Burns

Questão	Responda
Whats is a burn?	tissue loss caused by an exogenous injurious agent, heat, cold, chemicals, electricity, radiation severity depends on temp, conc of agent, duration of contact
skin functions	protects against infection prevent loss of body fluids control body temp functions as excretory organ functions as sensory organ produces vitamin D
General first aid priorities	stop burning process remove clothing, unless stuck cool/irrigate/re-warm thermal - cool running water for 20 minutes acid -irrigate -decontaminate 1 hr until burning sensation gone alkali - irrigate - decominate 2 hr until burning sensation gone cold induced injury - warm/tepid buckey water cover the burn and elevate avoid hypothermia
primary survey	airway maintenance with c-spine control breathing and added oxygen circulation with haemorrhage control disability - neurological status exposure and environmental control fluid resuscitation
airway	mechanism of injury envirionment injury occured examine patient for signs of: burns to mouth, sooty sputum, change in voice, productive cough, stridor, nasal flaring
breathing	deep dermal/full thickness burns can affect chest expansion soot in lower airways trauma associated injuries - haemothorax, pneumothorax, barotrauma
circulation	haemorrhage control temp, pulse, BP, colour, capillary refill, escharotomy required? to allow expansion intravenous access
disability	state of consciousness, AVPU, GCS
Exposure and environment	keep pt warm, remove all clothing, remove all jewellery, prevent hypothermia, assess burn size, warmed blankets
superficial	rapid capillary refill (blanch), thin walled blisters, moist wound (light reflection), pain, heal 7- 10 days
Mid dermal	thicker blister decreasing mosture, decreasing sensation, decreasing cap refill, heal 10-14 days
deep dermal	central white area dull sensation (no pain) slow cap refill slight moistue, heal 2-4 weeks
full thickness	no sensation, no cap refill, no moisture, need graft, flap
SHOCK	from depleted blood volume, low co, vasoconstriction, decrease tissue perfusion, fluid shift continues 36-48 hours
fluid resusitation	1st 24 hours - hartmann solution fluid (mls) = 4mls x %TBSA X WEIGHT (KG) - give half in first 8 hours - give half in next 16 hours monitor urine output - aim 0.5ml/kg/hour *urine output key to monitoring
What increase fluid needs?	inhalation injury, dehydration, electrical
probelms of fluid resuscitation	oliguria, poluria, fluid overload, haemoglobinuria
aims of burn wound care	promote healing, prevent desiccation of wound, prevent infection, comfort, management, allow movement
management of	temp, hydration, nutrition, infection, oedema
choose a dressing	generally silver based due of risk of infection transporting patients products
initial wound care	give appropriate pain relief debride all blistered non-vial skin shave wound to decrease bacterial load shave 5-10cm margin around wound aid future wound cleansing
Scar management	requires skin grafting un-grafted area that take longer than 10-14 days to heal on assessment involves massage and moisturisation, pressure garments generally 2-3 times daily, water-based moisturiser, firm pressure benefits - softens scar, increase pliability, reduces, cracking,decrease itch and risk of infective breakdown

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	Criado por Elizabeth Then mais de 6 anos atrás