453: Test 1 Burns

Pregunta	Respuesta
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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