burn lecture

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Author:
tcrupe
ID:
184635
Filename:
burn lecture
Updated:
2012-11-20 12:48:07
Tags:
burns
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Description:
sheri's burn lecture
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  1. goals
    • • Prevention
    • • Institution of lifesaving measures for the severely burned person
    • • Prevention of disability and disfigurement through early specialized and individualized care
    • • Rehabilitation through reconstructive surgery and rehabilitation programs
  2. alloderm
    dermis from a human cadaver for skin grafting
  3. autograft
    a graft from one part of the body to another part

    same patient's body
  4. alloderm advantages
    • less scarring and contractions
    • freeze dried
    • better if pt has large TBSA burn
  5. autograft advantages
    • own skin
    • less chance for rejection
  6. alloderm disadvantages
    costly
  7. autograft disadvantages
    have 2 sites (graft site and donor site)
  8. cultured epithelial autograft (CEA)
    cells froma  pt grown in a culture plate and regrafted to the pt
  9. contracture
    when collagen matures, the burn scar shrinks
  10. homograft
    • also called an allograft
    • graft from one human to another either living or cadaver
  11. heterograft
    • may be called a xenograft
    • graft from an animal or species other than the recipient
  12. pros of xenograft
    • readily available
    • long shelf life
    • help to protect wound
    • temporary wound coverage
  13. cons of xenograft
    • can be rejected
    • temporary
    • can only be used on noninfected areas and certain thicknesses
  14. escharotomy
    linear inceision through the non-viable tissue to release constriction of the underlying tissue
  15. fasciotomy
    • incision made through the fascia to release pressure from the muscle
    • deeper than escharotomy
  16. types/categories of burns
    • thermal/electrical
    • radiation
    • chemical
    • inhalation
  17. causes of thermal/electrical burns
    • flames
    • lightening
    • outlets
    • scalds/steam
    • contact w/ hot items
    • most common type of burn
  18. thermal/electrical burns can cause
    • damage to tissues, nerves, muscles
    • muscle and tissue can break down and cause myoglobin to be released
    • dysrhythmias
  19. A patient with an electrical burn should be placed on _____________.
    an EKG monitor
  20. what causes urine to turn a burgundy, rust color?
    release of myoglobin
  21. how can myoglobin affect kidneys?
    can cause the to go into ARF
  22. With thermal/eletrical burns, monitor ________ closely
    UOP
  23. causes of radiation burn
    • sunburns
    • tanning beds
    • problems w/ gamma radiation in cancer treatments
  24. causes of chemical burns
    • meth labs
    • facial treatments (orange peel burns)
  25. causes of inhalation burns
    • smoking
    • smoke from fire
  26. treatment of inhalation burns
    • bronchodilators
    • give 100% oxygen
    • possible ventilation if striddor/difficulty breathing
    • b-scope
  27. signs/symptoms of carbon monoxide poisoning
    • dizziness
    • HA
    • nausea/vomiting
    • decreased vision
  28. cold thermal or frostbite
    usually occurs in extremities (nose, finger tips, toes)
  29. skin review
    • outer layer:  edpidermis
    • inner layer:  dermis
  30. epidermis
    • -outter layer of skin
    • -has 2 layers
    • -no blood vessels, gets nutrients from the underlying dermis

    wrap on package
  31. dermis
    • -95% of skin
    • -most complex and has 2 layers
    • -one layer is thin loose connective tissue capillaries elastic fibers and collagen
    • -second layer has dense connective tissue, large blood vessels, mast cells, fibroblasts, nerve endings, lymphatics, and epidermal appendages (sebaceious glands, sweat glands, hair follicles)
    • -varies in thickness depending on location, age and gender

    package
  32. factors determining burn depth
    • how injury occured?
    • causative agent?
    • temperature of agent?
    • duration of contact w/ the agent?
    • thickness of skin?
  33. burn depth classification of burns
    • -superficial partial-thickness
    • -deep partial-thickness
    • -full thickness

    might run across transmural or 4th degree
  34. skin involved in superficial partial-thickness
    epidermis; possibly portion of dermis

