1. With Burns, what causes plasma to seep out into tissues?

2. when does the majority of this occur?

3. What happens to VS and why?

4. what happens to UO
1. increased capillary permeability

2. within the first 24 hours

3. fluid volume shifts from vessels to cells prepare for SHOCK

a. pulse increases
b. cardiac output decreases
c. BP drops
d. Respirations increase

4. decreaseseither kidneys are trying to hold, or they are not being

perfused
1. What significant hormones are secreted and why?

2. What is the most common airway injury?

3. Can O2 Sats be used with accuracy with burn victims

4. How do you treat above?

5. Blood test to determine above?

1. hormones secreted with burn victims:
a. epinephrineto vasoconstrict, shunt blood to vital organs
b. ADHto retain water
c. Aldosteroneto retain Sodium and water (to cause blood
volume to )

2. Carbon Monoxide

3. No because CO will bind quicker with hemoglobin and replace O2

causing the appearance of 100% Sat, but the pt will really be hypoxic

4. 100% oxygen

5. Carboxyhemoglobin
1. Why important to determine if burn occurred in open/closed space

2. With burns to face/neck/chest, think what?

3. Estimate Total Body Surface Area of BurnsRule of 9s

1. risk of CO poisoning increased; assess airway, facial hair, soot on
face, coughing up black; w/airway watch for swelling!!!!

2. airway compromiseintubate or trach (least invasive 1stintubate)

3. Rule of 9s
a. Head & neck 9%
b. Trunk front 18%
c. Trunk back 18%
d. Arm (each) 9%
e. Leg (each) 18%
f. Genital 1%
1. Estimate BSA for burns for children

2. one of the most important aspects of burn management

3. Give this to burn pt after the first 24 hours and why

1. Children & burn surface
a. Head & neck 21%
b. Chest & stomach 13%
c. Back 13%
d. Buttocks 5%
e. Arm (each) 10%
f. Leg (each) 13.5%
g. Groin 1%

2. Fluid replacement!

3. Albuminwill hold onto fluid in the vascular spacefluid replacement

a. Vascular volume
b. Kidney perfusion
c. BP
d. CO
1. Caution about giving burn victim albumin

2. Parkland Formulafluid therapy for the first 24 hours

1. Cautions:
a. Vascular volume will causing
b. Workload of heart to which could cause
c. Decreased kidney perfusion
d. Could cause fluid volume excess causing
i. Crackles in lung soundsposterior bases
ii. Measure CVP hourly
2. based on time of injurynot when tx started
a. 1st 8 hours = of total volume
b. 2nd 8 hours = of total volume
c. 3rd 8 hours = of total volume
d. to calculate fluid replacement, need to know pts weight in
kgs and TBSA affected
1. If pt is restless, could mean?

2. To determine if pts fluid volume is adequate, choose weight or UO?

3. Pt has order for morphine: 2 4 mg of morphine IV Q 2 hrs prn pain. If

pt is saying pain 4/10 what dosage give the pt?

4. Why is pt given
a. Tetanus Toxoid
b. Immune globulin
1. fluid replacement is inadequate, pain or hypoxia: hypoxia is priority

2. UOis quicker

3. 2always start with the lesser

4. For immunity
a. Active immunitytakes 24 wks for immune system to make
b. Passive immunitygives immediate protection