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Types of burns
Thermal
Chemical
Smoke/inhalation injury
Electrical
Cold thermal
Thermal burns
Most common
Occurs often in children, older adults
STOP, DROP, and ROLL Shuts off oxygen supply to fire
Flush with cold water
No ice on deep burns, only superficial
Cover patient with clean cover
Do not pull off clothing (skin will stick) Cut off
Keep NPO for possible surgery and to prevent stress ulcer, Curlings ulcer
Chemical burns
Smoke/inhalation injury
Electric burns
Severity of burn
Depth of burns
Superficial partial-thickness
Deep partial-thickness
Rule of nines
Lund-Browder chart
Pathophysiologic changes
Emergent phase
Closed method
5 Ps of compartment syndrome
Edema
Pain-free
Possible muscle/bone involvement
Head and neck 9
Right arm 9
Left arm 9
Trunk 36
Left leg 18
Right leg 18
Perineum 1
Adequate for initial assement of adult
More accurate
Patients age in proportion to body-area size
Zone of coagulation Coagulation affect
Zone of statis Decreased perfusion, edema formation 24-48 hrs
Zone of hyperemia Increased blood flow from inflammatory process
Emergent (resuscitative)
Acute (wound healing)
Rehabilitative (restorative)
Onset of burns Fluid remobilization
**24-48 hours
Purpose: Replace fluid loss
Greatest threat Hypovolemic shock
Foley catheter inserted to determine renal status
Burns exceeding 25% NGT for gastic decompression
Electrical burns ECG
IV meds only for immediate relief
Carbon monoxide poisoning most immediate cause of daeth from fire Suffocation
Aseptic management
Elevate burned extremities
Large bore IV catheters
Burgundy colored urine
Use crystalloids (LR, PNSS, D5NS)
Colloids to expand plasma (Albumin, dextran, FFP)
Do not pop blisters for first 24 hrs Increase infection risk
Tetanus toxoid IM
Hydrotherapy <30 minutes
LR 4 ml x KG body weight x TBSA%
amount first 8 hours; amoung given second 16 hours
Topical chemotherapy
No painful dressing changes
Visible for assessing
Not suitable for hands and feet (might adhere together)
Difficult to control body temperature
Difficulty transferring
Silvadene**, silver nitrate, sulfamylon
Topical chemo wrapped with gauze
Check circulation and constriction
Pain
Pallor
Pulselessness
Paresthesia
Paralysis