suspect if wheezing, labored breathing, rales, cough
1. How can electrical burns cause damage to tissues?
2. Vfib or asystole most common?
3. What is Myoglobinuria? What is its clinical manifestation?
4. How much urine output do you want to have with this type of burn?
1. Direct damage to nerves and vessels, and organs causing tissues necrosis
2. Vfib most common
3. Myoglobinuria: tubular necrosis from electrical burn that leads to kidney failure
Match depth of burn:
- Blisters
- Severe pain, edema
- Involves Epidermis and dermis
- Skin red, pink, wet, shiny seeping
B.
Match depth of burn:
- Dry, waxy-white, or hard skin
- No pain
A.
1. When assessing TBSA, which one is the most accurate?
2. Which one is used frequently for initial assessment?
1. Lund browder
2. Rule of 9
Location of burn: how will each location of burn affect the patient
1. Burn to face, neck, or torso
2. Extremities
3. Perineum, nose, and ears
1. respiratory problems
2. circulation hindered at hands and feet d/t swelling
3. Prone to infection
Prehospital care phase, first thing you do?
Difference between a small and large thermal interventions?
Other interventions?
First thing: Remove from burn source
Small (<10%): clean, cool tap water
Large: ABCs, don't use water, cover with dry sheet or blanket
Others: fluids and pain management
1. Describe the fluid emergent phase (Hypovolemic shock and edema formation)
2. Reason for for hypovolemia and edema?
3. What will Na and K look like?
Lasts 48-72 hours; 200-400ml/hr of water insensible loss
Reason for shift: Massive fluid shifts out of blood vessels d/t increased capillary permeability
Decreased serum Na, and increased K
What will happen to each with increased permeability in a burn victim?
1. Fluid shift: in or out of vessels
2. Blood volume
3. HcT (higher or lower)
4. Viscocity
1. Fluid shifts out of vessels (edema)
2. Hypovolemia
3. Higher HcT
4. Higher blood viscosity
How do you severe edema in a burn patient? (compromised blood flow causing edema)
Escharotomy
How can kidneys be damaged during emergent phase of burn?
2 ways
Hypovolemic shock can lead to kidney ischemia (ATN)
Myoglobin breakdown obstructs tubules
List collaborative management in emergent phase
Airway
Fluids
Wound care
pain/anxiety
early and aggressive nutritional support
DVT prophyalxis
Why are DVTs higher risk in burn patients?
Blood becomes thicker (higher HcT and blood viscosity)
List fluid therapy in emergent phase
What does the HR need to stay above?
What is the Parkland formula?
2 Large bore IV
Give fluids if TBSA >15% (>10% in kids)
HR: 120
Parkland: 4ml x %TBSA x weight (kg)
T or F: wound care in burn victims will be a sterile procedure
What are other considerations?
True
Other: put on gown and mask
- keep room warm
- admin tetanus shot
Nutrition: how many kcal/day will a patient need?
How much will their metabolism increase by?
5kcal/day
50-100% increase
Which pain med will you administer for wound care?
C.
What is look out for when giving Toradol?
Cr and BUN
What will you use instead of a systemic abx to treat infection?
Silver sulfadiazine
Describe the acute phase
How many hours does it start at?
How will fluid shift?
Amount of time to heal?
Starts after 72 hours
Fluid shifts back into vascular system
- Diuresis
Takes weeks to months to heal
List tx for partial and full thickness wounds in acute phase
Partial: Eschar removed
- Epithelial buds (eventually close wound)
Full:
- require surgical debridement
- skin grafting
- pt. education
- psychosocial support
During acute phase, how will sodium and potassium levels be affected?
Sodium: can be both high or low
- hydrotherapy pulls Na from open wounds
K:
- Can be high if deep muscle injury
- can be low if GI suction, vomiting, or diarrhea
Which one of these will be the biggest concern in acute phase?
A.
How do you prevent contractures in acute phase?
ROM, splints, stretch exercises
How will BG be affected during acute phase?
Can be high, due to increased cortisol levels.
- Give insulin instead of cutting down calories
What are some GI issues that can occur while treating the acute phase?
What is the first sign of a GI bleed?
Sepsis from ileus -> NG tube
Diarrhea from supplemental feedings
Constipation from decreased mobiility and narcotics
GI ulcers
- First sign in GI bleed is vomiting blood
What is autograft?
Growing of patient's own skin from biopsy
Takes 18-25 days, expanding up to 10,000x
What will rehab phase look like in burns?
How long can it take?
What will you do for patient?
What will you tell patient to avoid?
Pt's wounds are healing
Collagen fibers present in scar tissue
Tissues become raised and hyperemic
Nursing:
- ROM, splints, massages, and education
- Education: stay out of sun, smoking cessation
This type of garment will minimize hypertrophic burn scarring during rehabilitation phase
