thermal injury

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thermal injury
2012-04-03 11:18:02
thermal injury

thermal injury
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  1. what are the 3 phases in burn care
    • resuscitative or emergent
    • acute or wound healing
    • rehabilitative or restorative
  2. emergent or resuscitative phase entails
    period of time required to resolve immediate life threatening injury
  3. what is the greatest initial threat to a patient who has sustained a major burn
    hypovolemic shock and fluid and electrolyte shifts
  4. what is the primary survey
    abc's and c-spine immobilization
  5. initial management
    • remove jewelry, watches, belt
    • remove clothes and replace with dry sterile or clean sheets
  6. what are the s/s of resp distress
    • cyanosis/pallor
    • irritabilitty
    • grunting
    • weak cry
    • slowing of rr
    • apnea, gasping (late sign)
  7. what happens to cap perm
    • increased goes from vessels into third spacing
    • =diminished blood volume
  8. what are clinical manifes of burn and shock
    • blood pressure
    • weak pulses
    • decreased uop
    • increased rr
    • poor skin turgur
    • thirst
  9. fluids fluids fluids
    lr with large bore angiocath asap
  10. indication of adequate fluid replacement
    • no change in loc
    • p<120
    • normal electrolytes
    • no nausea or ileus
  11. charecteristics of partial thickness burns
    • partial is reddened/blistered
    • partial more painful
    • moist surface
    • cap refill present
  12. charecteristics of fulll thickness burns
    • waxy and white
    • less painfull
    • dry surface
    • no cap refill
  13. what are the 4 p's and t of circ compromise
    • pulse
    • pain
    • pallor
    • parasthesia
    • temp
  14. what topical agents are used with burns
    • silvadone
    • bacitracin
    • eucerin
  15. cultured skin grafts
    • takes 2-3 weeks to harves
    • wet dressing for 10days
    • fragile
  16. s/s of hyponatremia
    and why would you get this
    • lengthy hydortherapy, water pulls therapy from open wounds
    • weakness
    • dizziness
    • muscle cramps
    • fatigue
    • h/a
    • tachycardia
    • confusion
  17. hypernatremia
    why would you see this
    • following successful fluid therapy from overload of na in the fluids
    • thirst
    • dried furry tounge
    • lethargy
    • confusion
    • seizures
  18. how is severity of the injury determined
    (hint 4 items)
    • depth of the burn
    • extent of burn in percent (tbsa)
    • location of burn
    • patient risk factors
  19. how do you give fluid therapy in the first 24 hours
    • 1/2 in first 8 hours
    • 1/4 in second 8 hours
    • 1/4 in third 8 hours
  20. how do you estimate the percentage of a burn on a patient
    (what is the rule of the 9's)
    • rule of the nines
    • 9 percent on head and arms
    • 18 percent on anterior and posterior chest and legs
    • 1 % on peri area
  21. what is another way to estimate the percentage of the burn in a patient with odd shaped burns
    the palmar surface accounts for 1%
  22. how is the percentage of burn estimated differently in children prior to 1 and after
    • the head accounts for 19%
    • legs account for 13%
    • arms and torso the same as adults

    subtract 1% from head for each year over 1 year
  23. when does rehabilitation occur
    the first day after the burn has occured
  24. what kind of fluids are used for fluid replacement
    • colloids such as albumin
    • and crystalloids such as lr
  25. how do you assess adequacy of fluid replacement therapy
    • uop 30-50 ml per hour
    • 75-100 in electrical burn patient
    • sbp>90
    • hr<120
    • b/p best measured with an arterial line
  26. how should pain meds be given
    • iv because gi system may not be working properly to metabolize and absorb meds effectively
    • im the meds will pool
  27. what different types of skin grafts are there
    • sheet grafts
    • mesh grafts
    • cultured skin
  28. why would you see hyperkalemia and what would the clinical manifes be?
    • renal failureadrenocortical insuffieiency or massive deep muscleinjury
    • aeb muscle weakness and ecg changes
  29. why would you see hypokalemia and what clinical manifes would you see?
    vomiting diarrhea prolonged sxn and fluid therapy without K+ supplementation or additives
  30. describe the acute phase
    • wound care
    • excision and grafting
    • pain management
    • pt and ot
    • nutritional
    • psychosocial care
  31. a good time for rom would be
    after wound cleansing because not so much bulky dressing and skin is softer
  32. when does the rehabilitative phase begin
    when wounds have healed and the patient is able to resume a level of self care activity
  33. what are the goals in the rehabilitation period
    asist pt in resuming a funcional role in society and to accomplish functional and cosmetic reconstructive therapy
  34. what is a hypermetabolic state and what are the nutrition needs in burn patients?
    resting metabolic state is increaased by 50-100/% above normal in burn patients