Term
| 4 categories of burns based on depth of tissue destruction |
|
Definition
1) Superficial
2) Partial thickness
3) Deep Dermal
4) Full thickness |
|
|
Term
| First degree burns (_______), painful. May or may not _______ and ______. Reddened and dry. Minimal or no _____. They should be _____ and treated with ____ ____ and _____ ____. Heals in a ____ _____ to a week. Example ______. |
|
Definition
Epidermis
Painful, may or may not peel and blister. Minimal or no edema. Cleanse and treat with soothing lotion and pain meds. Heals in a few days to a week: sunburn |
|
|
Term
| Partial thickness/ ______ degree burns are caused by ______, _______, ____. The burn extends to the ______. Uniformly _____/_______, moist, ______, very painful with ______. Sensetive to ____ _____. Should heal in ___-___ weeks with some _____ and _____ changes such as _________. _______ may convert it to full thickness. This type of burn requires _____ _____. |
|
Definition
Second degree from scalds, flames, contact
Extends to the dermis
Uniformly pink/red moist, edematous, very painful with blisters.
Should heal in 2-4 weeks with some scarring and color changes of depigmentation.
Infection may convert it to full thickness.
Requires frequent care! |
|
|
Term
| Deep dermal burns extend ______ into the _____. The color is _____, mottled ____ and _____ or ______. Fairly ____ and may not be as ______ as partial thickness. Sensitive to _____ air. Causes _______. Difficult to differentiate from ____ _____. Topical ______ and frequent ______ ______ until ____ ____ _____. |
|
Definition
Extends deeper into the dermis.
White, mottled white and pink or red.
fairly dry.
May not be as painful as second degree/partial thickness burn.
Sensitive to cold air.
Scarring.
Difficult to differentiate from 3rd degree burns.
Topical antimicrobials and frequent dressing changes until excised and grafted. |
|
|
Term
| Full thickness/ ______ degree burns go through the ____ into _____ ______ and sometimes into _______ ______. Heal by _______ and _______ growth-scarring. |
|
Definition
| Third degree, through the dermis to subcutaneous fat and sometimes into deep structures. Heal by contraction and epithelial growth-scarring. |
|
|
Term
| Causes of 3rd degree burns |
|
Definition
| Electrical, molten metal, contact from mufflers, tar, flame, prolonged exposure to hot liquids and electrical current, chemical contact. |
|
|
Term
3rd degree burns clinical picture.
Wound appears ____, _____ white, ______ or ________. Skin is ____ with ____ exposed.
Wound can turn from ______ to ____ to ______ to ______. Pain is _______ because nerve fibers are _______.
____uria may be present due to _____ damage and _____ destruction.
_____ is present because of destruction of ______, ____ shifts into the ______ spaces |
|
Definition
Wound appears dry, pale white, leathery or charred.
Skin is broken with fat exposed.
Wound can turn from white, to red, to brown, to black
Pain free because nerve fibers are destroyed
Hematuria due to muscle damage (myoglobin), RBC destruction
Edema is present because of destruction of capillaries-- fluid shifts into interstitial space |
|
|
Term
| Recuperative course for 3rd degree burns |
|
Definition
| Eschar sloughs off, grafting is necessary, scarring and contractures, loss of digits or extremity, loss of capillary integrity (fluid shifts out of vascular space into interstitial space) |
|
|
Term
| A fourth degree burn is one that extends through the ____ ______ of the skin and into _____ _____, _____, ____ and ____. |
|
Definition
| Through the full thickness and into underlying bone, fat, muscle and tendons |
|
|
Term
| 3rd and 4th degree fluid shift. |
|
Definition
Damaged blood vessels leak fluid into the interstitial space. Leaking plasma and protein causes decreased blood volume and pressure.
