1. Management & Care of Burn Patients

2. Prevention of Burns Fire extinguishers and smoke alarms Keep emergency phone numbers by phone Have family exit plans for fires Teach to stop, drop, and roll Store lighters and matches aware from childrenand those unable to protect themselves Reduce water heater to < 120 degrees 3. Prevention of Burns Avoid sun exposure between 10am and4pm, use sunblock, and protective clothing Avoid tanning beds Avoid smoking in bed and when drinkingETOH or sedating medications 4. What is a burn? Injury to body tissue due to Heat Chemicals Electric current Radiation Effects of the injury are dependent upon Burning agent Duration of contact Type of tissue injured 5. Mortality Rates Highest among 4 year old and yongerchildren Over age 65 6. Types of Burns Thermal (most common) Flame, flash, scald, or contact with hot objects Chemical Acids, alkalis, and organic compounds Damage to eyes as well as skin Cold Thermal (Frostbite) 7. Types of Burns Smoke and Inhalation Injury Carbon Monoxide Poisoning cherry red skin color and may not have other injuries Inhalation injury above the glottis (upper airway) Redness, blistering, and edema leading to obstructed airway Suspect if facial burns, singed nasal hair, painful swallow, andburns around chest and neck Inhalation below the glottis (lower airway) Usually chemicals Signs of pulmonary edema and Acute Respiratory DistressSyndrome (ARDSbut may not appear until 12-24 hours afterburn 8. Types of Burns Electrical If current passes through vital organs there aremore life-threatening results Determine contact points Risk of dysrhythmias for 24 hours, cardiacarrest, severe metabolic acidosis, andmyoglobinuria which may lead to acute renalfailure 9. Treatment of Burns Related to the severity of the injury Depth of burn Extent of total body surface area (TBSA) burned Location of burn Patient risk factors Based on the severity patients can either betreated at any hospital or must be send to aburn center (Table 25-3 p.475.) 10. Depth of Burn Partial-thickness First and second degree Epidermis and dermis Partial-thickness pink to cherry-red and are wet andshiny with exudate; may have intact blisters and arepainful to touch and exposed air 11. Depth of Burn Full-thickness Third and fourth degree All skin layers Full-thickness appear dry and waxy white todark brown/black with minor sensation due tonerves being destroyed 12. Extent of Burn TBSA measurement Rule of 9s (Fig. 25-4 p. 476) Each side of leg = 9% Each side of arm = 4.5% Front or back torso = 18% Front or back head = 4.5% Genitalia = 1% Irregular burns Patients hand size is 1% 13. Location of Burn Face, neck, and cirumferential burns tochest/back may cause respiratory distress due toedema and obstruction possible inhalationinjury also Hands, feet, joints, and eyes problemsmaintaining function during healing Circulatory compromise distal extremity;compartment syndrome assess Color, Motion, andSensation, pulse to extremities Ears and nose high infection rate 14. Patient Risk Factors Older adults heal slower Poor prognosis ifcardiovascular, respiratory, or renal diseasedue to demands burns have on the body Diabetes and PVD impaired healing 15. Pre-hospital Care Remove from source of burn Stop burning process 10% or electrical or inhalation A patency and soot near nares/tongue, singedhair, dark membranes B check breathing C check pulses and elevate burned limbs to level ofheart 16. Pre-hospital Care Do not cool large burns for more than 10minutes or put ice on burns Leads to hypothermia Chemical burns Flush, flush, flush (20 min to 2 hours) Other injuries may take priority over burns 17. Emergent Phase Time required to resolve immediate, life-threatening problems from burn injury (upto 72 hours) Primary concerns Hypovolemic shock Edema formation Ends when diuresis begins 18. Hypovolemic Shock Massive fluid shift out of cells Second and third spacing May start within 20 minutes of burn injury BP, HR & RR H/H, K Na 19. Edema Formation Inflammatory response Neutrophils accumulate at injury Impairment of immune system 20. Most Common Sign or Unconsciousness orAltered Mental Status Hypoxia Head trauma, history of substanceabuse, sedation or pain medication Most patients are alert and are scared 21. Complications Cardiovascular Shock Circumferential burns act as a tourniquet soneed to cut skin open to allow circulation(escharotomy) 22. Complications Respiratory distress Upper airway obstruction and asphyxia due toswelling Lower airway oxygenation issues (ABGs) Renal Acute renal failure due to hypovolemia Myoglobin and hemoglobin breakdown and getstuck in the kidney tubules 23. Nursing Care During Emergent Phase Airway Management 100% humidified O2 (also treatment for CO poisoning) High fowlers position; reposition every 1-2 hours Cough & Deep Breathe every hour Early intubation (prevents tracheostomy) Ventilatory support (ABG monitoring) Bronchoscopy after smoke inhalation Bronchodilators 24. Nursing Care During Emergent Phase Fluid Therapy 2 large bore IVs if >15% TBSA Central line if necessary LR (initially) or Albumin (after first 12-24hrs) Parkland Formula (Table 25-12 p. 483) foramount to replace may tweak per patient Adequacy of fluid resuscitation best determinedby Urine Output MAP >65, BP>90, HR