CC BUrns

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  1. burns with total body surface (TBS) >20% is of concern
  2. 4 burn sources
    • thermal
    • chemical
    • electrical
    • radiation (sun)
  3. classification of burns
    superficial (1st) just epidermis

    • superficial partial thickness and
    • deep partial thickness (2nd) includes dermis

    full thickness (3rd) gets into muscle
  4. Image Upload
  5. calc of burn size is based on what?
    the rule of nines
  6. rule of nines:
    head
    chest
    back
    groin
    legs
    • head: front= 5%,   back= 4%
    • chest: 2x9= 18%
    • back: 2x9= 18%
    • groin: 1%
    • legs: front and back = 9% each
    • arms: 9% each

    equals 100%
  7. color tagging system for burn levels:
    <20% = yellow tag, intermediate risk, walky-talkys

    >20% = Red teg, major burn
  8. major problems with burns:
    Skin injury results in loss of
     1-6
    • protection from infection
    • body fluid loss
    • temp control
    • sweat glands and hair follicles
    • sensory receptors
    • scarring and keloid formation
  9. 3 zones of injury
    Center= zone of coag - most severe damage

    Middle = zone of stasis - impaired circulation

    outer = zone of hyperthermia - least damage
  10. Burn shock is the same as HYpovolemic shock
  11. 3 stages of burn management
    ermergency mangmnt / resuscetation phase (thru completion if fluid stability)

    reparative care (begining of diuresis thru would closure)

    rehab (wound closure on)
  12. ermergency mangmnt / resuscetation phase:

    Primary survey of ABCD's
    • Airway
    • Assess for signs of inhalation injury
    •  -progressive airway edema over 24-48 hrs
  13. Sx of inhalation injury
    look for soot or sx of inhalation of smoke and shit
  14. Primary Survey:
    breathing
    • assess rate, depth, sounds, SpO2
    • Escharectomy may be needed
    • eschar is non viable tissure impeding skin excursion
  15. CO poisoning:
    HbCO2 levels
    • 10-15% = HA
    • 15-60% = toxicity, inc Sx's
    • >60% = coma, death

    • Sx= dizzy, N/V
    •  =weak, memory loss, dec LOC
    •  =confusion -> coma
    •  = Skin Pink to cherry red - shows perfusion, but is CO2 perfusion
  16. primary survey:
    circulation
    • basic assessment:
    • HR and sounds
    • cardio monitor
    • BP

    Assess pulses and circumferential extremity burns

    loss of pulses or dec quality = Escharectomy
  17. circulation priority: IV fluids
    Parkland formula
    4mL LR x kg x TBSA% (as a whole #) = volume in first 24hrs from time of injury

    • 1/2 given in first 8hrs
    • 1/2 given in next 16 hrs

    4ml x 75kb x 30 (drop the %) = 9000
  18. UO is the bed indicator for fluid status
  19. what lab results do we monitor?
    • K, Ca, Na imbalances
    • Bun and Creat
    • bld glucose

    • dec Hgb d/t hemolysis
    • inc Hct d/t dehydration --> dilutional dec Hct
  20. risk fx for morbidity and mortality
    • age + TBSA = >100 poor prognosis
    • <2, >65 inc risk
    • location of burn (hand, feet, face, balls)
    • Hx of illness
    • inhalation injury
    •  -Primary cause of death in first 24 hrs
  21. Secondary survey
    • burn estimate, % and depth
    •  -expose wounds, leave ahereing clothing in place
    •  -remove clothing and jewelry is possible

    • Comple H&P (peripheral and lung focus)
    • Prevent Hypothermia
  22. Chemical burns: special considerations
    • injury greater than appears
    • brush off chemical powders
    • FLUSH SKIN WITH H2O FOR 15-30 MINUTES
    • Blisters ARE broken with chem burns (only burn)

    brush, flush, and break
  23. electrical burns

    Tx
    • assess enterance and exit
    • muscle damage (rhabdomyolysis) - burgendy (port wine) colored urine
    •  - kidney failure high risk

    Tx= INC IV fluids to maintain UO of 100-150 ml'hr

    acidosis and arrythmias occur
  24. Reparative phase goal
    wound closure, infection prevention, minimal scar formation
  25. GI and nutritional needs
    • Ileus risk
    • curling (stress) ulcers with >20% TBSA
    • INC protein diet b/c of hypermetabolic state and wound healing
  26. sepsis is a threat and primary cause of heath during the reparative phase of care
  27. no exudate seen with a partial thickness burn
    clean with chlorihexidine and flush with h2o
    topical AB ointment
  28. Exudate seen with deep partial thickness
    cleanse same as partial thick
    use Silver Sulfadiazine like icing a cake = penetrates eschar, can cause bone marrow depression
    Sulfamylon = topical AB, can be painful for up to 30 minutes
  29. open dressing for face and neck
  30. signs of wound infection
    • rapidly seperating eschar
    • purulent pockets or inc exudate
    • unclear demarcation of wound edges
    • sustained inc fever or WBC's
    •  -antibios and cultures are NOT routine
  31. hydrothereapy for 20-30 mins/day

    debrisment can be:
    mechanical
    enzymatic
    surgical grafting
  32. 5 types of surgical grafts
    • autograft - own skin
    • heterograft/xenograft - animal skin (pig)
    • Homograft/allograft - hhuman donors
    •    -partial or full thickness
    • synthetic skin
    • CEA - cultured endothelial Autograft
  33. Grafted site care
    • immobilize site for 3-7 days
    • sheet grafts are left open to air
    • elevate limb
    • no contact: pressure or shearing at site
    • medicate for icthy and pain
  34. Graft complications

    reportable assessments
    • rejection
    • contractures - position in extension, ROM for 5min Qhr

    • Reportable assessments:
    • inc pain or redness
    • inc temp or purulence
    • loss of distal pulse
  35. graft donor site care
    • skin creates a wound similar to partial thickness burn
    • prevent infection
    • site heals in 1-2 weeks
  36. Rehab phase

    goals
    • begins after wound closure is complete
    • may last for several years

    • goals= physical and emotional healing
    •  =scar managemnt, minimize hypertrophic scars
    •  =maximize functions
    •  =return to community, workplace
  37. pressure garments
    • on grafted site after 5-7 days
    • custom made garments made and worn 23/24 hrs for 6-12 months
  38. PT started within 24 hrs of burn
    ROM at least Q4

Card Set Information

Author:
kbryant86
ID:
278633
Filename:
CC BUrns
Updated:
2014-07-11 19:47:52
Tags:
cc burns
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Description:
cc burns final
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