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WPH - Care for the burn Patient
Terms in this set (77)
What commonly happens to airway mucosa during smoke and inhalation injuries?
Redness and airway swelling (edema)
What is a major predictor of mortality in burn victims?
Name three types of smoke and inhalation injuries?
- Carbon Monoxide Poisoning
-Inhalation injury above the Glottis
- Inhalation injury below the glottis
_________ and _____ account for the majority of the deaths at a fire scene.
Carbon Monoxide Poisoning and aphyxiation.
How is Carbon Monoxide produce?
Carbon Monoxide is produce from the incomplete combustion of burning materials.
How does carbon monoxide kill?
CO molecules displace oxygen molecules in hemoglobin causing hypoxia and carboxyhemoglobinemia and death when CO levels become too high.
What is carboxyhemoglobinemia?
Carbon Monoxide Poisoning
What nursing action should be taken if you suspect CO poisoning?
If CO poisoning is suspected, patient should quickly be treated with 100% humidified oxygen and the CO levels should be checked ASAP.
What is a tell tale sign of CO poisoning.
Cherry Red Skin Color is a classic sign of CO poisoning.
T or False
CO poisoning can occur in the absence of a burn injury to the skin?
Often thee victims of fires, especially those who were trapped in a _______ ______ will have elevated CO levels.
What is a general principle of an inhalation injury above the glottis.
An inhalation injury above the glottis is generally thermally produced.
What is a general principle of an inhalation injury below the glottis.
An inhalation injury below the glottis is generally chemically produced.
How does injury above the glottis usually occur?
Inhalation above the glottis may be caused by inhalation of hot air, steam, or smoke.
How do mucosa burns of the oropharynx and larynx manifest themselves?
Redness, blistering, swelling (edema) which may lead to closure of the airway.
What presents the major medical emergency with inhalation injuries above the glottis?
The major medical emergency is when due to swelling the mechanical airway is closed.
Name some reliable clues that could indicate an inhalation injury above the glottis?
- Presence of Facial Burns
- Singed Nasal Hairs
- Carbonaceous Sputum
- History of being burned an an enclosed space
- clothing burns on head chest neck
What is the inhalation injury below the glottis?
Tissue Injury to the lower respiratory tract.
What determines the extent of inhalation injury below the glottis?
Tissue injury to the lower respirtory tract is related to the duration of exposure to smoke and toxic fumes.
True or False
if the patient has had inhalation injury below the glottis the symptoms will appear immediately.
False - symptoms of pulmonary edema my not appear until 12 to 24 hours after the burn and then may appear as ARDS.
What is the number one thing patients with smoke or inhalation injuries should be evaluated for?
Respiratory distress or compromise
Your patient has been brought in for burns and inhalation injury....what is the appropriate unit for their care?
Describe the relationship between CO and O2 as it relates to hemoglobin.
Hemogloblin has a 200x more affinity for CO and as such CO will displace O2 in hemoglobin
what are electrical burns?
Electrical burns are the result of intense heat generated from electric current.
What are Signs and Symptoms of Carbon Monoxide Poisioning?
Respiratory failure, myocardial ischemia, Seizures, coma, death
Why do we use 100% oxygen to treat CO poisoning?
100% O2 (reduces CO half-life from 4hrs to 40min)
Why do we need ABG when suspecting CO poisoning...why cant we just use SPO2?
SpO2 will read "falsely high"
In suspected CO poisioning, what is required to get a "true" O2 saturation level?
ABGs must have co-oximetry to determine true O2 saturation
What determines the severity of of an electrical burn?
The amount of voltage/current, tissue resistance, current pathways, surface area in contact with the current and length of time current flow was sustained.
What is meant by tissue resistance in terms of electrical burns?
Tissue resistance is a measure of the electrical conductivity - it is a function of tissue density.
What effect does electrical current have on a high resistance tissue vs a low resistance tissue.
A low resistance tissue tends to conduct the electrical current where a high resistance tissue resists this conduction and the electrical energy is converted to heat and causes a burning of the tissue.
What are examples of high electrical resistant tissues?
Fat and Bone
Examples of low electrical resistant tissues.
blood vessels and nerves
Why is the extent of injury from an electrical burn difficult to determine.
The severity of an electrical injur is difficult to determin as most of the damage is below the skin. This is known as the "iceberg effect"
What special precautions should be used when transporting an electrical injury patient.
As falls and broken bones are extremely common with electrical injury patients, ALL WAYS CONSIDER THE POTENTIAL FOR CERVICAL SPINE INJUST AND INCORPORATE CERVICAL SPINE IMMOBILIZATION.
Why should we have an electrical injury patient hooked up to telly when admitted?
the shock can cause cardiac standstill or fibrillation. In fact, cardiac dysrthmias can appear without warning during the first twentyfour hours.
How does electrical injury affect the renal system?
