Where do most burns occur?
- In the home
What are safety considerations in the home to prevent burns?
- Keep electrical sockets covered and
... [Show More] lighters out of reach
- Smoke alarms
- Change smoke alarm batteries every 6 to 12 months
- Keep anything flammable 3 feet from heat sources
- Clean the lint traps in the dryer with each use
- Have and practice a safety plan
- Do not let pot handles stick out while cooking
- Drop in type stoves should be attached to the wall
- Do not use table cloths if children are not present
- Small appliances need to be kept out of reach of children
- Set water heater no higher than 120 degrees
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Why does plasma leak out of the tissues after a burn?
- Increased capillary permeability leads to leaking
When does a majority of leaking from tissues occur and what should you worry about?
- First 24 hours
- Shock
Why does the pulse increase in patient with burns?
- Losing fluid volume leads to not enough fluid circulating
- Heart tries to quickly circulate small amount of fluid
Why does cardiac output decrease in patients with burns?
- Losing fluid leads to less volume to pump out
Why does urine output decrease in patients with burns?
- Kidneys are trying to hold on to fluid or they aren't being perfused adequately
Why is epinephrine secreted in patients with burns?
- Makes you vasoconstrict so blood can be shunted to other organs
Why are ADH and aldosterone secreted in patients with burns?
- Retain sodium and water with aldosterone
- Retain water with ADH
- Both make blood volume increase
What is the most common method for determining the % of the body that is burned?
- Rule of Nines
What degree of burns are considered partial thickness burns?
- First and second degree
What degree of burns are considered full thickness burns?
- Third and fourth degree
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How does burn location help determine severity?
- If the burn is located on the face, neck, or chest it can interfere with breathing
- If the burn is located on the hands, feet, joints, or eyes it can interfere with a productive life
Who is at risk for burns?
- Anyone with heart, lung, or kidney disease
- Pre-existing diabetes (cannot feel legs or feet)
- Very old and very young
Why are the very young and very old at risk for burns?
- There skin is very thin and they have less subcutaneous fat
- Burns tend to go deeper
- Less BSA
How do you stop the burning process?
- Wrap the patient in a blanket
- Cool water for no more than 10 minutes (**NEVER ICE- INHIBITS BLOOD FLOW)
- Blankets keep out germs and keep in body heat
- Remove jewelry because of swelling
- Remove non-adhered clothing
- Cover burns with clean, dry cloth
What is the number one cause of death with burns?
- Inhalation injury
- Usually caused by carbon monoxide or hydrogen cyanide
Why is carbon monoxide poisonous to the human body?
- Carbon monoxide travels faster than oxygen and binds to the hemoglobin before oxygen can
- Patient becomes hypoxic
How do you treat carbon monoxide poisoning?
- 100% oxygen
- Puts more oxygen molecules in the "race"
The oxygen saturation will be __________ on a patient with carbon monoxide poisoning.
- Normal
How do you treat hydrogen cyanide poisoning?
- 100% oxygen
- Antidote may be given at the hospital
With cyanide poisoning, why is it important to determine whether the burn occurred in a closed or open area?
- If someone is burned in a closed area, they will have inhaled more carbon monoxide and/or hydrogen cyanide so the risk for complications are increased.
When you see a patient with burns to the neck, face, or chest, focus on what?
- Airway
What might the physician do prophylactically for a patient with burns to the face, neck, and chest?
- Intubate
What are indicators that a patient has an inhalation burn?
- Singed nose hairs
- Singed facial hair
- Soot on face
- Cough up secretions with dark specks
- Difficulty swallowing
- Wheezing
- Blisters on face and oral mucosa
- Hoarseness
- Substernal or intercostal retractions
- Stridor
If a burn patient's respirations are shallow, what are they retaining? What imbalance are they at risk for?
- Carbon dioxide
- Respiratory acidosis
What is the most important aspect of burn management?
- Fluid replacement
How many large bore IVs will a patient need if they are receiving large amounts of fluids?
- Two
What type of solutions will typically be used for fluid replacement?
- Crystalloids (LR)
- Colloids (albumin)
Why is it important to know when the burn occurred?
- So you know the rate to replace fluids
How do you calculate the amount of fluid to give a patient with a burn?
- (2-4 mL) X (Kg) X (% TBSA burned)= total fluid replacement for first 24 hours
- Calculate the total amount of fluid needed for the first 24 hours and give half in the first 8 hours
If a patient with burns is restless, what could this indicate?
- Inadequate fluid replacement
- Pain
- Hypoxia
How do you determine if a burn patient is getting adequate fluid replacement?
- Urine output
- 30 to 50 mL in an adult
- 75 to 100 mL in electrical injuries
- 1mL/kg/hr in children
What is albumin?
- Administered 24 hours after burn
- Holds onto fluid in the vascular space
- Causes vascular volume to increase, kidney perfusion increases, blood pressure increases, and cardiac volume increases
What should you be cautious of when administering albumin?
- You can stress the heart too much
- Causes the patient to go into fluid volume excess
- Cardiac output will decrease
What measurement should you take hourly when administering albumin?
- CVP
- Make sure you are not overloading the patient
When you are giving a narcotic what is the most important assessment to make?
- Respiratory
Why do you give IV medication over IM medications for a patient with burns?
- IV medications work quickly
- For IM medications to work you need perfusion to the muscles
What immunizations should you give to a patient with burns?
- Tetanus Toxoid
- Immune globulin
Why are broad spectrum antibiotics not used with patients who have burns?
-Because they could lead to secondary infections or sepsis
What is the exception to using broad spectrum antibiotics for a patient with burns?
- Will be used until wound cultures have returned
What should you monitor for when giving patients antibiotics that end in -mycin?
- BUN
- Creatinine
-Hearing loss (ototoxicity)
- Nephrotoxicity
Why might a provider use silver impregnanted dressings on a patients burns?
- Provide broad antimicrobial effects by delivering a uniformed amount of silver to the wound
How long can dressings be left in place on a burn?
- 3 to 4 days, depending on patient condition
What are common topical drugs used for burns?
- Mafenide acetate (Sulfamylon)
- Silver nitrate
- Antimicrobial ointments
Why should antibiotic drugs be alternated?
- Bacteria can build resistance or tolerance
How do you apply topical agents to a burn?
- Apply a thin layer using sterile gloves
- Aseptic technique
- Apply light gauze dressing to cover area
What is debridement?
- Enzymatic debridement agents are used to remove necrotic, dead tissues
When is using debridement agents contraindicated?
- Do not use on face
- Do not use if pregnant
- Do not use over large nerves
- Do not use if area is opened to a body cavity
What is most important to remember before sending a patient to hydrotherapy?
- Pain management
What could happen to a patient if immersion hydrotherapy is used?
- Cross contamination
- Could have different bacteria in different wounds
What is an autograft?
- Patient uses own skin
- Intact skin is taken from donor site and placed over burned area
If a patient is well nourished, the surgeon can re-harvest from the same donor site as soon as how many days?
- 12 to 14
If the skin graft becomes blue or cool what could this mean?
- Poor circulation
Why might a provider use a needle to aspirate blood or exudate from under the graft?
- If there is build up under the graft, then the graft cannot adhere
- Can lead to partial or total loss of graft
Do you think a patient with burns need more or less calories?
- More
What two things are needed in a burn patients diet to promote healing?
- Protein
- Vitamin C (boost immune system)
What lab work would you check to ensure proper nutrition and a positive nitrogen balance?
- Prealbumin (total protein albumin)
What procedures can help relieve pressure when a patient has decreased circulation due to circumferential burn?
- Escharotomy
- Fasciotomy [Show Less]