Term
| Which type of burn is caused by flame, flash, scald, or contact with hot objects? |
|
Definition
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|
Term
| Which type of burn results from tissue injury and destruction from acids, alkalis, and organic compounds? |
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Definition
|
|
Term
| Why can alkali burns be more difficult to manage than acid burns? |
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Definition
| alkalis are not neutralized by the skin and tissue as readily as acids are |
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Term
| What type of damage is caused by a smoke and inhalation injury? |
|
Definition
| damage to respiratory tract |
|
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Term
| What usually protects the respiratory mucosa from smoke and inhalation injury? |
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Definition
| the vocal cords and glottis |
|
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Term
| What is the mechanism by which carbon monoxide poisoning causes harm? |
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Definition
| carbon monoxide displaces oxygen on the hemoglobin causing hypoxia and ultimately death |
|
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Term
| Carbon monoxide poisoning becomes fatal when the percentage in the body becomes greater than what? |
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Definition
|
|
Term
| What is the skin indicator with carbon monoxide poisoning? |
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Definition
| skin becomes bright cherry red |
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Term
| How long after an inhalation injury can pulmonary edema occur? |
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Definition
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Term
| When pulmonary edema occurs following a burn injury what possibly will it present as? |
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Definition
|
|
Term
| What offers the most resistance to an electrical burn? What offers the least resistance? |
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Definition
most - fat and bone
least - nerves and blood vessels |
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Term
| What causes the most life threatening effects d/t an electrical burn? |
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Definition
| if the current passes through a major organ |
|
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Term
| What is the term for damage from an electrical burn that is under the skin? |
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Definition
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Term
| What are the two reasons a person may suffer a fracture with an electrical burn? |
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Definition
| fall or because an electrical burn can cause muscle contractions so forceful that it fractures a bone |
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Term
| What possibly fatal cardiovascular effects can occur as a result of an electrical injury? |
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Definition
| immediate cardiac standstill or V-Fib; dysrhythmias can occur spontaneously during the first 24 hrs s/p injury |
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Term
| What metabolic state can result from an electrical injury? |
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Definition
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Term
| What renal problem may result from an electrical injury? |
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Definition
| myoglobinuria; the released myoglobin from muscle damage is transported to the kidneys and can mechanically block the renal tubules because of their large size causing acute tubular necrosis and eventually acute renal failure |
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Term
| What are the 4 factors that determine the severity of a burn injury? |
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Definition
1. depth of burn
2. extent of burn (TBSA)
3. location of burn
4. pt risk factors |
|
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Term
| What layer of skin is included in a superficial partial thickness burn? |
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Definition
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Term
| What layers of skin are included in deep partial thickness burns? What degree burns are these? |
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Definition
-epidermis and dermis
-1st and 2nd degree |
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Term
| What layers of skin are included in full thickness burns? What degree burns are these? |
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Definition
-down to the fat, muscle, or bone
-3rd and 4th degree |
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Term
| Burns that cover greater than what percent TBSA should be referred to a burn center? |
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Definition
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Term
| Burns to what certain body parts should be referred to a burn center? |
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Definition
| face, hands, feet, genitalia, perineum, or major joints |