Electrical injury damages tissue and blood hemoglobin can release myoglobin pigments which travel to and clog the renal tubules causing Acute Renal Necrosis (ATN)
What is the risk for severe metabolic acidosis from electrical injury?
Very high, because of extensive tissue distruction and cell rupture severe metabolic acidosis develops within minutes after the injury.
a condition characterized by a deficiency of bicarbonate ions in the body in relation to the amount of carbonic acid in the body, in which the pH falls to less than 7.35
What is the treatment for metabolic acidosis?
What is the intervention for electrical injury induced ATN?
Latated Ringers along with an osmotic diruretic such as Mannitol to maintain urine output of 75-100ml hr.
what determines the treatment of a burn?
The treatment of a burn is determined by the severity of the injury.
What determines the severity of an electrical burn injury?
Severity is determined by:
- depth of the burn
- extent of burn as a % of body area
- location of the burn
- Patient Risk factors
What is meant by the term burn unit?
A burn unit is a specialized medical facility with personell and equipment for handling serious burn cases.
Where do you send minor burn injuries?
The majority of patients with minor burn injuries are seen as outpatients.
What are the goals of a burn center.
Goals include wound healing, prevention of infection, pain management and rehabilitation.
Burn injury involves the distruction of the ______________system.
Name the three layers of the skin
Epidermis - top
Dermis - Middle
Subcutaeous - bottom
the superficial, thinner layer of skin, composed of keratinized stratified squamous epithelium
second layer of skin, holding blood vessels, nerve endings, sweat glands, and hair follicles
Tissue, largely fat, that lies directly under the dermis and serves as an insulator of the body.
first degree burn
a burn involving only the epidermis, characterized by erythema (redness) and hyperesthesia (excessive sensation)
second degree burn
destroys the epidermis and part of the dermis; characterized by pain, blisters, swelling, and discoloration.
third degree burn
destroys epidermis and dermis, appear leathery and dark, no pain, insensitivity to pain due to nerve damage; fluid loss & increased risk of infection due to damage of protective barrier
partial thickness burn
a burn in which the first layer of skin (epidermis) is burned through and the dermis (second layer) is damaged. Burns of this type cause reddening, blistering, and a mottled appearence. (Also called second-degree burn).
superficial partial thickness burn
- 2nd deg., epidermis and upper portion of dermis
- Red, blistering, wet, painful
- Healing: 7 to 21 days (e.g. sunburn)
deep partial thickness burn
2nd degree, large think with weeping edema, cherry red dermis is exposed. this is very painful to cold air nerve endings are exposed
full thickness burn
a burn involving destruction of the entire skin; extends into subcutaneous fat, muscle, or bone and often causes severe scarring; commonly called a third-degree burn
what is the effect of skin regrowth after a burn.
if the burn is signicant enough to distroy the dermis, there may not be enough skin cells to regenerate new skin.
What is meant by the extent of a burn?
The extent of a burn refers to the total body surface area (TBSA) that was injured in the burn.
What is the method for determining the TBSA.
The rule of nines.
rule of nines
used to estimate the extent of burn area on the body: head and neck = 9%; each upper limb = 9%; each lower limb = 18%; front of trunk = 18%; back of trunk and buttocks = 18%; perineum = 1%
why is the location of a burn important in determining a burn's severity.
The location of a burn near a vuneral part of the body such as the face and neck could have respiratory issues, hand feet self care issues etc.
why are burns to the ears and nose dangerous?
Because they are cartilege and have poor circulation, they are prone to slow healing and infection.
-can cause total occlusion of circulation to an area due to edema
-Restrict ventilation if encircle the chest
Common in burn injuries it involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles
What is meant by the phases of burn management?
Historically, burn management has been catagorized into chronological phases each with their respective priorities. They are the emergent, acute, and rehabilitative phases.
When does the rehabilitation phase of a burn injury begin?
the day after the burn however the formal rehabilitation phase begins when the wounds have almost healed.
What is meant by the pre-hospital care of a burn victim?
prehospital care is that care taken of a burn before medical personel arrive or the patient arrives at the hospital.
What is pre-hospital care of a person with chemical burns?
Prehospital care of chemical burns is best treated by brushing solid particles off skin and lavage with water.
Do you need to use sterile water to lavage a burn?
Tap water is acceptable for flushing.
Why is it inadvisable to flush a large area burn (>10%)?
it could lead to unwanted heat loss
emergent burn phase
The emergent or resusciative phase is ther period of time required to reslove the immediate, life threatening problems resulting from a burn injury. It usually lasts 24 to 48 hours but could be 3 or more days.
When does the emergent phase end?
when fluid mobilization and diuresis begins.
what is the primary concern during the emergent phase
onset of hypovolemic shock and edema.
Wha is meant by fluid and electrolyte shifts during the emergent phase.
death of tissue caused by protein coagulation as a result of exposure to an acid - forms eschar
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