MS_Primers for Exam 3 Content > Burns Primer > Flashcards

Burns Primer Flashcards

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1
Q

What is the normal range for Hematocrit?

A

• 36-54%

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2
Q

What is the normal range for Hemoglobin?

A

• 12-18

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3
Q

In the emergent phase of burn care, what are our goals for BP and HR?

A
  • BP: ≥90 systolic
  • HR: <120
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4
Q

What are the common types of burn injuries?

A
  • Thermal
  • Inhalation
  • Chemical
  • Electrical
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5
Q

Describe causes of thermal burns.

A
  • Fire
  • Contact with hot objects
  • Scald (wet) burns
  • Cold thermal injury: frostbite
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6
Q

Describe causes of inhalation burn injury.

A
  • Smoke
  • CO2
  • Hot chemicals
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7
Q

Describe partial and full thickness burns.

A
  • Partial-thickness burn
    • Superficial partial-thickness burn
    • Involves the epidermis
  • Deep partial-thickness burn
    • Involves the epidermis and dermis
  • Full-thickness burn
    • Involves all dermal layers, fat, muscle, bone
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8
Q

Describe 1st degree burns.

A
  • Superficial partial thickness
  • The burn site is red, painful, dry, and with no blisters
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9
Q

Give an example of a 1st degree burn

A

• Mild sunburn

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10
Q

Describe 2nd degree burns.

A
  • Deep partial thickness
  • The burn site looks red, blistered, and may be swollen and painful
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11
Q

Describe 3rd degree burns.

A
  • May be deep partial thickness to full thickness
  • Pain less likely pending amount of nerve damage
  • Burn site may look white, blackened and/or charred
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12
Q

Describe 4th degree burns.

A
  • Full thickness
  • There is no feeling in the area since the nerve endings are destroyed
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13
Q

What are the 4 stages of burn care?

A
  • Prehospital
  • Emergent
  • Acute
  • Rehabilitation
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14
Q

Describe the prehospital stage of care.

A
  • Immediate care at point of injury
  • Stabilization for xport
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15
Q

Describe the emergent stage of care.

A
  • Resuscitative care and hemodynamic stabilization
  • The period time required to resolve the life-threatening problems resulting from the burn
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16
Q

How long does the emergent stage last?

A

• Up to 72hrs from time of burn

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17
Q

What are the primary life threatening concerns of the emergent phase?

A

• Hypovolemic shock and edema

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18
Q

When does the emergent phase end?

A

• When fluid stabilization and diuresis begins

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19
Q

What is the goal of the Acute phase of burn care?

A
  • Infection control
  • Healing and wound care
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20
Q

How long does the acute phase last?

A

• Can take weeks/months pending the severity of burns

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21
Q

When does the acute phase end?

A

• With wound closure

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22
Q

What is the purpose of the Rehabilitation phase of burn care?

A

• Pyschosocial, physical needs.

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23
Q

In prehospital care, the rescuer must be protected from becoming…

A

• Part of the incident

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24
Q

What are automatic assumptions with electrical burns?