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Term
| At what degree of burn should the pt be referred to a burn center? |
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Definition
|
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Term
| Which type of burns should be referred to a burn center? |
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Definition
| electrical, chemical, and inhalation |
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Term
| What are two examples of a superficial partial thickness burn? |
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Definition
| sunburn and quick heat flash |
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Term
| What will a 1st degree burn look like? |
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Definition
| erythema, blanching to pressure, pain and mild swelling, no vesicles or blisters (may blister and peel after 24 hrs) |
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Term
| What will a 2nd degree burn look like? |
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Definition
| fluid filled vesicles that are red, shiny, and wet if ruptured; severe pain caused by nerve injury, mild to moderate edema |
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Term
| What will a 3rd or 4th degree burn look like? |
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Definition
| dry, waxy white, leathery, hard skin, visible thrombosed vessels, no pain d/t nerve endings destroyed |
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Term
| What is the ultimate treatment to "cure" a full thickness burn that is not required for a partial thickness burn? |
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Definition
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Term
| What are the values assigned to the body parts for the "Rule of Nines"? |
|
Definition
Face - 4.5% front 4.5% back
Arms - 4.5% front 4.5% back
Torso - 18% front 18% back
Groin - 1%
Legs - 9% front 9% back |
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Term
| What are the 3 phases of burn management? |
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Definition
| Emergent (resuscitative); acute (wound healing); rehabilitative (restorative) |
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Term
| What immediate care should be performed for a small thermal burn (<10% TBSA)? |
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Definition
| cover area with a clean, cool, tap water-dampened towel |
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Term
| Cooling of a small thermal injury within what time immediately following the burn minimizes the depth of the injury? |
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Definition
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|
Term
| How long should large burns be cooled immediately following injury? |
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Definition
| less than 10 minutes; longer can lead to hypothermia |
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|
Term
| If a large burn is submersed in cool water or covered with ice immediately following injury what can possibly result? |
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Definition
| hypothermia and vasoconstriction of blood vessels |
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Term
| What should be done with the burn victims clothing immediately following a burn? |
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Definition
| remove burned clothing; leave adherent clothing to be removed in the hospital; |
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Term
| What should the burn be wrapped in immediately after cleansing while transporting the pt to the hospital? |
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Definition
| a dry, clean sheet or blanket to prevent contamination and provide warmth |
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Term
| What are the initial steps taken immediately following a chemical burn? |
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Definition
| remove the solid particles from the skin and remove clothing that is contaminated; flush the affected area with copious amounts of water for 20 minutes to 2 hrs |
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|
Term
| How long after a chemical burn can tissue destruction continue? |
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Definition
|
|
Term
| What is the initial intervention for a pt with carbon dioxide intoxication? |
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Definition
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|
Term
| What is the time frame for the emergent phase of burn care? |
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Definition
| time required to resolve the immediate life-threatening problem and lasts until fluid mobilization and diuresis begins; usually 72 hrs |
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Term
| What percent TBSA burn indicates the use of IV access and Foley insertion? |
|
Definition
| greater than or equal to 15% |
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|
Term
| The the burned limb be flat, elevated, or depressed? |
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Definition
| elevated; to help prevent edema |
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Term
| What are some interventions specific to inhalation burns? |
