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66 Cards in this Set
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- Back
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How do percentage of burns relate to length of hospital stay? |
approximately one day in the hospital per 1% burn 20% burn ≈ 20 days in the hospital |
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What are some common ways we might see someone in middle TN getting thermal, electrical, and chemical burns? |
thermal: trash burning in areas w/o trash pickup electrical: stealing copper from wires chemical: meth explosions |
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What pediatric age range is going to see higher burn incidence, which gender is more likely to be burned, and what are the anatomical areas where the burns are likely to be seen? |
age range: 1-5 yo gender: boys > girls where: upper extremities, head, & neck |
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what are the most common types of child abuse burns? |
thermal = contact or scald |
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What percentage of burns are going to be life threatening in peds, and which sorts of burns -- scalds, thermal, or chemical/electrical -- are going to have a higher BSA involvement and risk of inhalation injury? |
% of peds life threatening: 3-5% BSA/inhalation involvment: thermal |
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what admission requirements must be met regarding percentage of partial thickness burns, burn location, & degree of burns per the American Burn Association? |
partial thickness burns: must involve > 10% TBSA burn location: any involving face, hands, feet, genitalia, perineum, or major joints degree of burns: 3rd degree in any age group are admitted |
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Do electrical burns, chemical burns, and inhalation injuries qualify for admission? |
Yes, all three require admission |
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What are other contributing factors with burns that require admission? |
burns + trauma = admission burns + kids in non-qualified hospitals = admission burns + pre-existing condition = admission burns + pt with social/emotional/long-term rehab = admission |
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what does "mechanism" refer to with burns? |
how they were burned i.e. bonfire w/gas on it, car fire, etc |
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what do primary and secondary survey refer to? |
primary: life-threatening stuff = ABC; will dictate if we need to intubate before moving to other interventions secondary: non life-threatening stuff |
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what would primary survey assessment findings of deep facial burns, carbonaceous sputum, agitation/hypoxia, hoarseness/stridor, & respiratory distress be indicative of? |
inhalation injury |
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what is carbonaceous sputum? |
what it is: carbon in sputum |
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What might be another cause of hoarseness or stridor in a burn pt? |
smoking |
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what is a supraglottic inhalation injury, what burn is it caused by, what sort of edema would be seen in it, and what is the major risk for the ABC of this pt? |
what it is: above vocal cord burn type of burn: direct heat or chemical edema: upper airway edema ABC: edema causes loss of airway |
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what is a subglottic inhalation injury, what burns is it caused by, what sort of edema is it caused by, what sort of ABC issue would it cause, and what blood lab levels would we need to evaluate? |
what it is: below vocal cord burn type: chemical = CO or byproducts of combustion type of edema: pulmonary ABC: respiratory epithelial sloughing = mucous plug Lab: carboxyhemoglobin = CO levels |
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what is the fluid of choice for initial management of burns, and what are the rates for less than or equal to 5 yo, 6-13 yo, and greater than or equal to 14 yo, per the consensus formula? |
fluid choice: lactated ringers rates: less than or equal to 5 yo = 125 mL LR/hr 6-13 yo = 250 mL LR/hr greater than or equal to 14 = 500 mL LR/hr |
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when should we bolus fluids in burns? |
ONLY in hypotensive situations even if UOP drops we will only increase fluids, not bolus |
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do fluids begin in primary or secondary survey? |
primary |
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what are the areas we need to assess during the secondary survey and why is 2ndary so important? |
assessment: burn/trauma hx, PMH, allergies, medications, complete physical exam, calculate consensus formula = for fluids why important: bc burns can sometimes distract us from other serious trauma |
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what degrees of burns count toward calculation of TBSA? |
2nd = partial thickness 3rd & 4th = full thickness |
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what is the rule of nines, what age group is it used for, and what percentage TBSA calls for fluid replacement in adults & peds? |
what it is: percentage of BSA allocated to certain body parts head = 9% each arm = 9% each leg = 18% anterior torso = 18% posterior torso = 18% perineum = 1% age group: >15 yo fluid replacement: > 20% adults; > 10% peds |
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how is BSA allocated for < 15 yo? |
head = 18% each arm = 9% anterior torso = 18% posterior torso = 18% each leg = 14% |
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what is the formula for fluid resuscitation for adult burns? |
(kg x TBSA % x 2mL LR)/16 = mL/hr |
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what is the formula for fluid resuscitation for peds burns? |
(kg x TBSA % x 3 mL LR)/16 = mL/hr |
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what specific fluid do infants & young kids need for maintenance and why? |
fluid: 5% dextrose why: bc they have minimal glycogen stores |
