Degree of Burns
pale, mottled, red/white, moist or dry, typically less painful, blanching decreased and prolonged
Deep partial thickness (2nd Degree)
The skin layers and what they hold
The epidermis- superficial
Dermis- thicker layer, made of collagen, connective tissue, blood vessels, nerve endings, and sweat glands.
Hypodermis- deeper SQ tissue- bone, tendon, muscle
What are the 5 functions of the skin that change with burns?
1. barrier from infection
2.fluid and electrolyte balance
3. sensation/ pain reception
4. Vitamin D absorption
5. Temperature control
Fluid and Electrolyte
what happens to Potassium? Sodium? blood? vascular system? edema?
Hyperkalemia-due to cell injury and cellular escaping
Hyponatremia- NA is retained due to endocrine stress release response
Hemoconcentration- Vascular dehydration, blood concentrated, decreased O2 to tissue
Hypokalemia- after 24-36hrs when it goes back into cell and is excreted through urine.
edema resolves 48-72HRS normally.
What are the priorities?
Secure airway!
support circulation
prevent infection
maintain body temp
provide emotional support
Albumin and high dose Vit C- within 12 hrs
black, charred, thick, leathery eschar, bone, tendon or muscle may be visible
Full Thickness (4th Degree)
What causes Radiation burns?
Exposure to large amounts of Radiation
ex: chemotherapy with radiation, industrial settings.
Classifications of Burns
"Can Every Great Person Buy Huge Eggs"
Color, Edema, Graft requirement, Pain, Blister, Healing time, Eschar.
Respiratory
Most injury caused by inhaled toxic fumes/ super hot steam/smoke
airway and respiratory issues cause death-common
Respiratory Assessment
what do you look for to indicate an airway issue?
How to you identify and treat CO poisoning?
if there is an airway problem what are some interventions?
-look for singed eyebrows/eyelashes, smoky smell to their breath (Carbonaceous breath), burns inside mouth
- Cherry red color all over face, check COHb levels- treat with high flow O2
-have intubation equipment close, Keep HOB 35 degrees
Pink, red, dry, painful
superficial (1st Degree)
What can cause Electrical burns?
what does an electrical burn look like with the entrance and exit wounds- what is this called?
currents of electricity
looks like an arch
called the iceberg effect
How do we prevent them from infection?
Neutropenic precautions
no raw foods, no flowers, restrict visitors, wash hands and change gloves between dressings changes, they have their own BP cuff, stethoscope, etc.
Cardiac Changes
HR increases- normal response
CO decreases because of fluid shift and hypovolemia
may last 18-36HRS
if electrical burn- dysrhythmias
Cardiovascular Assessment
what are we monitoring?
what is the common cause of death in the early phase?
cardiac rhythm (especially in electrical injuries)
weight (fluid overload)
vital signs (may need invasive lines because hard to get BP with extensive burns)
moist, pink or mottled red, very painful, blisters, blanches briskly
Superficial partial (2nd Degree)
What can cause a chemical burn
industrial cleaners like bleach
pool chemicals
fertilizer
can be ingested and inhaled as well
How to prevent contractures?
what do compression dressings do?
elevate with pillows and immobilize extremity
neutral positions
if burned on head/neck-roll towel to support neck, no pillows
keep midline
use compression dressings for 23hrs a day to help with scarring, edema, swelling.
Metabolic Changes
due due stress endocrine response
can have acid base problems
Kidney/ Urinary Assessment
what can happen?
what do we monitor?
what happens when muscles are damaged?
decreased Kidney flow, decreased perfusion leading to Oliguria
Monitor- BUN, creatinine, Urine output, urine color and concentration
-when muscle is damaged it releases myoglobulin that circulates to the kidney causing damage and they will have tea colored urine- Rhabdomyolysis.
Thick, leathery eschar, dry, white, cherry-red, brown/black, painless, no blanching
Full Thickness (3rd Degree)
Thermal
give examples of what can cause a Thermal burn
distinguish between moist/ dry heat
Contact burn example
-From heat and flames
-dry heat- from house fire, explosions like meth house
-moist heat- from hot liquids and steam
- contact- hot metals from irons, tar, grease (hot to touch)
DRUGS
LR- has electrolytes, good for adults and children
Silver Sulfadiazine- no thick Eschar, cell wall and membrane, sulfa allergy, SE: leukopenia
Mafenide acetate- thick Eschar, draw H2O out of tissue, painful for 15-60 min, sulfa allergy SE: metabolic acidosis
high dose opioids- IV/PCA, no IM
Gastrointestinal & Immunologic
What immunization might a pt get if they have burns?
CO decreases and only goes to vital organs so the bowl isn't getting adequate blood flow.
abdominal distention
rf/ infection!
inflammatory response activated when skin is affected.
Tetanus
Gastrointestinal Assessment
What can reduced blood flow and mucosal damage cause?
how do you treat this?
can they have things by mouth?
reduced GI motility
paralytic ileus
bleeding
Curling's ulcer- H2 blockers (zantac) & Mucoprotectants (sucralfate)
NPO until resuscitation phase is over with