the respiratory tract | Smoke/Inhalation Burns |
| Clues may be facial burns, singed nasal hair, hoarseness, painful swallowing, or darkened oral and nasal membranes | smoke/inhalation burns causes redness and airway edema |
| Metabolic asphyxiation | account for majority of deaths at a fire scene. (Displaces 0xygen on the hgb, causing hypoxemia – manage with 100% humidified 02 and monitor levels of carboxyhemoglobin. May occur in the absence of burned skin. Hyperbaric tx controversial |
| Inhalation injury above the glottis | usually thermally produced. Redness, blistering, edema. Mechanical obstruction usually occurs quickly. |
| usually chemically produced. Clinical manifestations in 12-24 hrs. Can progress to ARDS. | inhalation injury below the glottis |
| Direct damage to nerves and vessels can occur causing tissue anorexia and death Can cause muscle contractions strong enough to break bones | electrical burns |
| This is seen with electoral burns: majority of damage beneath the skin making it hard to determine. | iceberg effect |
| Which burns have a very High risk for fall injuries, fractures | electrical burns |
| Risks associated with an electrical burn besides falls and fractures | dysrhythmias, cardiac arrest, severe metabolic acidosis (due to tissue destruction), and related renal issues |
| Causes vasoconstriction- Ice crystals form in intracellular spaces | Cold thermal injury/frostbite |
| Complications with cold thermal injury/frostbite | Re-warming is extremely painful Pain may last weeks to years May require amputation |
| There are 2 guides for determining the extent of 2nd and 3rd degree burns. What is considered a 1st degree burn? | sunburns "don't count" |
| classification of burn injury that is the most accurate and provides a percent calculation | Lund-Browder Chart |
| classification of burn injury that is simplistic and used more for adults | Rule of nines |
| Treatment of a burn depends on its severity. Severity is determined by what 4 things? | Extent of burn Depth of injury Location of burn, Risk factors |
| Criteria for burns to be treated in burn units (1-5) | 1. Partial-thickness burns >10% of total body surface area (TBSA). 2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints. 3. Third-degree burns in any age-group. 4. Electrical burns, including lightning injury. 5. Chemical burns. |
| Criteria for burns to be treated in burn units (6-7) | 6. Inhalation injury. 7. Burn injury in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality risk (e.g., heart or kidney disease). |
| Criteria for burns to be treated in burn units (8) | 8. Any patients with burns and concomitant trauma (e.g., fractures) in which the burn injury poses the greatest risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may be initially stabilized in a trauma center before being transferred to a burn center. |
| Criteria for burns to be treated in burn units (9-10) | 9. Burn injury in children in hospitals without qualified personnel or equipment needed to care for them. 10. Burn injury in patients who will require special social, emotional, or long-term rehabilitative intervention. |
| burn classification: epidermis to dermis | partial thickness |
| burn classification: deep dermis including sweat and oil glands | deep partial thickness |
| burn classification: all layers of the skin and beyond including bone and muscles | full thickness |
| Which types of burns are the most painful? | Partical thickness |
| Full thickness burns lead to release of _______ and _________ | myoglobin and hemoglobin |
| fluid and electrolyte shifts: The greatest threat initially with burns is ______________ | hypovolemic shock: Caused by massive shift of fluids out of vascular space Water, sodium, proteins move into interstitial spaces |
| Fluids and electrolyte shifts: what are the concerns? | 1. evaporation occurs through the burns 2. Hemolysis of RBC’s 3. Blood flow to kidneys decreased 4. 3rd spacing occurs 5. K+ released into the circulation 6. Shock and death may result |
| This phase usually lasts 24-72 hours. Always consider other injuries! | Emergent phase= Resuscitative Phase! |
| What is the primary concern with Emergent phase= Resuscitative Phase? | Hypovolemic shock |
| Why shivering occurs in burn victims | chilled by heat loss, anxiety or pain |
| When does the emergent phase end? | when fluid mobilization and diuresis begins |
| Medical priorities in the emergent phase | assess & re-assessmentof: 1. ABC’s 2. perfusion 3. vital signs 4. cardiac rhythm 5. oxygenation 6. LOC |
| What is the airway management of a burn patient? | Intubation, extubation when edema resolves. If no intubation necessary, humidified 02 |
| Fluid therapy consideration in the treatment of a burn patient | large bore IVs or Central Line crystalloids (NS or LR) or colloids (Albumin) or combo Weight specific You know you have enough fluid when UO of 30-50 ml/hr is achieved. |
| Treatments of a burn patient | IV Pain meds!! Tetanus shot- anaerobic contamination. Escharotomies/fasciotomies-respiratory or vascular compromise Labs- monitor ABG’s, fluid/electrolytes Wound care-debridement Infection control! PT starts very soon- ROM! Antimicrobials (topical) unless septic |
| Wound healing is also know as what phase? How long does it last? | Acute phase weeks to months |
| When does the acute phase of a burn begin? | with the mobilization of fluid and diuresis Less edema, Burns are more evident…necrotic tissue begins to slough |
| Electrolyte abnormalities with acute phase of burns | Hyponatremia - or hypernatremia from resuscitative fluid replacement/ |
| What do monitor in the acute phase of a burn | Infection, sepsis, prevention of contractures, prevention of ileus, increase in blood glucose (stress), pain control, psychosocial support |
| When does the burn acute phase end? | Phase ends when burned area is covered by skin grafts or wounds are healed |
| What phase begins when burns have healed and patient can perform at a level of self care? When does it occur? | Rehabilitation phase=Restorative 2 weeks-8 months |
| What are the greatest risks in the burn rehabilitation phase? | contractors and scar tissue Pressure garments (up to 24hr/day for 12-18 months) |
| What to access during the burn rehabilitation phase? | Itching during healing (Benadryl & lotions), initial skin is friable, protect from direct sunlight. Emotional support, self esteem issues- identity issues, loss of function, disfigurement, financial burdens, fear, anger, anxiety, guilt, depression, PTSD. |
| wound care: pink or cherry red, wet & shiny with serous exudate (may or may not have blisters) and painful to touch or exposed to air | partial-thickness burn |
| wound care: dry & waxy white to dark brown or black and minor/localized sensation | Full thickness burn |
| necrotic tissue is removed | Debridement |
| which method? burn covered in topical antimicrobial and no dressing over the wound | open method |
| Which method? sterile gauze laid over topical antimicrobials Changed Q12-24hr depending on product Must use PPE (sterile gloves to open wound) | closed method |
| What type of burn may grafting be necessary for? | full thickness |
| Surgury that may be necessary with burns: Think about swelling, stretch or lack of….. Think about circulation | Fasciotomies or Escharotomies: incision in tissue to relieve swelling |
| Nutritional therapy:____________ state due to increased metabolism by 50-100% of a normal patient | Hypermetabolic >20% BSA burn usually require enteral feedings |
| Nutritional therapy considerations for burn patients | Goal is to provide adequate calories and protein to facilitate healing. Fluid replacement first then nutrition Nutritional support within hours of burn can decrease mortality and increase healing time |
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