Card Set Information
Adult MedSurg 2
What is important about the stratum Germinativum?
This is where most cells regenerate. Whether or not a burn is deeper than the SG often determines if it will heal on its own.
What is a partial thickness burn?
appears red, swollen and blistered
usually heals in 2 weeks
can extend into the dermis (deep partial thickness burn)
Will heal well functionally and cosmetically.
Will blanch to touch.
may appear mottled with pink or red to waxy white areas with blisters and edema
Full thickness burn?
Dry, leathery, penetrates all layers of skin.
Usually painless except around the margins.
Sensory input also gone.
Will not blanch to touch.
What do you need to remember about assessing emergent skin burns?
What to do with a burn pt.
Intubate at 100% O2, but...
...get info first if possible.
What/when are you thinking with inhalation injury?
singeing around face/mouth/nose?
change in voice from baseline?-->think damage at larynx or below.
How can a full thickness burn around the trunk affect breathing?
Can impair ventilation
Respiration should be closely monitored.
T/F a little bleeding is normal with burns.
If you find bleeding, find the source and stop it.
If need fluid, us LR.
How is prehospital fluid management calculated?
After hospital admission, they get a foley and fluids are very tightly controlled.
T/F Your burn pt should be alert.
If not, find out why, ie
--pre-existing conditions like seizure
: Alert Verbal Pain Unresponsive
Identify any gross deformity/serious associated injury.
Exposure/Environmental control phase
remove clothing, jewelry, metal, diapers, shoes, etc.
Log roll pt to remove clothing. Assume spinal cord injury
Keep warm by covering with dry sheets.
What happens during the secondary survey?
Hx? Especially tetanus?
head to toe exam
Fine tune fluids/cath.
How do you calculate TBSA?
Rule of 9s
Bullet points about burn traumas
spinal until r/o
dont get distracted by the burn. Remember ABCs first.
Burns alone don't cause unconciousness or hypotension.
What is an escharotomy/fasciotomy?
: cutting through burned tissue to relieve pressure. Does not usually require OR.
: removal of dead tissue to prepare for graft. Muscle layer is exposed.
Initial wound care?
Report using SAMPLE method.
Fluid calcs for adults after hospital admit
2ml LR x TBSA x kg
Give half over 1st 8hrs, other half over next 16.
Adjust to UO to 30-50ml/hr.
If urine out of target for 2 consecutive hours increase or decrease fluid by 1/3.
Fluid calcs for peds after hospital admit
3ml x kg x TBSA
same admin regimen as adults.
Med calcs for electrical injuries
4ml Lr x kg x TBSA
May need to increase uo to 1-1.5ml per kg to maintian clear urine.
brush off if possible, remove clothing, irrigate for at least 20 min.
identify agent if at all possible.
chemical burn alone-->burn unit
Bone has high resistance so flows along bone surface and damages adjacent muscles
small surface burns can indicate deeper, more extensive damage.
Can have "entrance" and "exit" points where current travels.
Requires debridement internally.