After a burn, what happens to capillary permeability?
- It increases!
- Vessels are damaged from the burn and begin leaking
Can lead to fluid volume deficit!!
Why does the body secrete epi?
*Initially, heat from the burn makes you vasodilate.
Body releases epi to make you vasoconstrict to shunt blood to vital organs.
Speaking of vasoconstriction, at what point in systolic BP do we worry?
Anytime the systolic drops below 90, the pt is not getting adequate organ perfusion.
Why are aldosterone and ADH secreted after a burn?
- Aldosterone will make you retain sodium and water
- ADH will make you retain water
- Therefore, blood volume will go up
Even if the pulse ox reads at a normal level after a burn, why should we not trust it?
- Just because it's normal doesn't mean their not hypoxic.
- Pulse ox cant differentiate between carbon monoxide-bound hemoglobin or oxygen
- bound hemoglobin.
- It only detects that the hemoglobin is bound to something
How can carbon monoxide cause hypoxia
- It's a speedy little shit
- Travels much faster then oxygen, therefore it can bind to hemoglobin first.
If the client becomes restless, what 3 possible problems? Which is a priority?
- Inadequate fluid replacement
Hypoxia is the priority!!
Why is ice not a good thing to put on burns
- Causes tissues to vasoconstrict.
- Don't want to cut off circulation to the burn wound.
What medication might you give to burn pt?
- Albumin = hypertonic solution.
- it will hold onto fluid in the vascular space
- Vascular volume will go up
- Kidney perfusion will go up
- BP will go up
- Cardiac output will go up
What do you need to do if a pt is receiving fluids rapidly?
Take hourly CVP measurements (central venous pressure) to ensure your not overloading the pt with fluids
Why not give IM injection to burn pt
You need to have adequate blood flow to muscle for IM to work
Since burns are considered a contaminated wound, what might you need to give pt to prevent infection
- *Tetanus, which is an active immunity. takes 2-4 wks to develop own immunity
- *Immune globin: is immediate, Passive immunity. body doesn't have to work for it.
What type of immunity is IGg
- It's immune globin
What will you look at during circulation check?
- Cap refill
- skin color
- skin temp
- May be done if pt's vascular check on extremity is bad.
- Procedure relieves pressure and restores circulation.
- Cuts through eschar
- May be done if vascular check on extremity is bad
- Relieves pressure and restores circulation
- Cut is MUCH DEEPER into tissue, cuts through the fascia of muscle
What will you do for renal system
What would you do if urine was brown or red?
- Call the doc
- Red or brown urine after a burn is normal, but there is a risk of plugging up the kidney and causing renal death.
- With a burn that causes muscle damage, myoglobin is released and causes the discoloration.
What drug might be given to flush kidneys out.
- Mannitol *Diuretics usually not given to burn pts, but don't want to have decreased kidney output.
- Mannitol is exception to the rule
How long after burn should pt start to diurese and why?
- After 48 hours
- the fluid is going back into the vascular space
- Now we have to worry about fluid volume excess
what electrolyte imbalance will you be concerned about?
- Serum Potassium!
- Potassium is INSIDE the cell.
- With a burn, cells will lyse or rupture
- Therefore, the serum potassium levels increase!!
What might we give for the GI system?
- Magnesium Carbonate
- Pantoprazole (Protonix)
- Famotidine (Pepcid)
This will prevent a stress ulcer.
What type of stress ulcer can develop in burn patients?
- Curlsing ulcer
- Results from reduced plasma volumes leading to gastric tissue necrosis
What is magnesium hydroxide
- Milk of Magnesia
- An antiacid
Why might the doc want the burn pt NPO and have NG tube with suction?
Could develop paralytic ilius. If they have it, gastric secretions will continue to build up in stomach and pt could aspirate
Why would paralytic ileus develop?
- Vital organs are perfused first! GI is not considered a vital organ. Recall fight or flight. GI system shuts down:
- Decreased vascular volume to GI tract = decreased GI motility
- Hyperkalemia could also develop which means muscle weakness. GI is a smooth muscle.
What should be added to the pt diet?
- More calories to heal!
- Especially Protein and Vit C
With GI feedings, what should be done prior to every feeding?
- check gastric residual.
- Want to make sure previous feeding is being digested
- Peristalsis could be really slow or not at all.
What lab value might you check to ensure the pt is getting proper nutrition?
- Pre albumin = most sensitive since it has the shortest half life and will change first.
- Total protein
What is superficial burn
- formerly first degree burn
- Damage only to epidermis
What is partial thickness burn
- formerly 2nd degree burn
- damage to entire dermis and varying depths of the dermis
Full thickness burns
- formerly called third degree
- damage to entire dermis and sometimes fat
If hands are burned, what are some specific measures that should be taken?
- Wrap each finger separately
- Prevent contractures by using splints
How will we want to position the clients head
- Hyperextend the neck, so head is back
- No pillows which will promote chin-to-chest contracture
what is eschar
Should eschar be removed?
- if not, new tissue cant regenerate.
- Bacteria also likes to grow in eschar
What type of isolation should the burn pt have?
protective isolation = we need to protect them from us!!
What medication might be given to remove necrotic, dead tissue?
- Sutilains or Collagenase
- It's a enzymatic drug which eats dead tissue
- *Don't use on face as it could cause scarring.
- Don't use if prego
- Don't use over large nerves
- Don't use if area is opened to a body cavity... could cause significant damage to inner organs
- Whirlpool - another method to debride
- Give pain meds first
- Worry about cross contamination
Why are broad spectrum antibiotics avoided?
To prevent super infection or secondary infection
Exception: Broad spectrum may be used until wound cultures have returned
What do we worry about when giving mycin drugs?
- If the pt's BUN or creatinine increases or pt complains of hearing loss
- Mycin drugs can lead to ototoxicity or nephrotoxicity
- Therefore, monitor both labs
For skin grafts, how often can grafts be harvested from same donor site?
12 - 14 days
With electrical burn, what heart issue are we worried about?
pt is at high risk for V fib
How can kidney damage result from electrical burn?
- If there is muscle damage from burn, myoglobin and hemoglobin are released into the blood.
- This can clog up the kidney and cause damage or renal failure
What is Pantoprazole
What is famotidine
What is magnesium carbonate
type of anti-ulcer med for stomach