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
  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
Folders:

Description:
cc burns final
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