Burns
Name 3 Burn Center Referral Criteria
Partial-thickness burns equal to or greater than 10% of the total body surface area, Burns that involve the face, hands, feet, genitalia, perineum, or major joints, Full-thickness burns in any age group, Electrical injury, including lightening injury, Chemical injury, inhalation injury, burn injury in patients with preexisting medical conditions that may require complicated management, burned children (unqualified hospitals), burned injury in pts. who require special rehab
Destruction of the epidermis, dermis, and portions of sub q tissue, hair follicles, glands, and nerve endings are destroyed, leather like
Full Thickness
The trunk should be rewarmed last to avoid after drop.
False, rewarming the trunk first reduces the likelihood of after drop. Afterdrop is reduction in core temp due to shunting of cold blood from the periphery to their core. If the periphery is warmed too quickly, it can cause a bolus of cold hyperkalemic acidic blood to travel to the heart.
Coagulopathy, hypothermia, metabolic acidosis is describing what?
Triad of Death
hypothermia results in peripheral vasoconstriction, decrease in oxygenation, hypo perfusion, lactic acidosis and coagulopathy. Also results in myocardial performance.
"Low and Slow"
nerve endings are exposed, pink or red, blisters. What type of burn? Usually heals within 1-2 weeks with little to no scarring.
Superficial Partial Thickness
What type of graft?
cadaver skin is utilized for temporary coverage once eschar is removed to help protect the wound.
Allograft
Sun burn is what type of burn????
Radiation Burn due to UV radiation
Blisters are noted on superficial burns.
False. Think Sunburn!
do not apply ice, apply cool compress or water, no dressing, NSIADs, Tylenol, fluids, fragrance free lotions
100.4 F (38C) -104 F (40C)
Dizziness, Headache, n/v, hypotension
Heat Exhaustion
Fatigue, weakness, dizziness, headache, n/v, muscle cramps, tachycardia, tachypneic, hypotensive
Heat Stroke
> 104 (40C), red, dry skin, stopped sweating, confusion, delirium, seizures, coma, pulmonary edema, dysthymia, rhabdo
excessive agitation, hypersecreation, facial burns are indicative of what injury
Inhalation Injury
NAME THE A, B, C, D, E OF THE PRIMARY BURN ASSESSMENT
AIRWAY, BREATHING, CIRUCLATION, DISABILITY (NEURO ASSESMENT), EXPOSE AND EXAMINE, FLUID RESUSCIATAION
define compartment syndrome
fluid speeds from intravascular into interstitial and pressure within the tissues rises and confines swelling inside muscle compartments. Assess pulse, numbness and tingling, pain is disproportionate
A duoduodenal tube should be considered for a patient with superficial burns.
False. Duo tubes will supplement nutrition for patients with extensive/severe burns and prolonged hospitalization.
The Nurse should monitor for which clinical manifestation in a patient diagnosed with mild hypothermia? (Select All)
Ataxia? Shivering? Dysrhythmias? Oliguria? Hypogylcemia? What temp?
core temp
89.6F (32C)- 95F (32C-35C)
shivering, ataxia
Facial burns, Singed nasal hairs, soot in the sputum, and hoarseness are all clinical manifestations of?
Inhalation injury
The nurse recognized which etiology is consistent with a thermal burn?
A. Direct current
B. Scalding
c. Exposure to organic compounds
D. Ionizing radiation
B. Thermal burns can be a result of flash, scald, or contact with hot objects or flames.
Describe "After Drop"
Rewarming too rapidly can cause hyperkalemia (potassium shifts out of the cells) this is called after drop. There is precipitous reduction in core temp due to rapid shunting of cold blood from periphery to core. Leads to hypotension and dysrhythmias.
5ml/kg/hr is adequate urine output
False. 5ml/kg/hr can represent D.I. due to dysregulation of ADH (produced in hypothalamus, released by pituitary) give DDAVP or Vasopressin
Stridor, Hoarseness, rales, rhonchi can be indicative of what type of injury?
Inhalation injury resulting in: respiratory arrest, intubate patient.
When you drown, the sympathetic nervous system kicks in, resoling in what? (what vital signs?)
tachycardia and hypertension
Burn Shock occurs 30-60 min after injury
False, 24-48 hours after and like due to inadequate fluid resuscitation
Rule of Palm, Rule of 9's, Lund and Browder Classification
Rule of Palm: size of the patients hand accounts for 1% of TBSA
Rule of 9's: head, arm 9%, anterior 18%, posterior 18%, 1 leg 18%, palm 1%
Lund and Browder: most accurate method, chart that takes into account surface area related to age
utilize a pulse ox for O2 saturation in a patient with carbon monoxide poisoning
False. Pulse Ox is useless because the determination between o2 and Co molecules saturation the Hgb is not possible. Apply 100% O2 mask until carboxyhemoglobin levels are below 10%
Carboxyhemoglobin: a stable compound formed when carbon monoxide (CO) binds to hemoglobin in red blood cells, reducing the blood's ability to carry oxygen and causing CO poisoning
Patient presents with dermonecrosis following a brown recluse bite what does the nurse anticipate on in the treatment plan>
oral corticosteroids, dapsone (sulfone antibiotic used in both oral tablet and topical gel forms to treat a variety of conditions, including leprosy, dermatitis, and acne), colchicine (anti-gout), hyperbaric O2
What is most effective when given within 4-6 hours after envenomation. (snake bite)
Antivenin: patents need close monitoring, if they show hypersensitivity, stop infusion and give Eli IM, diphenhydramine, albuterol, and IV corticosteroids for anaphylaxis. Restart at a lower rate after treated, patient should be in ICU.