Causes edema!!!!! |
|
|
Term
| Systemic edema occurs when greater than ___% is burned |
|
Definition
|
|
Term
| Edema can be found up to ___ hours after burns |
|
Definition
|
|
Term
| Edema can lead to ischemia because the skin becomes ____ like a _____ |
|
Definition
|
|
Term
| Patients with extreme burns over >25% of the body are at risk for hyp____volemia, even when ____ is present. |
|
Definition
| Hypovolemia even when edema is present because "the hose has holes in it" and the water is leaking into the intersitial space |
|
|
Term
| Evaporated fluid loss through burn injury may reach __-__L or more over a ___hr period |
|
Definition
| 3-5 L or more over over a 24 hour period |
|
|
Term
__-__ hours post injury, capillary leak stops
__-___hours the diuretic stage begins
____ is usually resolved in __-__days |
|
Definition
24-36 hours, capillary leak stopes
48-72 hours the diuretic stage begins
Edema is usually resolved in 7-10 days |
|
|
Term
____ is a common cardiovascular manifestation in adequately and inadequately resuscitated adults
May be related to _____ as well as ______ |
|
Definition
Tachycardia
Pain
Hypovolemia |
|
|
Term
| Lower airway burns are _____ _____ and this includes burns below the ___ from inhalation of ______ |
|
Definition
more severe, below the glottis/ the voice box
Inhalation of chemicals
Tx is intubation |
|
|
Term
| Upper airway burns occur in the _____ and are caused by breathing in temperatures over ____ degrees or _____ |
|
Definition
Larynx/trachea
Temps over 150 degrees or edema |
|
|
Term
| Cardinal sign of inhalation injury |
|
Definition
|
|
Term
| ____ is the most common cause of inhalation injury |
|
Definition
|
|
Term
| Best indicator of possible inhalation injury |
|
Definition
Personal history: in closed space is the greatest risk
Face or neck burns, singed nasal hairs, dry cough, sooty sputum, ANY SOB, increased RR, O2 stats down are all signs of inhalation injury |
|
|
Term
Thermal inhalation injury
Exception? |
|
Definition
Hot gases or flaming substances
Usually local trauma above the larynx with rapid swelling
Exception: Steam, which effects the upper and lower and is critical! |
|
|
Term
| Asphixiants displace O2, causing _____. Carbon monoxide is odorless, colorless, and binds to _____, forming _____ which competes for _____ |
|
Definition
| Binds with hemoglobin, forming carboxyhemoglobin, which competes for oxygen. Hemoglobin is 250x more drawn to carbon monoxide than oxygen |
|
|
Term
| Most important question to find out in history |
|
Definition
| entrapment? (May indicate upper or lower inhalation injury) |
|
|
Term
|
Definition
duodenal erosion, from gastric binding secondary to massive physiological stress
Symptoms: occult blood, coffee-ground vomittus |
|
|
Term
| _____ and _____ injuries often result from electrical burns |
|
Definition
| cardiac and spinal (due to entrance and exit paths, destroys everything along the way) |
|
|
Term
| Metabolic needs of the burn patient _____. Patient may be on ____ and needs ____ the calories, as well as ____ ____. |
|
Definition
Increase
Double the calories, TPN, vitamins |
|
|
Term
| Leading cause of death in patients with burns |
|
Definition
SEPSIS!!!
