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classification of burns:
first degree (superficial)
how far does it go?
what are the causes?
EPIDURAL layer
sunburn, UV light, minor flash injuries, mild radiation burns
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classification of burns:
superficial
what might the skin look like?
- pink to bright red
- slight edema
- mild pain
- tx:
- mild analgesia
- water soluble lotion
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classification of burns:
second degree burn (partial thickness)
how deep does it go?
through layers of dermis
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classification of burns:
partial thickness two types?
- superficial partial-thickness
- deep partial-thickness
(type depends on depth of burn thru the layers of the dermis)
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classification of burns:
what can cause a superficial partial thickness burn?
- flash flame
- dilute chemical agent
- hot surface
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classification of burns:
what can cause deep partial-thickness burn?
- hot liquids, solids
- flash or direct flame
- radiant energy
- chemical agents
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classification of burns:
what might superficla partial thickness burns look like?
- bright red
- moist glistening appearance BLISTER
- PAIN in response to air or heat
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classification of burns:
what might a deep partial thickness burn look like?
- pale and waxy
- moise or dry BLISTER
- PAIN in response to air or heat
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classification of burns:
treatment for partial thickness burns?
- analgesia
- skin substitutes
- grafting may be necessary
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classification of burns:
third degree burn aka?
full thickness burns
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classification of burns:
third degree burns go how deep?
- all layers of skin
- may extend to subq fat, connective tissue, muscle, bone
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classification of burns:
what can cause third degree burns?
- prolonged contact with:
- flames
- steam
- chemicals
- high-voltage electrical current
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classification of burns:
what do 3rd degree burns look like?
- pale
- waxy
- yellow
- brown
- mottled
- charred
- nonblanching skin
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classification of burns:
3rd degree burns. do they still have sensation?
- NO NO NO
- since receptors were destroyed
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classification of burns:
how to treat 3rd degree burns?
usual tx is skin grafting
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what is parkland formula?
TBXA (%) x Wt (kg) x 4mL
- give 1/2 total requirements in 1st 8 hrs
- then give 2nd half over the next 16 hrs
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hypovolemic shock aka?
burn shock
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how does hypovolemic shock manifest itself in the CARDIOVASCULAR system?
arrhythmias
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what happens immediately after injury(burn) to 24 hrs after?
fluid shift (3rd spacing)
*we'll see weight gain; edema
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where does the fluid shift during 3rd spacing (burns)?
intracellular > intravascular >interstitial
*^ permeability -> ^ intracellular edema -> ^ osmosis
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when does FLUID REMOBILIZATION happen (burn shock)?
48-72 hrs after injury
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what happens during FLUID REMOBILIZATION?
diuresis
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what's the normal urine loss?
30-50 ml/hr
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when a severely burned pt is in the diuretic phase, how much urine do they lose?
200-400ml/hr
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what can cause arrhythmias?
- >40% tbsa (total body surface area) loss
- electrolyte shifts and cellular damage
- peripheral vascular alteration -> compartment syndrome
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in a burn patient, what might wheezing indicate
partial obstruction
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burns to the airway?
(can happen thru direct inhalation)
- inflammation
- interstitial pulm edema
- hoarseness
- raspy cough
- drooling
- black mouth
- (resp manifestations can also be a systemic response)
- inflammation
- intersitial pulm edema
- upper airway
- smoke poisoning
- CO poisoning
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Gi manifestations of burn?
- paralytic ileus
- stress (curling's) ulcer
- ischemic bowel > bacterial dislocation > sepsis > multiple organ dysfunction (MOD)
- *dysfunction r/t SIZE of BURN WOUND
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what can cause paralytic ileus in burns?
- decrease blood flow
- decreased sympathetic tone
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what can cause stress (curling's) ulcers in burns?
- increased stress
- decreased blood flow
tx: h2 antagonist
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(burns) urinary system manifestations?
- early stages:
- decrease renal blood flow = decrease GFR
- myoglobinuria (from muscle breakdown) - dark concentrated urine
- progresses to renal failure
- NI:
- uo and color
- I & Os
- BUn
- creatinine
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immune system manifestations for burns?
- compromised system d/t stress response
- open wounds and decrease immune function
*infection and sepsis is the leading cause of death in acute phase
- s/s of infection:
- ^wbc
- purulence
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in a burn pt, how much can the RESTING metabolic rate increase by?
50-100%
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what can cause increased metabolic and catabolic rates in burn patients?
heat and water loss
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what happens to a burn pts metabolism?
loss of h2o and heat ->^ metabolic & catabolic rates -> increase caloric needs -> resting metabolic rates ^50-100%
- increased secretion
- activated stress response
- extent of injury dictates caloric needs
- increase in core body temp
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what are the 3 stages of treatment for the burn patient?
- 1. emergent (rescusitative stage)
- 2. acute phase
- 3. rehabiliation stage
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this stage's onset in 24-48 hrs.
urine is heavily concentrated.
decreased CO. increased HR.
emergent-resuscitative stage
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what is the priority for the first stage of treatment (burns)
- airway management (intubation)
- fluid resuscitation - crystalloids
- IV - 2x large bored
- pain meds - morphine IV
- abx
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what is the most common cause of death in the emergent-resuscitative stage?
- burn shock
- *restore circulation volume to decrase risk
- *replace elctrolytes
- *maintain adequate urine output
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(burns) when does the acute phase happen?
- 36-48 hrs til wks, months, years
- begins w/ diuresis (fluid shift)
- ends with would closure - wounds are healed
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(burns) what is the patient at risk for in the acute stage?
- fluid depletion
- hypokalemia
- hyponatremia
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why is burn patient at risk for fluid depletion in the acute stage?
massive UO (diureses)
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what is the priority in the acute phase (burns)?
- monitor electrolytes
- meet patients increased caloric needs (TPN)
- wound management
- monitor for s/s of infection
- prevent sepsis
- pain management
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this stage begins with wound closure. (burns)
rehabilitative stage
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what are the priorities in the rehabilitative stage? (burns)
- prevent contractures and scars
- pt returns to work, fam, & social roles
- vocation, occupation, physical, psychosocial rehab
- *restore optimal health status and FUNCTION
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NO DIURETICS in the stage. think EDEMA! (burns)
emergent - resuscitative stage
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when pt reaches the ER, what does hx the does staff obtain pertaining to the burn injury?
- 1. time of injury
- 2. causative agent
- 3. early tx of burn
- 4. client's past med hx
- 5. clients age and body wt
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