Types of burns
-flush with copious water
-remove contaminated clothing
-brush off dry chemicals first
-identify chemical agent
Describe a superficial partial thickness (second degree).
(appearance, pain, healing, scarring)
Appearance: thin walled, fluid filled blisters develop within minutes
Pain: severe, nerve endings exposed when blisters break
Healing: 3-4 weeks with adequate nutrition
Scarring: unusual unless healing takes longer than expected
What are some signs and symptoms of burn shock?
-third spacing (edema)
-decreased cardiac output
-hypotension
-tachycardia
-decreased urine output
Emergency: Illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm
Disaster: A mass casualty incident in which the number of casualties exceeds the resource capabilities of a particular community or hospital facility
What do the colors mean in a disaster triage?
What does each mean?
-"Doing the greatest good for the greatest number of people"
-Black: death is expected
-Red: immediate help and intervention (compromised airway, breathing and circulation)
-Yellow: care may be delayed, stable enough to wait up to several hours
-Green: minor injuries "walking wounded"
-continuous cardiac monitoring
-monitor urine output
-assess for compartment syndrome
-fluid resuscitation
Describe a deep partial thickness (second degree) burn.
(appearance, depth, distinguishing feature, healing, scarring)
Appearance: waxy white, surrounded by superficial injury margins
Depth: entire dermis involved, spares hair follicles and sweat glands
Distinguishing feature: hair follicles/skin buds appear by 7-10 days
Healing: weeks, often requires surgical excision and skin grafting
Scarring: hypertrophic scarring common with poor cosmetic results
What is the formula used when administering Lactated Ringers for fluid resuscitation in burn victims?
4mL x weight in kg x %TBSA
Emergency triage sorting is that of 5 levels...what are they?
Level 1: immediate life saving intervention is required
Level 2: high risk situation, disorientation, severe pain, and/or VS in danger zone
Level 3: VS are not in danger zone, but two or more resources are required
Level 4: One resource will be required
Level 5: no resources will be required
(resources consist of labs, imaging, IV fluids, medications, consultation, sutures or sedation)
How do fat embolisms form?
What are some signs and symptoms of fat embolisms?
What are the nursing interventions?
-long bone fractures
Signs and symptoms:
-neurologic changes- restlessness, confusion, decreased LOC
-respiratory changes- dyspnea, tachypnea, hypoxia, pulmonary edema, ARDS
-petechia- to conjunctiva, chest, upper torso and arms
Nursing interventions:
-elevate HOB and bedrest
-give oxygen
-immobilize/stabilize the fractured extremity
-IV fluids
-possible administration of steroids
What is the care for patients with radiation burns?
-cool compresses
-avoid further exposure
-gentle skin care
-pain management
-monitor for infection
Describe a full thickness (third degree) burn.
-extends through entire dermis
-requires skin grafting
-diagnostic tool- laser doppler imaging- non invasive method to assess burn depth and guide surgical decisions
What electrolyte will be off from fluid shifting?
Why is hypernatremia present?
-Potassium (hyperkalemia)
-dehydration
What is the primary assessment for traumas?
A- airway/cervical spine
B- breathing
C- circulation
D- disability
E- exposure
F- full set of VS and facilitate family presence
G- get adjuncts (labs, monitor, naso/orogastric tube, oxygenation, pain)
What are the signs and symptoms of Anthrax?
What are the nursing interventions?
Signs and symptoms:
-blister/sores
-fever/chills
-cough
-headache
-fatigue
Nursing interventions:
-antibiotics (ciprofloxacin, doxycycline)
-death could occur without antibiotics
-spread through animal products
-high flow oxygen
-elevate HOB
-prepare for intubation
-monitor ABG's, carboxyhemoglobin
(skin layer lost, appearance, pain, skin function, treatment, expected outcome)
Skin layer lost: epidermis
Appearance: pink, red, dry, no edema, no blistering
Pain: yes
Skin function: yes
Treatment: clean soap and water, pat dry, apply topical ointments (silvadean, aquafor)
Expected outcome: heal in 3-6 days
What are some signs and symptoms of Small Pox?
What are the nursing interventions?
Signs and symptoms:
-fever
-body aches
-fluid filled skin sores
Nursing interventions:
-isolation would be essential
-an agent of research
-a single case today would be a health emergency
What is the secondary assessment for traumas?
H- history/head to toe assessment
I- inspect posterior surfaces
What are signs and symptoms of Botulism?
What are the nursing interventions?
Signs and symptoms:
-nerve dysfunction leading to progressive paralysis and eventually death
Nursing interventions:
-antitoxin and supportive care
-most commonly spread through foods such as honey, improperly canned fruits/vegetables or preservatives
What is the ED nurses responsibilty when assessing thermal burns?
What are some interventions for fire burns?
If the burn was intentional or unintentional.
-remove clothing
-cool patient
-rinse with water (not cold)
-do not want patient to shiver
-protective sheet
What is it called when they assess the damage on a patients body?
"The rules of 9"
In circumferential burns (chest or extremities) may cause damage to blood vessels, what is the surgical intervention and possible complication of this?
Intervention: escharotomy
Complication: compartment syndrome
What are the 5 phases of disaster management?
-preparedness (disaster plan in place)
-mitigation (knowledge of disaster, reduce poor effects)
-response (quick reply)
-recovery (phase of rebuilding)
-evaluation (analyzing what worked and what did not)
What are the signs and symptoms of Ebola?
What are the nursing interventions?
Signs and symptoms:
-fever, fatigue
-severe GI symptoms
-bleeding
-multisystem organ failure/shock (late)Nursing interventions:
-isolation precautions and proper use of PPE is essential
-transmitted via infected animals or sick/dead infected humans