the basics
who is at risk for burns?
highest risk for death?
the very young and very old
elderly (>60), >40% TBSA burn, inhalation injury
THERMAL
2 TYPES- WHAT ARE THE TYPES? GIVE EXAMPLES
DRY- open flame, explosions
MOIST- liquid, steam
1ST DEGREE : Superficial Thickness
Damage only to?
Caused by exposure to ...?
What does it look like??
WHEN DOES IT HEAL?
damage only to EPIDERMIS
caused by exposure to high heat for short duration and low heat for long duration
PINK TO RED, NO EDEMA/PAIN, NO BLISTERS
Skin peels and heals in 1 week
Cardiovascular assessment
body thinks its in...?
occurs in 1st (?) and can continue to ?-? hours
hypovolemic shock
1st 12 hrs
can cont to 24-36 hrs
1st phase- emergent/resus
what 2 labs do we look at in first 24-48 hrs?
what can we give in first 24?
WHEN DO WE INTUBATE?
INCREASED H+H, HYPONATREMIA, HYPERNATREMIA
1st 24 albumin or synthetic plasma expanders
INTUBATE IF AIRWAY SWELLING IS SUSPECTED
#1 priority for burns
closure of wound and prevent infection
CONTACT
Direct contact w/...?
hot metal, tat, grease
2ND DEGREE: SUPERFICIAL AND EXPOSED/DEEP
Involves entire ..? and parts of ...?
Caused by?
SUPERFICIAL- what does it look like? when does it heal?
EXPOSED/DEEP- what does it look like? what might it need? when does it heal?
caused by scalding, flames, brief contact w hot objects
superficial - pink-red, moist w/ edema. heals in 2 weeks
exposed- red and moist, blanching and blistering, some pain, eschar soft and dry. MAY NEED GRAFT, heals 2-6 weeks
cardiovasc assessment
what will we see?
TACHY
ELECTROLYTE IMBALANCE
HYPOTENSION
FLUID OVERLOAD
HYPERKALEMIA
HYPONATREMIA
INCREASED H AND H
1ST PHASE CONTINUED
what med to prevent infection?
analgesics? what to monitor?
anesthetics?
tetanus
opioids- monitor for resp dep
ketamine
burns cause difficulty....?
which leads to an increase in (?) to maintain (?)
difficulty regulating body temp, inability to sweat, and changes in sensory function
increase in metabolism to maintain body heat
CHEMICAL
Exposure to what kind of agents?
Severity depends on?
Flush w...?
COVER BURNED AREAS W...?
exposure to cleaners, bleach, drain cleaner and agents in an industrial setting
severity depends on duration of contact, concentration of chemical, amount of tissue exposed, and chemicals action
flush with large amounts of water
cover burned areas with DRY STERILE DRESSING
3RD DEGREE- DESTROYED INTO ...?
what does it look like?
requires...?
how long to heal?
DESTROYED INTO FAT
any color, severe edema, no blistering/pain, eschar hard and inelastic
REQUIRES GRAFTING
weeks to months for healing
What do we do for a cardiovascular assessment? USING WHAT?
Monitor..?
WHAT MIGHT THEY NEED?
FLUID RESUS W 2 LARGE BORE IV
daily weights, urine output (0.5 ml/kg/hr), monitor for s/s of fluid overload
may need albumin and blood products
1ST PHASE THERMOREGULATION FOR DECREASED TEMP
NURSING CARE?
Low grade fever in first few hours can stay increased for how long?
WARM INSPIRED AIR
WARM ROOM AND BLANKETS
FLUID WARMER
KEEP WOUNDS COVERED AND WORK QUICK
increased for several weeks
orofacial burns cause ....?
burns can occur on inhalation
orofacial burns cause edema that impairs breathing
ELECTRICAL
what is the iceberg effect?
The electrical current penetrates skin and...?
What labs do we monitor?
Hook them up to (?) and watch for (?)
iceberg- surface injuries look small, internal injuries LARGE
penetrates skin, flows thru body and causes damage until it exits the body
MONITOR CARDIAC ENZYMES AND ABGS
Hook up to EKG watch for arrythmias
4TH DEGREE- MUSCLE AND BONE
what does it look like?
Graft does not...?
Healing?
Black, severe edema, no blistering and no pain, eschar present
GRAFT DOES NOT WORK
TAKES WEEKS TO MONTHS FOR HEALING OR NEVER!
RESPIRATORY ASSESSMENT
when do we suspect a respiratory burn? what will we see?
singed nasal hair/eyebrows
drooling
wheezing
edema of nasal septum
smokey breath
hoarseness
sooty septum
1ST PHASE
whats decreased?
whats increased?
myoglobin release=?
THESE PATIENTS NEED..?
decreased- sodium, albumin, wbc
increased - edema, K, and HCT
myoglobin release= aki and hypovolemic shock
THESE PTS NEED MASSIVE FLUID RESUS
LISTEN FOR....?
assess mouth nose and throat
listen for cough, sob, and hoarseness
RADIATION
caused by?
sunburns, cancer tx, working in nuclear industry
METABOLIC AND IMMUNOLOGIC
? occurs due to stress response
? cal/day .... DOUBLE TRIPLE ?-? days after burn
increase what?
HYPERMETABOLISM
5000 cal/day. DOUBLE TRIPLE 4-12 days after injury
INCREASE PROTEIN AND CARBS
what is a risk?
>?% indicates smoke inhalation
Manifestations? TX?
INHALATION INJURY
>10%
HALLMARK- CHERRY RED LIPS AND CHEEKS
sloughing mucosa in resp tract, nausea, tinnitus, upper airway edema
TX- Lab draw COHB lvl, high flow 02 for 6 hr
2ND PHASE- ACUTE PHASE
begins when? until when?
H+H?
NA?
K?
WBC?
GLUCOSE?
ABG?
TOTAL PROTEIN/ALBUMIN?
Begins 36-48 hrs AFTER INJURY
h+h- decreased
na- decreased
k- decreased
WBC- inital increase then decrease
glucose- increased
ABG- slightly hypoxic and metabolic acidosis
Pro/alb- decreased