Burns (Lightening-long term burn care)
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- reverse triage
- direct vs side strike
- Identify contact points
- neuro exam and doc over time
- internal injuries
- assess for compartment syndrome
- warm extremities slowly
- warm pt as much as possible
- narcotics (fentynil-->relax, pain/versed-->amnesia!)
- can heal without surge
- TPA: Tissue plasminogen activator
What is a tub room
- Keeps pt warm
- has a tub for rub-a-dub-dub
- Has water hoses from ceiling.
How does a burn systemically effect pt?
- catecholamines--> release of local and systemic mediators
- --o2 free rads
- --something else
Increased cap permeability-->supply damaged area-->edema-->can lead to pulmonary edema
- Immediate vasoconstricution due to catecholamies
- arterial bp may be mainteained even in sever hypovolemia due to massive catecholamines.
Systemic effect of burns on gI
- paralytic ileus due to stress
- ng tube decompress and enteral feeds
- prophylax for stress curlings ulcer)
Renal effects of burns?
- ATN caused by occlusion of tubules by hemoglobin.
- use of renal toxic antibx and vasopressors
- fluid resuscitation to open up.
Immunologic effects of burns?
- infammatory--> masssive response--> v WBC because they are actually depleted. (24-48hrs)
- WBCs will spike, then drop-->immunosupressed pt.
- increased morbidity mortality
- supportive treatment
Management of partial thickness
- silver: moist, antibiotic action
- collagenase: soothing, breaks down collagen-->easy debridement.
- Abx impregnated dressings, ie Mepilex.
Management for full-thickness
- OR and graft
- Autograft: pt's own skin from another location transplanted to wound area.
- Mesh autograft: like autograft, but gets perforated to cover more area.
- CEA: Grow pt's own skin in volume to graft. Very expensive.
- Allograft: cadaver skin
- Xenograft: pig skin
- Autograft is preferred because has higher chance of taking.
- All the way through.
- Requires OR
- May require amputation of burned limb.
Steven-Js and toxic epidermal necrolysis
- Mortality is higher than burn of same size
- usually Rx reaction
- Mucosal involvment often severe
- 1-6 weeks recovery
- NGT, prevent nfxn, full fluid resuscitation.
- swelling-->blisters tissue-->death
- treat nfxn, then graft dead tissue.
Abdominal compartment syndrome
- caused by overaggressive fluids
- 3rd spaces into abd-->pressure on kidneys, bowel, lungs, and blood flow
- check bladder pressure q4h
- requires OR.
Long term burn care?
- PT OT to resume ADLs
- compression garments for scar and edema
- follow up in burn clinics.
- Follow up with burn psychologist for body image or job place anxiety r/t source of injury.
What is the most common cause of ALOC in a burn pt?
Smoke inhalation/CO2 poisoning.
What is "slugging?"
The thickening of blood in response to fluid shift from vasculature to 3rd spacing and damage to small capillary beds.
What is the leading cause of death for pt with inhalation burn injury?
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