First line of defense is broken! |
|
|
Term
|
Definition
|
|
Term
| Calculation for mortality |
|
Definition
Age + % TBSA = mortality
ex: 25 years + 25% TBSA = 50% survival |
|
|
Term
|
Definition
| "degloving," skin is pulled right off |
|
|
Term
| Anyone over the age of ____ is at risk of burns |
|
Definition
|
|
Term
| Southeastern US and ______ have the highest fire-related fatalities |
|
Definition
|
|
Term
| The first 24-48 hours following a burn is the _______ phase. It's important to secure ______, support ________, provide ______, prevent ______, regulate _______, provide _____ ____ |
|
Definition
Emergent phase
Secure airway
Support circulation
Provide comfort
Prevent infection
Temperature
Emotional support |
|
|
Term
| From 48 hours following a burn to _____ _____ is known as the _____ _____. This may last ______ or _____, to ______/ |
|
Definition
48 hrs-wound closure
Acute phase
May last weeks, months, years |
|
|
Term
|
Definition
| Majority of wound closure to the return of the individuals optimum level of functioning |
|
|
Term
| ***Emergent phase, the first thing |
|
Definition
Secure an airway
Oxygen
Support circulation by establishing IV lines. Done in field or RIGHT AWAY in hospital |
|
|
Term
|
Definition
| turn up the heat, blood warmer, iv warmer cover with warm blankets to reduce risk of hypothermia |
|
|
Term
|
Definition
D- Extent of disability
E-Exposure |
|
|
Term
| Pulse ox is 95%. What should the nurse do? |
|
Definition
| Give oxygen ANYWAY, assess depth of respiration. |
|
|
Term
| In addition to automated BP machines, to manage pt's circulation the nurse should take ____ ____, ____ ____ because a ____ ____ ____ could be a first sign of _____ not yet picked up on the machine. |
|
Definition
Take manual BP, peripheral pulses
Thready pulse--> Shock
Bounding--> Fluid overload |
|
|
Term
| Always assess the area _____ the burn for signs of _____, and to do ____ checks |
|
Definition
| around the burn to assess for ischemia and CMS checks |
|
|
Term
| No matter what the patient says, all ____ and ____ must be removed because ____ is going to occur |
|
Definition
| All clothing and jewelery because edema is going to occur |
|
|
Term
|
Definition
ABCDE
Includes all things involved in this assessment. All is done during/prior to resuscitation efforts
May be in EMT report |
|
|
Term
Secondary survey
____ to ____ evaluation
______ exam
_____ and _____ studies |
|
Definition
Follows primary survey, after resuscitation efforts well established
Head to toe exam
H&P exam
Radiographic laboratory studies |
|
|
Term
| Initial care for thermal burn |
|
Definition
Cover with clean, dry cloth
NO ICE OR COLD WATER |
|
|
Term
| Initial care for electrical burn |
|
Definition
Cutaneous and internal injury
Cardiac monitor |
|
|
Term
| Initial care chemical burn |
|
Definition
Brush powders from skin
Flush with copious water
Remove contaminated clothing
Eye irrigation
Exposure protection |
|
|
Term
| Always make sure injury matches ____, or call ______ |
|
Definition
injury matches story
Call Social services
Additional xrays to look for further injury |
|
|
Term
| If a burn is electrical always FIND ______ burn |
|
Definition
SECOND BURN
Entrance and exit |
|
|
Term
| ____ status is important for all burn victims. This is part of the _____ survey. |
|
Definition
| Tetanus status. Secondary. |
|
|
Term
| Head to toe, as well as all blood work is part of the _____ survey. |
|
Definition
|
|
Term
| Quick way to estimate burns |
|
Definition
Rule of 9's. 9 to major body surfaces.