A
  • That the victim fell and sustained back/cervical spine injury until ruled out
  • There is more tissue damage than what can be seen as the electricity traveled from entry to exit point
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25
What is the prehospital care for chemical burns?
* Brush particles off skin * Remove clothing from burned area/cut around clothing fused to skin * Use water lavage
26
How are small thermal burns covered in prehospital care?
• Clean, cool, tap water dampened towel
27
What are the priority prehospital actions for large thermal burns?
* ABCs * Do not immerse in cool water or pack with ice. * Remove burned clothing. * Wrap in clean, dry sheet or blanket
28
Why are large thermal burns wrapped in a clean, dry sheet or blanket?
• To prevent contamination and provide warmth
29
Why should large burns be cooled for no longer than 10 minutes?
• To prevent hypothermia
30
What should be the first action when treating a burn victim in the prehospital phase?
• Observe for signs of respiratory distress or compromise
31
What are some key indicators of possible inhalation burn injury?
* Presence of facial burns * Singed nasal hair * Hoarseness, painful swallowing * Darkened oral and nasal membranes * Carbonaceous sputum * History of being burned in enclosed space * Clothing burns around chest and neck
32
Rule of Nines percentage for Head?
• 9%, 4.5 anterior, 4.5 posterior
33
Rule of Nines percentage for Torso?
• 36%, 18 anterior, 18 posterior
34
Rule of Nines percentage for Arms?
• 9%, 4.5 anterior, 4.5 posterior
35
Rule of Nines percentage for Legs?
• 18%, 9 anterior, 9 posterior
36
Rule of Nines percentage for Genitals?
• 1%
37
What is the Parkland formula used for?
• Fluid resuscitation for the first 24hrs after burn injury
38
What is the Parkland formula?
* 4mL/kg/%TBSA * ½ given w/in first 8hrs from injury * The other half is split between the following two 8hr periods
39
What fluid is used with the Parkland formula?
• Lactated Ringers isotonic solution
40
What is the pathophysiology of Burn Shock?
* Burn → * ↑ Vascular permeability → * ↓ Intravascular volume (due to 3rd spacing of fluids which present as edema) → * Third spacing of fluids leads to ↓ intravascular blood volume (hemoconcentration) → * ↑ Hematocrit → ↑ viscosity → * ↑ Peripheral resistance → Burn Shock
41
What is normal insensible fluid loss?
• 30-50mL/hr
42
What is the estimated fluid loss/hr for a severely burnt patient?
• 200-400mL/hr
43
What is key to monitor for results of fluid resuscitation?
• Urine OP
44
RBCs are hemolyzed by a circulating factor released at the time of the burn. Why is this of concern?
• It can result in thrombosis in the capillaries and affect blood flow
45
What causes elevated HCT and HGB in burn victims?
• Third spacing pulls fluids out of vascular system leaving the RBCs behind resulting in hemoconcentration?
46
How is elevated Hct and Hgb resolved in a burn patient?
• Administration of fluids will dilute the blood and restore levels
47
What happens to the levels of Sodium (Na) and Potassium (K+) in the first 24hrs of a burn patient?
• They can become hyponatremic or hyperkalemic due to fluid shifts
48
What are the normal level ranges for sodium and potassium?
* Sodium: 135-145 * Potassium: 3.5-5
49
How is CO poisoning treated?
• 100% O2 via non-rebreather
50
What kind of drugs are used for pain management of the burn pt?
• Opioids
51
What is asepsis?
• State of being free from disease-causing micro-organisms
52
How is body temp regulated with burn victims?
• Typically via room temperature w/ thermostat set to 85°
53
Why do we assess bowel sounds in the burn patient?
• To check for paralytic ileus
54
What is Curling’s Ulcer and how is it treated?
* Gastric stress ulcers * Treated with H2 Blockers
55
What is the open method of burn wound care?
• Burn is covered with a topical antibiotic with no dressing over the wound.
56
When open burns wounds are exposed, staff should wear…
* Disposable hats * Masks * Gowns * Gloves
57
What is the closed method of burn wound care?
• Sterilized gauze dressings are laid over a topical antibiotic.
58
When are closed method burn dressings changed?
• Dressings may be changed from every 12 to 24 hours to once every 14 days.
59
What method of burn wound care is used for facial burns?
• Open
60
Corneal burns are treated with…
• Antibiotic ointment
61
The emergent phase ends with?
• Diuresis (and Fluid stabilization)
62
What is done prior to wound debridement?
• Medicate pt with opioids as it is PAINFUL
63
Explain excision and grafting.
* Eschar is removed down to the subcutaneous tissue or fascia * Skin graft is placed on clean, viable tissue.
64
What are circumferential burns?
• Burns that completely surround a limb or part of the body (arm, leg, etc)
65
What is the inherent danger of circumferential burns?
• Compartment syndrome
66
How do we test for oxygenation/tissue perfusion when circumferential burns are present?
* Assess breathing * Assess distal pulses * Assess for successful pain relief with medication
67
What is done to treat compartment syndrome as a result of a burn injury?
• Escharotomy to relieve pressure
68
When treating burn patients, how often are blood labs run?
• Every 4-6hrs
69
Besides fluid shifts, how else may a burn patient develop hyponatremia?
* Excessive GI suction * Diarrhea
70
What are the s/s of hyponatremia?
* Weakness/fatigue * Dizziness, HA * Confusion * Muscle cramps * Tachycardia
71
The burn patient may also develop a dilutional hyponatremia called water intoxication. To avoid this condition, the patient should…
• Drink fluids other than water, such as juice, soft drinks, or nutritional supplements
72
In the burn patient, Hypernatremia may develop following
* Successful fluid resuscitation if copious amounts of hypertonic solutions were required * Improper tube feedings * Inappropriate fluid administration
73
What are the s/s of hypernatremia?
* Patient will present with thirst; dried, furry tongue; * Lethargy; confusion * Possibly seizures
74
Hyperkalemia can cause
* Cardiac dysrhythmias & ventricular failure * Muscle weakness * ECG changes
75
Hyperkalemia will be noted if patient has what physiological conditions?
* Renal failure * Adrenocortical insufficiency * Massive deep muscle injury
76
Hypokalemia with the burn patient can be caused by
* Lengthy IV therapy without potassium * Vomiting, diarrhea * Prolonged gastrointestinal suction
77
What kind of diet is required for the recovering burn patient?
• ↑ calories & ↑ protein
78
Acute phase of burn care ends with…
* Wound closure (healing) or * Skin graft
79
What are Cultured epithelial autographs (CEAs)?
* Cultured epithelial autograft (CEA) is a method of obtaining permanent skin from a person with limited available skin for harvesting * Grown from biopsies obtained from the patient’s own skin
80
How long does it take for a burn wound to become raised and hyperemic (good blood flow)?
• 4-6 weeks
81
Mature healing is reached in…
• 6 months to 2 years
82
True or False Burnt skin never completely regains its original color.
• True
83
True or False Burn scar discoloration deepens over time
• False, it fades w/ time
84
True or False Pressure can help keep scar flat.
• True
85
True or False Newly healed areas can be hypersensitive or hyposensitive to cold, heat, and touch.
• True
86
True or False Healed areas must be protected from direct sunlight for 6 months
• False, they need to be protected for 1 year
87
Gerontologic Considerations Normal aging puts the patient at risk for injury because of:
* Unsteady gait * Failing eyesight * Diminished hearing * The fact that wounds take longer to heal
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