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what is the palmar method of TBSA calculation and why must TBSA be reassessed after 24 hr? |
palmar method: one of their hands = 1% reassessment: bc it can can 24 hrs for burns to develop |
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what is the UOP goal of adult fluid resuscitation, why is UOP so important, and how will we adjust fluids to meet goal? |
goal: 30 mL/hr why: UOP is #1 indicator of fluid tx success adjust: up rate by 20% each hour until UOP is met i.e. rate is 100 mL/hr then up to 120 mL/hr *** no bolus except in hypotension *** |
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what are the peds UOP goals for 0-1, 2-8, & 9-14 yo? |
0-1 yo = 2 mL/kg/hr 2-8 yo = 1 mL/kg/hr 9-14 yo = same as adults |
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why do we start fluid resuscitation at 10% for peds versus 20%, and what are the fluids we'll give to 0-1 yo and 2-14 yo? |
why: greater BSA:body mass & glycogen stores are small (monitor BG!) fluids: 0-1 yo = D5LR + D5 1/2 NS for maintenance 2-14 yo = LR + D5 1/2 NS for maintenance |
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what is a major safety concerns for staff and pt with chemical burns, when will we stop irrigation of a pt, and what might we need to do to tx chemicals in the eyes? |
concern: decontamination stopping irrigation: when pH of runoff h2o is low enough chemicals in eyes: morgan lens = emergency irrigation; ophthalmology referral |
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what is the range of pH paper we'll need to have on hand to test during chemical burns? |
1-14 |
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what is a normal carboxyhemoglobin level, what happens at 20% and 50-60%, how are too high CO levels tx, and what is the half-life of CO cut to by O2 tx?? |
normal: 3%, but up to 15% in smokers 20%; 50-60%: HA/dizziness; comatose/no recovery tx: 100% O2 non-rebreather, cyanide kits, aggressive ventilator therapy O2 tx: half-life of CO cut to 30 min |
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how is a cyanokit reconstituted, what is it administered with, what is the dose, what is the length of time for infusion, and what are SE? |
reconstituted: 200 mL NS administered with: nothing dose: 5 g time: 15 min SE: pink excretions |
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what is the benefit of early intubation for a inhalation injury and what procedure might be done to promote thoracic expansion in pt w/thoracic burns? |
benefit: sometimes airway compromise r/t inhalation injury is delayed so we won't see effects until later on promote thoracic expansion: escharotomy |
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which cause more death, high or low voltage electrical injuries, why, and what is the difference between electrocution and electrical injury? |
more death: low voltage why: cause cardiac arrhythmias i.e. v fib electrical injury v. electrocution: electrocution = death; electrical injury ≠ death |
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what are the indicative marks of a lightning strike and what other issues come from a lightning strike besides burns? |
pattern: fern patterned burns other injuries: blood in urine, muscle damage |
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what is the difference between a high tension injury and a flash injury? |
high tension injury: current passes through the pt flash: current arcs causing a flash but the current does not pass through the pt |
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what is the fluid resuscitation formula for high voltage injury and what are the UOP goals for adults and peds? |
formula: (kg x TBSA% x 4 mL LR)/16 = mL/hr UOP: adults = 75-100 mL/hr; peds = 1 mL/kg/hr |
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what are complications of the airway, cardiac issues, and spine r/t high voltage injury? |
airway: edema cardiac: VT, VF spinal: lightning strike can fracture vertebrae and impact injury from being thrown across the room |
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what are the zones of coagulation, stasis, and hyperemia? |
zone of coagulation: innermost point; where the burn occurred; NOT SALVAGEABLE zone of stasis: second most inner point; capillary occlusion and decreased perfusion; MIGHT BE SALVAGEABLE zone of hyperemia: redness and blood flow to this area; SHOULD BE SALVAGEABLE |
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which part of the skin is involved in a superficial/1st degree burn, is there pain/redness, how long to heal, and should it be used when calculating TBSA %? |
skin: epidermis only pain/redness: yes/yes, localized healing: 2-5 days TBSA %: not considered |
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which part of the skin is involved in partial thickness/2nd degree burns, is there pain/redness, and how long will it take to know if it is developing into 3rd degree? |
skin: epidermis and dermis pain/redness: extremely painful; partial thickness = pink, beefy red, blistered, deep partial thickness = pale & mottled *will blanch* 3rd degree development: 24 hrs |
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which part of the skin is involved in 3rd degree/full thickness burns, is there pain/redness, and how long will they take to heal? |
skin: epidermis, dermis, subcutaneous tissue pain/redness: little to no pain but may have neuropathic pain -- white/waxy,red/brown/leathery appearance that will not blanch healing: will not heal; tissue must be excised or it will become necrotic |
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what causes 4th degree burns, which part of the skin is involved in 4th degree burns, is it painful, what is the appearance, and what procedures may be indicated? |
cause: prolonged exposure to flame, chemicals, & high voltage skin: all parts + muscle/bone pain: none appearance: black or charred procedures: amputation, fasciotomy, escharotomy |
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why do hypermetabolism and hypercatabolism occur in burns? |
hypermetabolism = body unable to regulate temperature hypercatabolism: body is unable to get enough energy so it begins to break down muscle |
