Burns (Intro-Electrical)

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Burns (Intro-Electrical)
2013-02-27 23:45:10

Adult MedSurg 2
Show Answers:

  1. 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.
  2. What is a partial thickness burn?
    • destroys epidermis
    • 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.

    • Deep partial:
    • Very painful
    • may appear mottled with pink or red to waxy white areas with blisters and edema
  3. 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.
  4. What do you need to remember about assessing emergent skin burns?
    • ABCs FIRST!!!
    • Then...
    • Disability
    • Exposure
  5. What to do with a burn pt.
    • Intubate at 100% O2, but...
    • ...get info first if possible. 
  6. What/when are you thinking with inhalation injury?
    • enclosed space?
    • fumes?
    • smoke?
    • stridor
    • carbonaceous sputum?
    • singeing around face/mouth/nose?
    • change in voice from baseline?-->think damage at larynx or below. 
  7. How can a full thickness burn around the trunk affect breathing?
    • Can impair ventilation
    • Respiration should be closely monitored.
  8. T/F a little bleeding is normal with burns.
    • False
    • If you find bleeding, find the source and stop it. 
    • If need fluid, us LR.
  9. How is prehospital fluid management calculated?
    • <6yrs---125ml/hr
    • 6-13yrs---250ml/hr
    • >13yrs---500ml/hr

    After hospital admission, they get a foley and fluids are very tightly controlled. 
  10. T/F Your burn pt should be alert.
    • True
    • If not, find out why, ie
    • --CO poisoning
    • --substance abuse
    • --hypoxia
    • --pre-existing conditions like seizure
    • AVPU: Alert Verbal Pain Unresponsive
    • Identify any gross deformity/serious associated injury. 
  11. 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. 
  12. What happens during the secondary survey?
    • Hx? Especially tetanus?
    • wt?
    • head to toe exam
    • %TBSA?
    • Admin lines/tubes
    • Fine tune fluids/cath.
    • extremity perfusion
    • ventilation?
    • pain?
    • Psych assessment
    • Reassess ABCs
  13. How do you calculate TBSA?
    • Rule of 9s
  14. 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.
  15. What is an escharotomy/fasciotomy?
    • Escharotomy: cutting through burned tissue to relieve pressure. Does not usually require OR.
    • Fasciotomy: removal of dead tissue to prepare for graft. Muscle layer is exposed. 
  16. Initial wound care?
    • Cover
    • Transport
    • Report using SAMPLE method.
  17. Fluid calcs for adults after hospital admit
    • Adult >14yrs. 
    • 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. 
  18. Fluid calcs for peds after hospital admit
    • 3ml x kg x TBSA
    • same admin regimen as adults.
  19. Med calcs for electrical injuries
    • 4ml Lr x kg x TBSA
    • UO--> 75-100ml/hr
    • May need to increase uo to 1-1.5ml per kg to maintian clear urine. 
  20. Chemical burns?
    • protect yourself
    • brush off if possible, remove clothing, irrigate for at least 20 min. 
    • identify agent if at all possible. 
    • chemical burn alone-->burn unit
  21. Electrical burns?
    • 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.