Burns

what is the most common type of burn

thermal

what determines the severity of a thermal burn

temp and duration of contact with heat

what is the typical cause of chemical burns

acid

what is the risk/complication of smoke inhalation

carbon monoxide poisoning and asphyxiation

what are the physical characteristic of electrical burns

entry and exit point, muscular and neurological damage, necrosis and tissue death

what are the characteristics of 1st degree burns (superficial partial thickness)

erythema with blanching

what are the characteristics of a second degree burn (superficial deep)

blisters, skin appears red, shiny, and wet, severe pain

what are the characteristics of 3rd degree burns (full thickness)

involves nerves, vasculature, muscle, and bones, skin is dry, waxy/leathery, and white, no pain

TBSA head/neck (front and back)

9%

TBSA front of arms and hand

4\.5%

TBSA back of arms and hand

4\.5%

TBSA chest

9%

TBSA abdomen

9%

TBSA upper back

9%

TBSA lower back

9%

TBSA front of legs/feet

9%

TBSA back of legs and buttocks

9%

TBSA genitals

1%

complications of circumferential burns

impairs circulation (leads to ischemia and eschar) and respirations (impaired ability to expand chest)

complications of burns to the face, neck, and chest

impaired airway and breathing

complications of burns to the hands, feet, joints, and eyes

impairs self care (conractures)

complications of burns to the nose, ears, perineum, and buttocks

risk for infection (cartilage and lack of circulation in nose/ears, contamination from urine or stool in perineum/butt)

how does peripheral vascular disease and DM increase a pts risk for experiencing complications from burns

delayed wound healing

how does kidney disease increase a pts risk for experiencing complications from burns

burns that involve the muscle (electrical) release large amounts of myoglobin that filter through the kidney

how does heart disease increase a pts risk for experiencing complications from burns

there is increased demands on the heart due to fluid and electrolyte shift

what populations are at a grater risk to experience complications from burns

elderly and children

what does the emergent phase of a burn occur

24-48 hours after burn

what is the highest priority during the emergent phase of a burn

fluid and electrolyte shift (risk for hypovolemia)

what causes hypovolemia in the emergent phase of a burn

fluid shifts out of blood vessels and into the interstitial spaces causing blisters and volume depletion

what is the focus of tx during the emergent phase of burns

fluid replacement, airway (early intubation)

when does the acute phase of burns occur

(weeks to months after burn) when fluid starts to shift back into the vascular space until the burns are healed or covered with grafts

what are the characteristics of burns during the acute phase

eschar separation and epithelialization occurs along with excising, debridement, and grafting

what is the most common complication during the acute phase of a burn

risk for infection

what is the focus of treatment during the acute phase of a burn

pain management, PT and OT begin

when does the rehabilitative phase begin

burns are nearly healed and the pt begins engaging in self care

what is the most common complication during the recovery phase of a burn

contractures

pt education during the recovery phase of a burn

discoloration will go away with time, contour is controlled with pressure garments

fluid and electrolyte changes during the emergent phase of a burn

albumin, fluid, and K+ leave cells, Na moves into cell

fluid and electrolyte changes during the acute phase of a burn

Na leaves cell and returns to circulating blood along with water, K+ enters cell

what causes hypovolemic shock in burn patients

increased capillary permeability causes a mass shift of fluids out of blood vessels (third spacing)

how do we treat/prevent hypovolemic shock in burn patients

give fluids

how should you administer total fluid resuscitation requirements for the first 24 hours

1/2 in first 8 hours, 1/4 in second 8 hours, 1/4 in third 8 hours

what indications fluid resuscitation is successful for burn patients

urine output 30-50cc/hr (75-100 for electrical), SBP 90-100 (MAP>65), HR

why do patients with electrical burns need to produce more urine that other burn types

electrical burns cause necrosis and muscle injury which releases a large amount of myoglobin putting extra strain on the kidneys

how is the airway maintained in acutely burned patients

early intubation and ventilation with PEEP, escharotomy of chest wall

what burn complication impairs airway

inhalation injuries cause alveolar damage and interstitial edema which prevents gas exchange

what is an escharotomy

incision through the tissue to release pressure and allow blood flow to prevent compartment syndrome and ischemia

what are the main complications seen during the emergent phase of a burn

impaired airway, hypovolemia shock, AKI

what are the main complications during the acute phase of a burn

infection, impaired airway, hypovolemic shock, neuro damage from hypoxia or electrolyte imbalances, increased BG

what are the main complications seen during the recovery phase of a burn

contractures, scarring, emotional

what are the nutritional needs of a burn patient

fluids, up to 5,000 calories due to increased metabolism, vitamins and iron, NGT at first then progress to oral once bowel sounds return

what is an autograft

skin graft from another site on the patients body that is permanently applied to the burn

what promotes healing in a burn patient

vitamin c, zinc, copper

how do we minimize scarring in burn patients

pressure garments, ROM, elastic bandage, moisturizing, sun protection