Feeling Better
Phases of Burn Management
In the emergent (resuscitative) phase, the primary goals of wound care are ??
1. Coverage
2. Prevention of infection
Phases of Burn Management
This phase is the period of time required to resolve immediate life-threatening problems. This phase lasts 48 to 72 hours from the time of the burn.
Emergent (resuscitative) phase
Phases of Burn Management
With full-thickness and electrical burns, ___ and ___ are released into the bloodstream and can occlude the renal tubules
1. Myoglobin
2. Hemoglobin
Phases of Burn Management
In the emergent (resuscitative) phase, what kind of prophylaxis should be instituted (if not contraindicated)
Thromboembolism prophylaxis
Phases of Burn Management
In the acute (wound-healing) phase, the first-line of treatment for pain is drugs. For treatment-induced pain, premedicate patient with ___ and ___ via the IV or oral route
An analgesic; an anxiolytic
Phases of Burn Management
In the rehabilitative (restorative) phase, management of the patient's injuries includes
1. Positioning
2. Splinting
3. Exercise to minimize skin and joint contractures
These are the 3 phases of burn management
1. Emergent (resuscitative)
2. Acute (wound healing)
3. Rehabilitative (restorative)
Phases of Burn Management
If an inhalation injury has occurred, the upper airway is vulnerable to ___ and ___
1. Edema formation
2. Airway obstruction
Phases of Burn Management
In the emergent (resuscitative) phase, the greatest threats to the victim are ___ and ___
1. Hypovolemic shock
2. Edema formation
Phases of Burn Management
In the emergent (resuscitative) phase, if the patient is hypovolemic, what could happen to the kidneys?
Kidney blood flow may decrease, causing renal ischemia; if it continues, acute kidney injury (AKI) could develop
Phases of Burn Management
What are the goals of wound care in the acute (wound healing) phase
1. To prevent infection
2. To promote reepithelialization and/or successful skin grafting
Phases of Burn Management
In the rehabilitative (restorative) phase, burned arms may be wrapped in ___ and burned legs may be wrapped with ___
Tubular elastic gauze; elastic (e.g. tensor/Ace)
Phases of Burn Management
In the emergent (resuscitative phase), interventions would include
1. Airway management
2. Fluid therapy
3. Wound care
4. Analgesics for pain
Phases of Burn Management
This phase begins with the mobilization of extracellular fluid and subsequent diuresis and concludes when the burned area is completely covered by skin grafts or when wounds are healed. This may take weeks or many months.
Acute (wound healing) phase
Phases of Burn Management
In the acute (wound healing) phase, PARTIAL-thickness wounds form ___, which begins separating fairly soon after the injury
Eschar
Phases of Burn Management
In the acute (wound healing) phase, margins of full-thickness eschar take longer to separate and, as a result, may require ___ and___ for healing
1. Surgical debridement
2. Skin grafting
Phases of Burn Management
In the acute (wound healing) phase, wound care consists of
1. Observation
2. Assessment
3. Cleansing
4. Debridement
5. Dressing reapplication (as appropriate)
Phases of Burn Management
In burn care, the typical topical item used for treatment is
Silvadene - antibiotic ointment
Phases of Burn Management
In the acute (wound healing) phase, nutritional therapy is very important. The patient should be provided adequate ___ and ___ to promote healing
Calories; protein
Phases of Burn Management
In the acute (wound healing) phase, the predominant therapeutic interventions are
1. Wound care
2. Excision and grafting
3. Pain management
4. PT/OT
5. Nutritional therapy
6. Psychosocial care
Phases of Burn Management
In the acute (wound healing) phase, intervention AFTER wound care is aimed at
1. Promoting rapid, moist wound healing
2. Decreasing pain at the site
3. Preventing infection
Phases of Burn Management
Some complications that may develop during the acute (wound healing) phase could include
1. Cardiovascular and respiratory complications seen in the emergent phase may continue
2. Paralytic ileus (if patient becomes septic)
3. Patients can become extremely agitated, withdrawn or combative
4. As scar tissue forms, patient may develop limited range of motion with contractures
Phases of Burn Management
These are the 2 kinds of pain in the acute (wound healing) phase
1. Continuous background pain existing throughout the day and night
2. Treatment pain associated with dressing changes, ambulation and rehab activities
This is the Parkland formula for calculating fluid resuscitation for burn patients
Weight in kg x 4 x % of burn = fluid resuscitation required in the first 24 hours
Anterior:
1. Face = 4-1/2%
2. Chest = 9%
3. Abdomen = 9%
4. Right arm = 4-1/2%
5. Left arm = 4-1/2%
6. Groin = 1%
7. Right leg = 9%
8. Left leg = 9%
This is the breakdown of the body in calculating the BSA (body surface area) posteriorly
1. Head = 4-1/2%
2. Upper back = 9%
3. Lower back (flank) = 9%
4. Right arm = 4-1/2%
5. Left arm = 4-1/2%
6. Right leg = 9%
7. Left leg = 9%
Phases of Burn Management
At the scene of the injury, priority is initially given to doing what for the victim?
1. Removing the person from the source of the burn
2. Stopping the burning process
3. Assess and monitor ABCs
4. Provide initial wound care (remove burned clothing, cover thermal burns with clean cool tap water-dampened towel)
5. Remove any chemical particles from the skin and flush with copious amounts of water
Phases of Burn Management
This phase begins when wounds have healed and the patient is able to participate in self-care activity. This may occur as early as 2 weeks or as long as 7-8 months after a major burn
Phases of Burn Management
What are the main goals in the rehabilitative (restorative) phase
1. To assist the patient in resuming a functional role in society
2. To accomplish functional and cosmetic reconstructive surgery
Phases of Burn Management
What technique is used when caring for patients with burns and why?
Sterile technique (cap, gown, mask and gloves) to prevent cross contamination