Burns

parkland formula

4mL LR x TBSA % burned x patient weight (kg) = total amount of fluid this is just an estimation and may change depending on patient UO and hemodynamic status

primary assessment

ABCDE

rule of nines

a system that assigns percentages to sections of the body, allowing calculation of the amount of skin surface involved in the burn area

lower airway injuries

airflow obstruction due to chemicals can cause respiratory failure, ARDS, and pulmonary infections

psychosocial

appearance functional status healing process

2nd degree superficial partial thickness characteristics

blisters erythemic weeping of serous fluid painful

electrical burns can result in decreased

neuro status may be delayed onset

disability

neuro status, LOC

upper airway injuries

non rebreather mask prepare for endotracheal intubation

breathing

observe WOB, O2 sat

exposure

observe entire body surface area

2nd degree deep partial thickness characteristics

pallor/erythema prolonged blanching edema decreased moistness

GI

paralytic ileus curling stress ulcers -> anti ulcer medications

TBSA is used to calculate the percentage of the burned area for what type of burns?

partial and full thickness

2nd degree burns are

partial thickness

pain

pharmacologic methods necessary to ensure patient comfort and decrease O2 demand

burns and hyperkalemia

potassium shifts into serum

AKI

prerenal from hypovolemic shock -> decreased perfusion

joint burns

promote ROM

3rd degree full thickness burns characteristics

range of colors from pale yellow to red, white, brown, or black may see eschar dry, leathery lack of sensation

debridement

removal of loose skin, nonviable tissue with sterile scissors avoid disruption of new granulation tissue

renal

risk for AKI decreased CO and renal perfusion myoglobinuria

metabolic

severe burns associated with hypermetabolism, physiologic stress, and inflammation

cardiac arrythmias

shifts of electrolytes (potassium) electrical burns cardiac monitoring

initial resuscitative wound care

stop burning phase head to toe evaluation (ABCDE) evaluation for potential transfer to burn center fluid resuscitate pain medications cleansing of wound with sterile saline or mild soap

1st degree burn example

sunburn

1st degree burns are

superficial

3 types of burns

superficial (1st degree) partial-thickness (2nd degree) full thickness (3rd degree)

2nd degree (partial thickness) subcategories

superficial partial thickness deep partial thickness

TBSA can determine

the extent of the injury

types of debridement

mechanical biodebridement: maggots chemical surgical

edema peaks in _____ hours, meaning the patients neck and face may swell more after admission. this is important when considering airway and intubation

48

adequate UO

0.5mL/kg/hr 30-50mL/hr

the patients palm represents _____% of his or her body surface

1%

parkland formula fluid estimation schedule

1/2 of total in first 8 hours 1/4 in second 8 hours 1/4 in third 8 hours

if more than ____% of the body surface is burned, consider transferring patient to a burn center

10%

fluid resuscitation

LR or isotonic fluids crystalloid infusion dependent upon urine production and hemodynamic status parkland formula to guide resuscitation

why are full thickness burns not as painful?

burned off neurons

acute rehabilitative wound care

cleansing of wounds with water and mild soap to remove exudate and devitalized tissue debridement

circulation

concern for hypovolemic shock vascular to third space

airway

consider face and neck edema, inhalation burns

myoglobinuria

damaged muscle tissue from burns, very nephrotoxic maintain adequate UO to prevent injury related to myoglobin

2nd degree deep partial thickness burns exhibit more ______ characteristics

dry

neuro

effects more common in electrical burns altered LOC, seizures, peripheral nerve injuries, memory problems, muscle weakness effects can be acute or delayed

2nd degree deep partial thickness involves

epidermis and extends deeper into dermis

2nd degree superficial partial thickness involves

epidermis and upper portion of dermis

3rd degree full thickness burns involve

epidermis, dermis, and subcutaneous laters of skin and tissue

1st degree superficial burns characteristics

erythematous blanches tingling, increased sensitivity to area heals within a week

3rd degree burns are

full thickness

rehabilitation goals

minimization of adverse effects promotion of functional ability psychosocial wellbeing social integration

cardiovascular management

hemodynamic instability fluid resuscitation cardiac arrhythmias

post 36 hours the body is in a state of

hypermetabolism -> hyperglycemia increased nutritional needs (increase calories)

first 24-36 hours of injury the body is in a state of

hypometabolism

why might a burn patient experience hemodynamic instability?

hypovolemic shock

nutrition

increased nutrition to meet hypermetabolic needs

1st degree superficial burns involves

intact epidermis

TBSA

total body surface area

2nd degree superficial partial thickness burns exhibit more _______ characteristics

wet