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  1. Kids with burns....
    always a reportable injury
  2. Chemical burns are caused by....
    • necrotizing substances
    • acids/alkalis

    cause tissue destruction
  3. 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
  4. How do you treat a person with smoke inhalation injury
    high flow O2
  5. When to suspect inhalation injury
    • facial injury
    • singed nasal hair
    • .....sputum
    • wheezing
    • pharyngeal edema
    • hoarseness
  6. 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
  7. What am I looking at at site of exit for an electrical injury?
    what's the tissue like at the exit site?
  8. 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
  9. How do you calculate the TBSA?
    Total body surface area of injury....

    guestimation....1% for persons own palm of their hand
  10. Superficial burn
    1st degree and will show as red area
  11. Partial thickness burn
    • 2nd degree
    • will show as redness with blisters and open skin
  12. Full thickness
    3rd degree

    deep wound without pain
  13. Rule of 9's
    To calculate TBSA

    • Head and neck 9%
    • Arms 9%
    • Anterior trunk, posterior trunk, legs are 18% each
    • Perineum 1%
  14. 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)
  15. Where is an area that you see compartment syndrome a lot?
    circumferential chest
  16. What makes it harder for a person to heal from a burn?
    • elderly heal slower
    • cardiac disease
    • respiratory disease
    • renal disease
    • DM
    • alcoholism/drug abuse
    • concurrent trauma
  17. Interventions for a person with a facial burn
    • HOB elevated
    • shave hair to reduce infection
    • don't use pillows
  18. 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
  19. Who requires fluid resuscitation?
    anyone with burns >15%....even if have co morbidities still give them fluids!!
  20. 24 hours after a burn....
    you will see fluid shifts and electrolyte imbalances
  21. 4 Stages of burn care
    • Prehospital care
    • Emergent phase
    • Acute phase
    • Rehabilitation phase
  22. Prehospital care....
    stop the burning....and ABC's
  23. Emergent phase
    begins at the time of injury for 48 hrs and lasts until massive fluid and protein shift has stabilized
  24. Acute phase
    begins 48-72 hours after injury and continues until the wound closes
  25. Rehabilitation phase
    goal is to restore the patients ability to fxn in society and with their family/role
  26. All burn victims need....
    a tetanus shot if they haven't had one in last 10yrs
  27. Airway management
    • nasotracheal/endotracheal intubation
    • extubate after 3-6 days
    • High fowlers with 100% O2
    • Bronchodilators
  28. Fluids used in resuscitation
    • LR
    • NS
    • D5NS
    • Albumin
  29. 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
  30. Example of Parkland fluid resuscitation
    50% TBSA
    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
  31. How do you know if a person is being successfully resuscitated with fluids?
    • UO
    •  adult will be 30-50cc/hr
    • children 1cc/kg/hr

    • appropriate sensorium
    • appropriate BP and pulse
    • relief of nausea/ileus within 24 hours
  32. Wound care
    not addressed till ABC's and fluid replacement are established

    • debridement-removal of necrotic skin
    • Tub-<20-30 min
    • Shower-T<104

    **give morphine and verced and warm the room
Card Set
Test 5....N176
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