Summary Synthesis test 4 Care of patients with burn injury – 11 questions

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Synthesis test 4
Care of patients with burn injury – 11 questions
Introduction
• Depending on the extent, amount of total burn surface, depends on whether they have systemic or just
local problems
• Most of the time they require critical care and extensive rehab
• Highest risk for burns—children and the elderly o generally, children under 4
o Most occur when cooking, bathing-scalding hot water, using electrical appliances
• Decrease burn injuries— o sprinklers, smoke/co detectors, flame resistant pajamas/child clothing,
public building codes
• thermal burns—
o Scalding, thick liquids, flames
• Chemicals burns—
o Acids, corrosives, ingestion of chemicals, inhalation (graniteville chlorine spill)
• Electrical burns— o lightning
• When someone gets burned… ( first 24-48 hours ) o lots of pathophysiology in the body is affected o
fluid shifts—main stay of burn resuscitation is administration of fluids
 rapid fluid shifts into the tissues, goes out of the intravascular system and into the tissues
– can lead to hypovolemic shock bc of the fluid leaking into the tissues
o Initially there is an increase in hgb level, but once the fluid goes back into the intravascular
system, the hct and hgb decreases
 Hence why these burn patients need blood o hyperkalemia,
hyponatremia o decreases in cardiac output
o Decrease in right atrial pressure (central venous pressure)
o Decrease is pulmonary wedge pressure
o Initially, hr tries to compensate and increases (tachycardic), the vessels constrict and peripheral
pulses are generally weak to absent (absent in large burns)
o Skin is the largest organ of the body
 So, thermal regulation is lost
 Temperature changes due to heat loss—patient becomes hypothermic
o higher energy requirements—
 Body needs more energy to try and work on healing and keeping warm
o If this is not treated and treated properly/timely, the patient will not survive

Burn types
• Classification of burns (will have to identify on test) – depends on depth of burn, amount of tissue
damage and extent of body surface that’s affected (tbsa- total body surface area).
o superficial (1st degree)
 Epidermis is generally destroyed and maybe part of the dermis (but
not always the dermis)
 Clinical manifestations—  think of a sunburn—

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• Very painful, red, generally no blisters (but may have some), no scarring
 generally heals within 7-10 days
 Treatment—
• Soothing ointments (aloe, lidocaine spray), otc oral pain medicine, cool compresses, hydration
• No er trip
o Partial-thickness (2nd degree)
 Epidermis and upper and deeper part of dermis are destroyed
 Clinical manifestations—
• Pain, blisters, redness, may be weeping, looks worse than superficial/1st degree
burns
 Can come from scalds, hot liquids
 Generally takes 14-21 days to heal (2-3 weeks)
 Depends on tbsa whether you need to get extra treatment or care—
• May have a physician look at it, but if not covering a large surface area, then may
not have to go to the er quickly
o Full-thickness (3rd degree)
 Epidermis, dermis, and subcutaneous tissue is destroyed
 May even involve some connective tissues and muscles
 Clinical manifestations—
• No pain, insensate, nerve fibers have been destroyed
• Can be red, white, or brown but tends to look black, charred and leathery
• Generally, comes from prolonged exposure to hot liquids, chemicals, or electrical
current
• Tx: requires skin grafting
o Fourth degree
 Still a full thickness, plus more (fat, fascia, muscle, bone)
 Includes muscle and bone, destroyed  clinical manifestations—
• Shock, microgloburia, burn will always look charred, hemolysis, red pigment in
urine and bone cell destruction
 Tx:
• May require amputation
• Skin grafting will definitely be required but sometimes the burn is so severe that
skin grafting will not help
o Patients can have more than one level of burn at the same time
o For child abuse or accident—look at the pattern of the burn, lineation, story told
 Child abuse is normally a more clearly, delineated burn, demarcation is clear
determining total body surface area (tbsa)—
• Rule of 9’s (know this method for the test – will have to calculate)
• <20% tbsa  local response
• >30% tbsa  local and systemic response (fluid/electrolyte shifts, respiratory distress)
• head – 9%
• Anterior chest – 18%
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• Posterior chest – 18%
• L arm – 9%
• R arm – 9%
• Peritoneum – 1%
• L leg – 18%
• R leg – 18%




o if you have a patient that has both legs burned in entirely—
 Tbsa 36%
o If they have burns from the knee (one knee) down—
 9%
o If they have one elbow burned down to the hand (one sided)—
 4.5 %
o Front of head/neck counts as 4.5% and back of head/neck counts as 4.5% for a circumferential
total of 9%
o Perineal-
 1%
o Posterior/back-
 18%
o Anterior/chest-
 18 %
o Both arms, circumferential—
 18 % - 9% each arm all the way around (half arm 4.5% or only one side of arm 4.5% )
• Lund and browder method
o More accurate and precise – recognizes % as it relates to age and developmental level o
normally for pediatric patients
 Infant has a big head and no neck, so the head is bigger than the chest; so if you have an
infant the head is the largest % because it’s the largest portion of the infant (infants head
Would be 18% and anterior/posterior chest would be 9% each)
o Takes in to consideration the age and body proportions of the patient
• Palm method (on test) o used
for scattered burns
o Use the size of the patients’ own palm
o Each palm is 1%
 A burn on the hand, the foot, and the arm—
• 3%
Burns

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