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Definition
-provide 100% humidified oxygen
-obtain ABGs, carboxyhemoglobin level, and chest x-ray
-anticipate need for fiberoptic bronchoscopy or intubation |
|
|
Term
| What is the greatest initial threat to life following a major burn? |
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Definition
|
|
Term
| What causes hypovolemic shock after major burns? How quickly following the burn can shock occur? |
|
Definition
-increased capillary permiability
-as quickly as 20 mins s/p burn |
|
|
Term
| What is the term for fluid accumulation in the interstitual space? |
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Definition
|
|
Term
| What is the term for fluid accumulation where fluid is rarely or never found? |
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Definition
|
|
Term
| What are examples of 3rd spacing? |
|
Definition
| exudate, blister formation, or edema in non-burned areas |
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|
Term
| Where does thrombosis occur that impairs circulating RBCs? |
|
Definition
| in the capillaries of burned tissue |
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|
Term
| What happens to the hematocrit following a burn? |
|
Definition
-initially hematocrit is high d/t hemoconcentration r/t fluid loss
-following fluid replacement hematocrit will be low d/t dilution |
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|
Term
| Following a burn what happens to sodium and potassium? |
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Definition
-sodium shifts to the interstitial space and remains there until edema ceases
-potassium shifts out of injured cells into circulation |
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|
Term
| What happens to the burn victims hematocrit? |
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Definition
| initially will be high d/t fluid loss; following fluid resuscitation will be low d/t dilution |
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|
Term
| What effect is noticed in the WBCs of a burn victim? |
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Definition
| defects occur in the function of WBCs |
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Term
| What effect is noticed in the abd of a burn victim? |
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Definition
| slowed to absent bowel sounds; possible ileus |
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Term
| What is the most likely cause of unconsciousness or altered mental status in a burn victim? |
|
Definition
| hypoxia from smoke inhalation |
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|
Term
| What are the 3 most commonly affected organ systems of a burn victim? |
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Definition
| cardiovascular, respiratory, urinary |
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|
Term
| What are the 2 major cardiovascular complications most commonly noted in the burn victim? |
|
Definition
| dysrhythmias and hypovolemic shock |
|
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Term
| What is an escharotomy and what is it used to treat? |
|
Definition
| it is an incision or a series of incisions made by the physician to treat circumferential burns that make breathing easier or allow circulation to extremities |
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|
Term
| What causes sludging in the burn victim? |
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Definition
| increased blood viscosity and impaired microcirculation is impaired d/t damaged capillary systems |
|
|
Term
| How is sludging corrected? |
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Definition
|
|
Term
| What can be used to confirm a lower airway inhalation injury? |
|
Definition
| fiberoptic bronchoscopy and carboxyhemoglobin blood levels |
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|
Term
| How long after a burn can changes still occur that will be noted on the chest xray? |
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Definition
|
|
Term
| What 2 complications can result from too vigorous fluid resuscitation? |
|
Definition
| heart failure and pulmonary edema |
|
|
Term
| Is the burn pt at an increased risk for VTE? |
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Definition
|
|
Term
| How does hypovolemia ultimately damage the kidneys? |
|
Definition
| hypovolemia causes decreased blood flow which leads to renal ischemia which leads to acute renal failure |
|
|
Term
| How can full-thickness and electrical burns cause renal damage? |
|
Definition
| myoglobin (from muscle cell breakdown) and hemoglobin (from RBC breakdown) are released into the bloodstream and occlude renal tubules |
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|
Term
| How is the occlusion of renal tubules by hemoglobin and myoglobin treated? |
|
Definition
|
|
Term
| How soon after suffering a major burn to the neck and face should a pt be intubated? |
|
Definition
|
|
Term
| How soon after a suspected smoke inhalation injury should the pt receive a fiberoptic bronchoscopy? |
|
Definition
|
|
Term
| What are the treatments to promote oxygenation of the burn pt who is not intubated? |
|
Definition
-100% humidified oxygen
-high Fowlers position
-cough and deep breathe q 1 hr
-reposition q 1-2 hrs
-chest PT and suction PRN |
|
|
Term
