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Kids with burns....
always a reportable injury
Chemical burns are caused by....
- necrotizing substances
cause tissue destruction
How long does tissue destruction last when you have a chemical burn? What do I do?
up to 72 hours
remove agent by flushing copiously with water
How do you treat a person with smoke inhalation injury
high flow O2
When to suspect inhalation injury
- facial injury
- singed nasal hair
- pharyngeal edema
Electrical injury is from....what do I need to assess?
lightning or live wire
check for site of entry and exit for both....and watch EKG for abnormalities and s/s of rhabdomylisis
What am I looking at at site of exit for an electrical injury?
what's the tissue like at the exit site?
4 things to do for a person with an electrical injury
- Lg bore IV 16-18 gauge
- IV fluids of LR to maintain UO of 75-100mL/hr
- Sodium bicarb IV alkalinize the urine
- Monitor peripheral circulation closely
How do you calculate the TBSA?
Total body surface area of injury....
guestimation....1% for persons own palm of their hand
1st degree and will show as red area
Partial thickness burn
- 2nd degree
- will show as redness with blisters and open skin
deep wound without pain
Rule of 9's
To calculate TBSA
- Head and neck 9%
- Arms 9%
- Anterior trunk, posterior trunk, legs are 18% each
- Perineum 1%
How does location of burn affect things?
- Face-airway/self image
- Circumferential chest-effects respiratory fxn
- Hands, feet, eyes, joints-difficulty w/self care and future fxn
- Ears, nose, perineum-infection (cartilage=no blood)
Where is an area that you see compartment syndrome a lot?
What makes it harder for a person to heal from a burn?
- elderly heal slower
- cardiac disease
- respiratory disease
- renal disease
- alcoholism/drug abuse
- concurrent trauma
Interventions for a person with a facial burn
- HOB elevated
- shave hair to reduce infection
- don't use pillows
Referral criteria for transfer to a burn center
- Partial thickness burn >10%
- Any full thickness burn
- Burns involving face, hands, feet, genitalia, perineum or major joints
- Chemical/Electrical burns
- Pre ex med cond. that can affect recovery
- Associated trauma
- Unqualified hospital
Who requires fluid resuscitation?
anyone with burns >15%....even if have co morbidities still give them fluids!!
24 hours after a burn....
you will see fluid shifts and electrolyte imbalances
4 Stages of burn care
- Prehospital care
- Emergent phase
- Acute phase
- Rehabilitation phase
stop the burning....and ABC's
begins at the time of injury for 48 hrs and lasts until massive fluid and protein shift has stabilized
begins 48-72 hours after injury and continues until the wound closes
goal is to restore the patients ability to fxn in society and with their family/role
All burn victims need....
a tetanus shot if they haven't had one in last 10yrs
- nasotracheal/endotracheal intubation
- extubate after 3-6 days
- High fowlers with 100% O2
Fluids used in resuscitation
How do you use parkland to calculate fluid volume? How is it given?
4cc's/per % of TBSA/per kg of body weight
- 1/2 given in first 8 hours
- 1/4 second 8 hrs
- 1/4 third 8 hrs
Example of Parkland fluid resuscitation
4 cc x 50= 200 x 70kg=14,000 cc fluid total
- 7,000 in first 8 hrs
- 3,000 in 2nd/3rd 8 hours
How do you know if a person is being successfully resuscitated with fluids?
- adult will be 30-50cc/hr
- children 1cc/kg/hr
- appropriate sensorium
- appropriate BP and pulse
- relief of nausea/ileus within 24 hours
not addressed till ABC's and fluid replacement are established
- debridement-removal of necrotic skin
- Tub-<20-30 min
**give morphine and verced and warm the room