BURN
Intervention
Intervention
EMERGENT STAGE
What is from onset of injury to completion of fluid resucitation.
-ABC’s
-stop burning process
-stabilize related injuries
-IV fluids: in the first 48 hrs fluids shift lead to hypo K+ & if untreated hypovolemic shock
-vitals: LOW BP, tachycardia, low urine ouput(olguria)
-pco2 increased due to resp. Injury
-ph decreased (metabolic acidosis)
-po2 decreased
-pain control
Adult
-entire head and neck 9%
-front of trunk: 18%
-back 18%
-arms 9% each
-perineum 1%
-legs 18% each
Partial thickness (superficial)
what is first to second degree: involves the epidermis and papillae of dermis; bright red to pink blanches to touch, serum-filled blisters, glistens, moist
-sensitive to air, temp, and touch; 7-10 days healing time
Flame
What is house fire is common cause
-usually associated with an inhalation injury. If burned on torso, neck, or head look for soot in mouth and assess ABC’s
Acute Stage
What is from the start of diuresis to near completion of wound closure
-clean, debride, dress
-prevent infection -skin grafting is needed
-maintain nutrition and fluid/electrolyte balance: enteral feedings via NG tube w/i 4-6 hrs of injury reduces mortality & infectious morbidity
-replace protein lost
-prevent ulcers (antacids) (h2 receptors antagonist)-prevent infection (antibiotics)
-pain management (opioid analgesic) IV
Child
Entire head and neck 18%
front of trunk 18%
back 18%
arms 9% each
perineum 1%
legs 13.5% each
Partial thickness (deep)
What is second degree: involves epidermis to 7/8 of dermi; blisters may be present, light red to white, soft and pliable, blanching present.
-pressure may be painful because of exposed nerve endings; 14-21 days healing time
-may need grafting to decreasing scarring
CONTACT
what is hot tar, hot metals, or hot grease can produce full thickness injury on contact
Rehabilitation Stage
What is from wound closure to return of optimal level of physical & psychosocial function(may never be 100% again)
-reconstructive surgery
-prevent contracture: physical therap may be ordered
-psychosocial care: PTSD, depressio, anxiety from burn event
-scarring or disfigurement may disturb patients self esteem, self-image and feelings of worth (psychological therapy)
Full thickness
What is third to fourth degree: epide, dermis, tissue, muscle, bone; snowy white, gray, or brown; texture is firm and leathery; inelastic
-no pain because nerve endings are destroyed; grafting necessary to complete healing
Scald
-more common in children younger than 5 and adults over age 65
-usually involves lower regions of the body
Skin Grafts
Split mesh graft placed in a Mesher which creates diamond shaped holes. It goes from 1/2 inch to 9x bigger than the original size.
-full pedicle flap: muscle, soft tissue, hands, feet, eyelids
-keep graft site immobilized
-graft “takes” or vascularization is complete in 3-5 days
-requires frequent circulatory checks, including assessment of color, warmth, sensation, pulses, and capillary refill
CHEMICAL
What is usually occurs in an industrial setting
-initiate immediate copious tepid water lavage for 20 minutes, along with simultaneous removal of contaminated clothing.
-cover patient with clean sheet and obtain a history of the burning agent
-identify the substance that caused the injury because the nature of the substance can contribute to the intensity of the burn and how initial care will be determined
Escharotomy
What is a linear excision through the Eschcar to the superficial fat that allows for expansion of the skin and return of blood flow or chest expansion.
-if there is an increase in pressure secondary to the burn, edema occurs
- the burn acts like a tourniquet impeding arterial and venous flow. Can cause diminished pulses in foot if leg is burned
-common sites: extremities, Trunk, and chest which cab cause respiratory insufficiency.
Radiation
What is can result in an industrial setting, result of treatment of A disease, or from UV light
-severity depends on the type of radiation, duration, depth of penetration, distance from source, and absorbed dose.
ELECTRICAL
What is one of the most serious types of injuries
-entry wounds are usually ischemic, charred, and depressed
-the exit wound may be explosive
-bones offer greatest resistance to the current, resulting in great damage