Not accurate for infants/children due to larger BSA of head and smaller BSA of legs. |
|
|
Term
Burn center referral criteria
____ degree burns greater than __%
Burns to these locations:
__rd degree burns
Chemical or ______ burns
Burns accompanied by pre-existing medical conditions
Burns accompanied by ____ where burn injury poses great risk of morbidity
Burns to children in hospital without ______ services
Patients with special ____, ____ or rehabilitative needs |
|
Definition
2nd degree greater than 10%
Burns to hands, face, feet, genetalia, perineum, major joints
3rd degree burns
Electrical, chemical, inhalation
Accompanied by pre-existing medical conditions
Accompanied by trauma where burn injury poses great risk of morbidity
Children in hospitals without pediatric services
Patients with special social, emotional or rehabilitative needs |
|
|
Term
| Even ___ degree burns are potentially serious |
|
Definition
|
|
Term
Goal of fluid resuscitation is to maintain ____ ____ and ____ ____ while avoiding complications of _____ or _____ fluid therapy
Next to managing _____ _____ the most urgent need is preventing _____ _____ by replacing lost _____ and ______ |
|
Definition
maintain tissue perfusion and organ function while avoiding the complications of inadequate or excessive fluid therapy
next to managing resp difficulties, most urgent need is preventing shock by replacing lost F&E's |
|
|
Term
|
Definition
| Ringers lactate. Contains all elctrolytes except magnesium. Is isotonic. |
|
|
Term
| Fluid resuscitation formula for adults and older children |
|
Definition
Baxter
RL 2-4mL X kg wt X %TBSA
So for a 31.81lb person with 50% TBSA
2mlx70kgx50%TBS=7000ml/24hrs |
|
|
Term
| Infant and children fluid resuscitation |
|
Definition
RL 3-4mLxkg weight x%TBSA burn
PLUS D5LR at maintenance rate, adjust based on pt response |
|
|
Term
| NEVER give _____ solution to a burn patient |
|
Definition
| hypotonic (1/2 NS), move solutions out of vascular space into cells |
|
|
Term
| Sometimes we give _______ solutions like ______ |
|
Definition
|
|
Term
| Infuse 1/2 of estimate fluid over next _____ post burn |
|
Definition
|
|
Term
| Fluids should be ____, as a steady ____ or _____ in rate Q___min |
|
Definition
| Titrate steady increase or decrease Q15m |
|
|
Term
| Urine output ___ml/hr is great |
|
Definition
|
|
Term
Fluid calculation is an _____!
Increase in fluid needs is common with pre-existing conditions, severe burns |
|
Definition
|
|
Term
Children less than ____kg should have ___ml/kg/hr
Adults are .5ml output per hour |
|
Definition
|
|
Term
| The best guide for resuscitation is _____ |
|
Definition
| Indwelling urinary catheter |
|
|
Term
| ____ is often a result of inadequate resuscitation, associated with decreased ______. Requires more rapud fluid administration. ____ are contraindicated. |
|
Definition
| Oliguria is often result of inadequate resuscitation associated with decreased CO. Diuretics contraindicated. |
|
|
Term
Red pigmented urine is associated with ________ and ______
Cause:
Fluids: |
|
Definition
Myoglobinuria and hemoglobinurua
High voltage elctrical injury or soft tissue injury due to mechanical trauma
MUSCLE DAMAGE
Administer fluids to maintain UOP of 1.0-1.5 ml/kg/hr |
|
|
Term
| ____ needs to be considered if a pt's been intubated for more than ___ days, ____ efforts have failed, pt has a major problem with ______, recurrent______ |
|
Definition
| intubated greater than 7 days, extubation efforts have failed, major problem with secretions, recurrent mucous plugging |
|
|
Term
| When patients are sedated and they have been trached, you should ______ their ____. |
|
Definition
| tie their hands down so they don't pull it out when they wake up |
|
|
Term
| Daily physical therapy prevents ____ and ____ |
|
Definition
| disfigurement and contractures |
|
|
Term
| To avoid withdrawal from mends, ____ meds. Also let patient know about ___ symptoms. |
|
Definition
|
|
Term
| Partial thickness wounds take _____ weeks to heal ____ scarring. _______ and _____ dressings are used. At this point, they do not require frequent ____ ______. These dressings offer wound ____ and relieve _____ |
|
Definition
2-3 weeks without scarring. Biologgical and biosynthetic dressings.
Offer wound closure and pain relief. Does not need frequent changes, does need antimicrobial |
|
|
Term
| With Deep dermal burns _____ dressing changes are need until ______ and _____. |
|
Definition
| Frequent dressing changes until excised and grafted. |
|
|
Term
| Full thickness burns REQUIRE ______ and there will be _____ |
|
Definition
| skin grafts and there will be scarring |
|
|
Term
| Silver-based meds are _______ |
|
Definition
|
|
Term
| ____ is a dermal substitute layer made from bovine tendon collagen. It is protective and is removed ___ weeks after application. Benefit is that it can be ____. |
|
Definition
Integra
2 weeks
Can be stored |
|
|
