A
True or false, we can do wet to dry dressing changes on burns?
FALSE
the initial fluid shift happens when?
first 24 hours after burn injury
fluid is superstitial space:
edema
True or false, third degree burns are usually painful
true or false, burns are preventable
true
Layers of the skin in order
Epidermis
Dermis
Hypodermis
Subcutaneous layer
True or false, if the burn goes past the nerve the patient cannot feel it
TRUE
what is the treatment plan for burns based on?
type of burn
severity of the burn
There's a risk for what with burns?
Infection- administer tetanus
risk for metal fragments with burns from an explosion
fluid loss leads to:
increased potassium- tall peak t waves
decreased sodium
Hct/Hgb
Hyponatremia
Potassium
WBC
decrease due to fluid shift from interstitial splace back into vascular fluid
still present
increases more due to renal loos & movement back into cells
initial- increase
later- decrease & left shift
what does a burn assessment assess?
extent of body surface burned
depth of burn and manifestations
1st fluid shift
Hyperkalemia
Hyponatremia
Hct/Hgb
Happens immediately after burn injury from massive cell destruction (stays up for days)
can occur during different healing phases (from plasma loss)
elevated from fluid shift
When does fluid mobilization happen?
48-72 hours after burn injury
Diagnostic testing part 2
Chest xray
ECG- for electrical burns
Creatinine- deep burns
Myoglobin- deep burns
Different causes of burns
thermal
chemical
electrical
radioactive
inhalation
Fourth Degree (deep full thickness)
burns through all layers of the skin plus muscles, tendons, and bones
-black color
-no pain
-no edema
-charred
burns lead to a loss of:
temperature regulation
sweat & sebaceous gland function
sensory & organ function
Age- babies & elderly burn easier & deeper due to frail skin
Burn depth
Amount of surface area affected by burns (TBSA) causative agent
baseline of patient
location of injury
respiratory involvement
Diagnostic testing used
CBC
Serum electrolytes- sodium
BUN
ABG- C02, inhalation, PC02
Fasting blood glucose- depleting
Liver
UA- red in urine= muscle
clotting
Second Degree (superficial partial thickness)
burns through the epidermis, into parts of the dermis
-blisters
-red-white color
-painful
-mild-moderate edema
-no eschar
causes:
-flames
-burn scalds
First Degree (superficial)
Burns through the epidermis
-no blisters
-pink-red color
-painful
-mild edema
-no eschar
causes:
-sunburn
-flash burns
Third Degree (deep partial thickness)
burns through the epidermis, deep into the dermis
-no blisters
-red-white color
-painful
-moderate edema
-soft/dry eschar
causes:
-flames, burn scalds, grease, tar, chemical burns
Rules of nines
front & back of head- 4.5% each
back & front back- 4.5%
chest- 9%
abdomen- 9%
lower back- 9%
front & back leg- 9%
front & back arm- 9%
perineum- 1%
burns through the epidermis, deep into dermis, through the subcutaneous tissue, causes nerve damage
-nerve damage
-no blisters
-red-tan, black, brown, white color
-may be painful (depends on nerve)
-severe edema
-hard inelastic eschar
causes:
-burn scalds, grease, tar, chemical burns