| What is the the Parkland formula for fluid replacement? |
|
Definition
4 mL/kg/%TBSA; 1/2 given in first 8 hrs 1/4 given over each of next 2 8 hrs
-time starts at time of injury |
|
|
Term
| What is the Brooke formula for fluid replacement? |
|
Definition
2 mL/kg/%TBSA; 1/2 given in first 8 hrs 1/2 given over next 16 hrs
-time starts at time of injury |
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|
Term
| At what percent TBSA should 2 large bore IVs be inserted? |
|
Definition
|
|
Term
| At what percent TBSA should a central line be considered? |
|
Definition
|
|
Term
| How soon after injury can colloids be started and why the delay? |
|
Definition
| 12-24 hrs; after this time the colloids will stay in the vascular space and pull fluid back in |
|
|
Term
| What is the amount of colloids that should be infused in the 2nd 24 hrs? |
|
Definition
|
|
Term
| What is the most commonly used parameter to assess adequacy of fluid replacement? |
|
Definition
UOP of 0.5-1.0 mL/kg/hr
or 75-100 mL/hr for electrical burn with evidence of hemoglobinuria/myoglobinuria |
|
|
Term
| What are the CV factors used to assess adequacy of fluid resuscitation? |
|
Definition
-MAP greater than 65
-systolic greater than 90
-HR less than 120/min |
|
|
Term
| What do partial thickness burns look like? |
|
Definition
| pink to cherry red; wet and shiny with serous exudate; possible blisters |
|
|
Term
| What do full thickness burns look like? |
|
Definition
| dry and waxy white to dark brown/black |
|
|
Term
| Burn pt shower water shouldn't exceed what temperature? |
|
Definition
|
|
Term
| How long can some of the newer antimicrobial dressings be left in place? |
|
Definition
|
|
Term
| Describe the open method of wound dressing. |
|
Definition
| the burn is covered with a topical antimicrobial and no dressing |
|
|
Term
| Describe the closed method of wound dressing. |
|
Definition
| sterile gauze dressings are impregnated with topical antimicrobial and changed every 12-24 hrs or up to every 14 days |
|
|
Term
| What should you wear when removing dirty dressings and washing the dirty burn wound? |
|
Definition
|
|
Term
| What should you wear when applying ointment and sterile dressings to the burn? |
|
Definition
|
|
Term
| What temperature should the room of a burn pt be kept? |
|
Definition
|
|
Term
| Why is the face normally not wrapped following a burn? |
|
Definition
| because the face is highly vascular and subject to a great amount of edema |
|
|
Term
| Why should the pt with ear burns not use a pillow? |
|
Definition
| ears are poorly vascularized, need to be protected from pressure, and could stick to the pillow |
|
|
Term
| How should a burned hand be positioned? |
|
Definition
| elevated and splinted to a position of function |
|
|
Term
| How soon is physical therapy began? |
|
Definition
|
|
Term
| What are the 4 benefits of early ROM for the burn pt? |
|
Definition
-mobilizes fluid back into the vascular space
-maintains function
-prevents contractures
-reassures pt movement is still possible |
|
|
Term
| What are the 3 reasons analgesics should be given IV to the burn pt? |
|
Definition
-onset of action is faster
-GI function is slowed or impaired
-IM injections won't be absorbed; this can lead to pooling and overdose when fluid shifts back |
|
|
Term
| If the burn pt hasn't received a tetanus shot in ____ years, a vaccination should be considered. |
|
Definition
|
|
Term
| Why are systemic antibiotics not typically used in the burn pt? |
|
Definition
| because there is poor or no blood supply to the wound so the medicine will not be supplied to the wound |
|
|
Term
| What type of dressing can be left in place from 3-14 days? |
|
Definition
|
|
Term
| In what situation should systemic antibiotics be used with a burn pt? |
|
Definition
|
|
Term
| What nutritional supplements should be added for the burn pt? |
|
Definition
| supplements high in calories or milk shakes; also protein powders and supplemental vitamins |
|
|
Term
| What should the feeding rate be started at for a burn pt? How quickly should the goal rate be reached? |
|
Definition
-began slowly at 20-40 mL/hr
-aim to reach goal within 24-48 hrs |
|
|
Term
| What events determine the beginning and end of the acute phase of burn treatment? |
|
Definition
-begins with diruesis and mobilization of fluid
-ends with burns being covered with grafts or wounds healed |
|
|
Term
| In what direction will a burn heal? |
|
Definition
|
|
Term
| What must be removed for re-epithelialization to occur? |
|
Definition
|
|
Term
| How soon will a partial thickness burn heal? |
|
Definition
|
|
Term
| A burn pt will prefer to assume a flexed posture, why can this be harmful? |
|
Definition
| contracture can occur with wound healing |
|
|
Term
| What is the best way to prevent Cushings ulcer? |
|
Definition
| feeding the pt as soon as possible |
|
|
Term
| Is there an increase or decrease in glucose levels during the acute burn phase? |
|
Definition
|
|
Term
| Is there an increase or decrease in insulin production with the burn pt? |
|
Definition
| increase; however insulin's effectiveness is decreased |
|
|
Term
| What is used to remove the old antimicrobial agent and loose necrotic tissue? |
|
Definition
| soap and water or normal saline moistened gauze |
|
|
Term
| What is the best way to evacuate blebs from the graft site? |
|
Definition
| aspiration with a tuberculin syringe |
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