    taking wrapping off the package
  35. examples of superficial partial-thickness burns
    • sunburn
    • low-intensity flash
  36. symptoms of superficial partial-thickness burns
    • tingling
    • hyperesthesia (supersensitivity)
    • pain that is soothed by cooling
  37. wound appearance of superficial partial-thickness burns
    • reddened; blanches w/ pressure; dry
    • minimal or no edema
    • possible blisters
  38. recuperative course of superficial partial-thickness burns
    • complete recovery w/in a week; no scarring
    • peeling
  39. skin involved in deep partial-thickness burns
    epidermis, upper dermis, portion of deeper dermis
  40. possible causes of deep partial-thickness burns
    • scalds
    • flash flame
    • contact
  41. symptoms of deep partial-thickness burns
    • pain
    • hyperesthesia
    • sensitive to cold air
  42. wound appearance of deep partial-thickness burn
    • blistered, mottled red base; broken epidermis; weeping surface
    • edema
  43. recuperative course of deep partial -thickness burns
    • recovery in 2-4 weeks
    • some scarring and depigmentation contractures
    • infection may convert it to full thickness
  44. skin involvement in full-thickness burns
    • epidermis, entire dermis, and sometimes SC tissue
    • may involve connective tissue, muscle and bone
  45. possible causes of full-thickness burns
    • flame
    • prolonged exposure to hot liquids
    • electric current
    • chemical
    • contact
  46. symptoms of full-thickness burns
    • pain free
    • shock
    • hematuria and possibly hemolysis (blood cell destruction)
    • possible entrance and exit wounds (electrical burn)
  47. wound appearance of full-thickness burns
  48. methods to estimate total body surface area (TBSA) burned
    • rule of nines
    • Lund and Browder method
    • Palm method
  49. Rule of nines
    body is broken into 9 areas which total 100%
  50. head total
    9%
  51. face
    4.5%
  52. back of head
    4.5%
  53. front trunk total (anterior trunk)
    18%
  54. chest/back
    9/9
  55. total back (posterior trunk)
    18%
  56. abd/lower back
    9/9
  57. total arms
    18%
  58. arms
    4 1/2 a piece for each side
  59. total legs
    18%
  60. legs
    9 a piece for each side
  61. groin
    1%
  62. Lund and Browder method
  63. Palm method
  64. 3 phases of burns
    • emergent/resuscitative
    • acute/intermediate
    • rehabilitation
  65. time of emergent/resuscitative phase
    from time of trauma to end of fluid resuscitation
  66. treatment on scene for emergent/resuscitative phase
    • ABC's (now CAB)
    • circulatory assessment
    • neurological assessment
  67. ED care in emergent/resuscitative phase
    • ABC's (now CAB)
    • humidified air
    • encourage to cough or suction w/ bronchodilators
    • intubate if needed
    • obtain burn scenario hx
    • large bore (16-18g) access or central line placement
    • if nauseated or major burns place NGT for gastric decompression/paralytic ileus
  68. ED care in emergent/resuscitative phase
    • clean technique of inital wound assessment
    • assessment percent burned using the rule of nines for fluid resuscitation
    • clean sheet under and over patient
    • foley (hourly output) 30-50 mL/hr
    • baseline wt, ht, labs, EKG
    • tetanus prophylaxis due to wound contamination
    • physical stabilization
    • meet psychological needs
    • transfer to burn center
  69. fluid/electrolyte shifts in emergent/resuscitative phase
    • generalized dehydration (fluid moving from intravascular to interstitial)
    • reduced blood volume and hemoconcentration (^ hct and decreased hgb = thick blood = prolonged PTT)
    • decreased urine output (muscle damage = release of myoglobin = renal tubules blocked = acute renal failure)
  70. fluid/electrolyte shifts in emergent/resuscitative phase
    • trauma causes release of K+ into extracellular fluid (hemolysis)
    • increased capillary permeability = Na+ and protein traps in edema fluid and shifts into cells as K+ is released
    • metabolic acidosis
  71. resuscitative fluid in emergent/resuscitative phase
    NO consensus so use Parkland/Baxter Formula

    • -LR
    • -4mL x kg in wt x % TBSA = total fluid
    • -day 1: 1/2 amt in first 8 hours of post burn and rest over next 16 hours
    • -day 2:  varies
  72. Parkland/Baxter formula
    4mL x wt in kg x % TBSA = total fluid
  73. Nursing respobsibilites in emergent/resuscitative phase
    • adequate airway
    • maintain temperature
    • control pain
    • provide emotional support
  74. complications in emergent/resuscitative phase
    • resp distress
    • ulcers
    • shock
    • compartment syndrome
    • paralytic ileus
  75.  

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