total
body surface
area used to
fluid resucitation
calculate the exact
thats needed and
Example
:
recquired
level of care
head and neck 9 % total
W
4 S % front
.
4 Sy baCK
.
client has burns on anterior legs
perineum ,
1% peri
Calculate 1 of TBSA
+
=
Example Pt weigh 100kg
:
19 % TBSA
4MLX100Kg X
=>
.
.
"
W
9
9
7 600mL Within first 24hr
,
in Ehrs
45
45
19TBSA
45
.
remaining
:
3 000mL
,
16 hus
:
another 3, 000 mc
and
18 %
legs
19 % TBSA
CH24
Burn
:
Partial-Thickness
erythema
moderate to severe pain
no fluid vesicles
Sheals
in 7-10 days)
Partial-Thickness (deep
·
d
erythema
painful
·
fluid filled vesicles
heals 14-21 days
Full Thickness
/3 and 4th)
charred appearance
black or white in color (non
dry
blanching)
leathery touch
impaired sensation
Chemical Burn
when touched
·
burning
·discoloration
·
tissue destruction up to Tears
Electrical Burns
·
burn odor
possible
cardiac
myoglobin
and
arrest/dysrhythmias
hemoglobin
released
minimal/absent pain
Smoke and Inhalation
singed hasal/facial
burns to face , neck ,
darkened
·
hoarseness ,
stridor, or
around
soona
mouth
nose
lips
oral/ nasal
Injuries
hairs
membranes
resp
.
changes
Phases of Burn
Management
Emergent Phase (last
Cres ive
hypovolemic shocledema
Tzhus,
immegiate issues
:
(ABCs) airway
,
breathing
are concerns ,
Y
circulation !"
may
pain
hypovolemic shock !
increased
:
Sedatives
ledemals" spacing)
Vitamins
·
blood volume
decreases/ viscosity increases
Most
=
peripheral
resistance
complicated
Cardiovasculae
intubation
morphine/fentanyl.
·
(
begins !
need to take place
I- Zhus after
Management
I analgesics
capillary permeability
blood's find components leal out
dirresis
-
,
Fluid and Electrolyte Shifts
watch for
ends when fivids :
injury
Silvadene
pepcid/protonix
basic Dallin's microbial
systems
e
Respiratory
Urinary
ATN) Acute tubular necrosis
dysrythmias
upper or
·hypovolemic snock
inhalation injuries can look normal
if pt becomes hypovolemic
on chest X-rays
blood flow decreases to the kidneys
circulation can be impaired due to
deep circumferential
burns
/edema
L
ame for the
greater
·
pulse
MAP
·
my arterial line
invalid / burs
pneumonia
:
than 30 %
can
myoglobin and hemoglobin
pre-existing lung
Watch for
released
develop
disorders
*
thermal/chemical
sepsis !
gramaterial
advit eletrical
tachyphea, tachycardia , and
WBC
hallmark of inadequate
fluid resucitation
adult
·
·
blocks renal tubles
w
:
Infection
bs
RENAL ISCHEMIA
ABG but may
PH pt at greater risks
less than 120
greater than
systolic greater than 90
b
Change over time
:
best to measure BP
blc manual is often
airway
Es
sludging impaired microcirculation
*
lower
hypotension
10, 000 and
decreased wine opt
:
30-50m/hr
75-100m2/hr
begins w/
-
Acute Phase
mobilization of
-> extracellular fivid and
subsequent divresis !
ends w/ partial thickness
healed or full thickness my
ski
grafts !
Pain Management
Continuous background
~
IV administration of Opioid
~PCA pump
~slowvenace twice a day
Opioids
Treatment Induced
Acute Phase
hyponatremia
dilutional
labs
·
hyponatremia
:
"water intoxication"
after fluid resucitation,
inappropriate fivid administration
hypokalemia vomiting
:
,
diarrhea ,
prolonged
Pitchen
wo
2 restrict sudium
through
bun wounds
malline
deep
insufficiency
injury
post Op care of Skin Grafts
.
maintain dressing
changes WI
aceptic technique !
should be pink after
S
days
prevent contractures
·elastic bandages placed (omo-I year to
prevent hypertrophic scaning
Skeletal traction used to
non-arg (meditation
deep breathing)
PT and
,
exercise is
OT
Therapy
great awing dressing changes
heck bur pt do not sleep my
with head dangling
pillows or
(hyperextension)
K supplements
muscle
pre-medicate
~
,
apply
custom
Venal failure
:
advenaicortical
graft
rivas
improper tube feeding
alsuction
IV treatment
hyperkalemia
give
,
hypernatremia
or
excess al suction/diarrhea
:
·
splints
and check for
any breakdown
Nutrition
initially
NPO
hypermetabolic and catabolic state !
high protein and high Carbs
don't give icechips/ free water bl may
enctrolyte imbalance
cause
Rehabilitation Phase
complications
contractures
·
·
·
scarring
infection
non-healing burns