Burns

Question 1

First Degree Burns

Answer 1

• Superficial
• Epidermis (top layer) damaged
• dry, no blisters, minimal or no edema
• erythematous
• very painful
• rapid heat loss
• healing: 2-5 days with no scarring
• may have some discoloration

Question 2

Second Degree Burns

Answer 2

• Epidermis destroyed + dermis injured
• can be SHALLOW to DEEP

Question 3

Second Degree: Partial Thickness

Answer 3

• moist blebs, blisters
• underlying tissue: mottled pink + white, cherry red, weeping wounds
• coagulated blood vessel visible in deep dermal 2nd degree injuries
• good capillary refill
• very painful
• rapid heat loss

Question 4

Third Degree: Full Thickness

Answer 4

• complete destruction of epidermis
• dermis injury down to subcutaneous tissue
• may include fascia, muscle, + bone
• dull, red, dry, leathery eschar
• mixed white, waxy, pearly, khaki, mahogany, soot stained
• insensate
• less rapid heat loss
• large areas require grafting

Question 5

Burn shock + Fluid Resuscitation

Answer 5

• Goal: maintain tissue and organ perfusion
• Modified Brooke Formula
• need more fluid: inhalation injury, associated injuries, dehydration, electrical injury, ETOH
• Monitoring: management of oliguria, increased resuscitation fluid, no fluid boluses, avoid diuretics

Question 6

Modified Brooke Formula

Answer 6

2mL LR x Weight (kg) x BSA (Burn Surface Area) = # of mL in 1st 24 hrs
- 1/2 in first 8 hours
- 1/4 in second 8 hours
- 1/4 in third 8 hours

Question 7

Electrical Burns: Immediate Care

Answer 7

• determine power source
• turn power off
• assess for cardiac/respiratory arrest
• C-spine control
• assess LOC, other injuries, contact points (entrance-exit wounds)
• keep patient warm

Question 8

Electrical Burns: Hospital Care

Answer 8

• possible intubation
• cardiac monitoring (12 lead EKG)
• C-spine control
• IV access
• Foley catheter (keep urine output >75-100mL/hr)
• labs, urine myoglobin
• assess pulses (all extremities)
• x-rays to assess C-spine + fractures
• reassure patient and family

Question 9

Chemical Burns: Emergency Treatment

Answer 9

• protect yourself (wear gloves)
• remove clothing (don’t forget boots/shoes)
• continuous flush 10-30 min
• eye burns (flush)
• ABC’s
• FLUSH! FLUSH! FLUSH!
• wound care
• look for hidden burns

Question 10

Inhalation Burns: S/S

Answer 10

• agitation, anxiety, stupor, cyanosis, or other signs of hypoxia
• hoarse voice, brassy cough, grunting, or guttural respiratory sounds
• use of accessory muscles
• inability to swallow
• facial burns, singed nasal hairs, soot
• tachypnea, rhonchi, diminished breath sounds
• nasal or oral-pharyngeal edema

Question 11

Inhalation Burns: Treatment

Answer 11

• maintain patent airway
• consider intubation
• 100% O2; non-rebreather mask
• obtain ABGs
• frequent suctioning
• ventilator

Question 12

Inhalation Burns: When to Intubate…

Answer 12

• airway obstruction imminent (progressive hoarseness, stridor, LOC-GCS <8)
• Don’t Intubate just because the face is burned!!!

Question 13

Control of Infection

Answer 13

• environmental control (temperature control)
• wound care + hydrotherapy
• topical antimicrobials
• infection + sepsis

Question 14

Treating Pain

Answer 14

• PRE-MEDICATE BEFORE WOUND CARE
• opioids
• continuous infusion
• sustained release
• anxiolytics
• NSAIDS
• PCA
• sedation

Question 15

Promote Wound Healing + Patient Recovery with Good NUTRITION

Answer 15

• increased metabolism and catabolism
• need to increase calorie intake
• supplements + increase protein for healing
• enteral feeds vs. parenteral feeds
• vitamins + antioxidants

Question 16

ABCD’s of Burn Care

Answer 16

• Airway maintenance w/ cervical spine protection
• Breathing + ventilation
• Circulation w/ hemorrhage control
• Disability (assess neuro deficit)

Question 17

Airway Maintenance w/ Cervical Spine Protection

Answer 17

• must be assess immediately
• consider endotracheal intubation

Question 18

Breathing + Ventilation

Answer 18

• auscultate the chest. verify breath sounds in both lungs.
• assess rate + depth of respirations
• high flow O2 @ 15L (100%) w/ a NRB
• circumferential full thickness chest burns of the trunk may impair ventilation + must be monitored closely

Question 19

Circulation w/ Hemorrhage Control

Answer 19

• assess adequacy of circulation
• vascular access (2 large bore IVs into unburned skin if possible)
• begin fluid administration
• doppler examination (circulation deficit in circumferentially burned extremity)
• pulse oximetry probe (circulation check)

Question 20

Disability (assess neurological deficit)

Answer 20

• Burn patients are usually alert and oriented initially
• Altered LOC, consider: carbon monoxide poisoning, hypoxia, associated injury, substance abuse

Question 21

Nursing Interventions: Acute Phase

Answer 21

• universal precautions
• fluid resuscitation
• baseline vitals (O2 management)
• insert gastric tube (tube feedings as indicated)
• insert foley catheter
• assess pulses and extremity perfusion
• continued vent assessment
• pain management
• psychosocial assessment

Question 22

Wound Care per Physician Order

Answer 22

• topical AG (silver) antibacterial cream
• wound vac after skin grafting
• prevent infection

Question 23

Wound Care: s/s of infection

Answer 23

• localized redness
• purulent drainage
• breakdown of healed areas
• temperature >100.3 degrees
• cellulitis surrounding wound

Question 24

Rehab: Major Goals

Answer 24

• return patient to his/her pre-burn level of activity
• facilitate re-entry to society
• achieve an acceptable functional and cosmetic outcome
• psychosocial acceptance