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why might peripheral neuropathy, delirium, and PTSD occur in burn PTs? |
neuropathy: bc of nerve death delirium: due to long ICU stay; countered by regulating light cycles w/ lights on @ 0700 & lights off @ 1900 PTSD: trauma r/t intense pain; Pt may have trouble getting back to activity that led to the burn |
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what effect will fluid loss have on the blood, the heart, and the periphery? |
fluid loss = increased hemoconcentration = increased blood viscosity increased viscosity = increased cardiac workload increase viscosity = decreased peripheral pulse strength |
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what method of IV tx might we need to consider if the pt has lost significant fluid? |
central line |
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why might someone with smoke inhalation be at risk for decreased gas exchange and pneumonia, and why is the rotoprone bed going to be used during aggressive pulmonary tx?? |
pneumonia: sloughing lung tissue might not get cleared and increased chances of pneumonia decreased gas exchange: buildup of soot in the lungs r/t poor filtration (i.e. singed nose hairs etc) rotoprone: increases the lung surface area |
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what GI risks are there in a burn pt and what interventions will be taken to mitigate the risks? |
risks: ileus, malabsorption, ischemia, supplemental nutrition, constipation interventions: ice cream for extra calories, > 400 mL residual will result in 50% cut in feed volume, nocturnal tube feeds to maintain nutritional status |
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why might acute & late renal failure occur in these PTs, what is myoglobinuria, what is abdominal compartment syndrome, and what is normal abdominal pressure? |
acute renal failure: poor perfusion r/t decreased CO r/t fluid loss late renal failure: coincides with sepsis & MODS myoglobinuria: myoglobin in urine r/t insufficient fluid = ARF risk abdominal compartment syndrome: burns put pressure on visceral organ s& bladder so UOP drops = visceral ischemia and bowel necrosis normal abdominal pressure: < 15 mmHg |
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for pre-hospital wound care, what should be given IV, how should the wounds be covered, should we be giving antibiotics, and what shot should we give? |
IV: pain meds = morphine & fentanyl cover wounds: clean, dry sheet & prevent hypothermia Antibiotics: no, wounds have been sterilized by the burn shot: tetanus |
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what should be done with initial wound care with respect to blisters, hair, and method of wound cleaning? |
blisters: open them hair: shave them cleaning: wash them with antibacterial soap |
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how should pain meds be dosed for daily wound care, how should the wound be tx with the dressings, and what should be done with loose tissue? |
pain meds: PRN dressing: soak off/remove topical ointment, wash wound tissue: debride loose tissue |
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what is the difference between sheet grafts and split thickness sheet grafts with respect to care and placement on the body? |
sheet graft: skin laid whole and intact on wound; used in cosmetic areas of the body; requires meticulous care to prevent fluid accumulation split thickness sheet graft: skin passed through a machine to create mesh slits to it can be expanded to cover a larger wound; often wrapped & protected for 3-5 days while graft adheres to wound bed |
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what is a xenograft and what is the purpose of it? |
what it is: pig skin graft purpose: lets the body think there is a scab over the wound to speed the healing process; might sometimes be used before grafting their own skin on |
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what are the SE at the harvest site of harvesting skin for a graft? |
infection may become full-thickness wound |
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when is an escharotomy going to be done and what aspects is it going to be performed on? |
full thickness circumferential burns loss of circulation loss of movement performed medial & lateral |
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what is integra and where does it sit on a burn dressing? |
what it is: collagen-like substance, looks like saran wrap where: goes on wound bed & sits between wound and negative pressure dressing |
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what is a cultured epithelial autograft and when is it used? |
what it is: PT's own skin grown in lab; skin can grow up to one inch around itself when used: with pt who has significant damage and grafts not possible |
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when is bacitracin used and what is the main SE or prolonged use? |
when used: almost all the time prolonged use: contact dermatitis |
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what is silvadene-silver used for, what is the risk, and what is the benefit with respect to antibiotic properties? |
used for: penetrating deep eschar wounds risk/downside: sulfa drug = allergy risk; have to scrub it from the wound bed to get it off benefits: Gram neg & gram positive coverage |
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how is sulfamylon reconstituted & used, and what is the downside? |
reconstituted: NS used: wet to dry downside: high price |
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what is collagenase used for and what is the downside? |
used for: debriding; good for small 3rd degree burns downside: Pt may say it hurts |
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what is Acticoat, what is the benefit, what is the downside, and when will a pt most likely have this? |
what it is: antimicrobial dressing benefit: can stay up to 7 days so daily wound care not needed downside: high cost seen: when leaving OR |
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when should splints be used for rehab? |
in joint burns to prevent contractures pt may sleep in a splint seen frequently in axillary burns |
