Ch 25 – Phases of Burn Management

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3 stages
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emergent – resuscitative acute – wound healing rehabilitative – restorative
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primary focus in acute phase
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wound care but also takes place in emergent & rehabilitative phases
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prehospital care – priority given to
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removing person from source of burn stopping burning process rescuers must protect from injury
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prehospital care – electrical injuries – initial managment
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removal of patient from contact of electrical source
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prehospital care – small thermal burns (=<10%TBSA) – care
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covered with clean, cool, tap water-dampened towel ensures comfort/protection until medical care
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helps minimize depth of injury
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cooling injured area (if small) within 1 minute
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larger burns >10% TBSA or electrical or inhalation burn
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attention on ABCs
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ABCs – Airway
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check for patency soot around nares/on the tongue singed nasal hair darkened oral or nasal membranes
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ABCs – Breathing
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check for adequacy of ventilation
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ABCs – Circulation
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check for presence and regularity of pulses elevate burned limbs above heart to decrease pain & swelling
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preventing hypothermia
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large burns cooled for no more than 10 minutes
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to prevent extensive heat loss
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do not immerse burned body part in cool water
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hypothermia & vasoconstriction of blood vessels occurs when
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covering a burn with ice
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result of covering a burn with ice
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reduces blood flow to injury
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to prevent further tissue damage
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gently remove as much burned clothing as possible adherent clothing should be left in place until in hospital
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to prevent further contamination of wound & provide warmth
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wrap in dry, clean sheet or blanket
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chemical burns – best treated
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removing the solid particles from skin any clothing containing chemical removed to stop continuation of burning process flushed with alot of water irrigate skin anywhere from 20 min to 2 hours postexposure tap water acceptable for flushing eyes exposed to chemicals
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chemical burn – tissue damage how long
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can continue for up to 72 hours after chemical burn
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inhalation agents observe for
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signs of respiratory distress or compromise need to treat quickly & efficiently at scene for survival if CO intoxication suspected – 100% humidified O2
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both body burns & inhalation injuries – where to transfer
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nearest burn center
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emergent phase – other name
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resuscitative phase
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emergent phase – define
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period of time required to resolve the immediate, life-threatening problems resulting from burns
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emergent phase – timeframe
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lasts up to 72 hours from time of burn
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emergent phase – primary concerns
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onset of hypovolemic shock & edema formation
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emergent phase – phase ends when
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fluid mobilization & diuresis begins
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emergent phase – patho – F&E shifts – greatest threat to patient with major burn
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hypovolemic shock
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emergent phase – patho – F&E shifts – hypovolemic shock cause
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massive shift of fluids out of the blood vessels result of increased capillary permeabilty can begin as early as 20 minutes postburn
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emergent phase – patho – F&E shifts – result of capillary permeability
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water, sodium & later plasma proteins (especially albumin) move into interstitial spaces & other surrounding tissue colloidal osmotic pressure decreases with progressive loss of protein from vascular space
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emergent phase – patho – F&E shifts – results of capillary permeability – continued
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results in more fluid shifting out of the vascular space into the interstitial spaces
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fluid accumulation in interstitium termed
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second spacing
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other places fluid flows
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also moves to areas that normally have minimal to no fluid termed third spacing
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examples of third spacing with burns
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exudate and blister formation edema in nonburned areas
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other sources of fluid loss during this period –
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insensible losses by evaporation from large, denuded body surfaces & respiratory system
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normal insensisble loss
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30-50 mL/hr increases in severely burned patient
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net result of fluid shifts & losses is
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intravascular volume depletion
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other manifestations of hypovolemic shock
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decreased blood pressure increased heart rate
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if hypovolemic shock not corrected
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irreversible shock and death
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circulatory status – result
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impaired due to hemolysis of RBCs
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RBCs hemolyzed by
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circulating factors (e.g. oxygen free radicals) released at time of burn as well as by direct insult of the burn injury thrombosis in capillaries of burned tissue causes additional loss of circulating RBCs
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resulting from fluid loss – RBCs
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elevated hematrocrit caused by hemoconcentration
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after fluid balance restored – H&H
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lowered secondary to dilution
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Electrolyte shifts
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Potassium and sodium
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Sodium shifts where
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to intersitial spaces remains there until edema formation ceases
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potassium shift – why
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initially because injured cells & hemolyzed RBCs release potassium into the circulation
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end of emergent phase – capillary membrane
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restored if fluid replacement adequate fluid loss & edema formation cease interstitial fluid gradually returns to vascular space
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diuresis
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noted with low urine specific gravities
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inflammation & healing – patho – burn injury causes
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coagulation necrosis tissues & vessels are damaged or destroyed
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inflammation & healing – patho – result of tissue & vessel damage/destruction
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neutrophils & moncytes accumulate at site of injury fibroblasts & newly formed collagen fibrils appear & begin wound repair wound repair within 6-12 hours after injury
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inflammation & healing – patho – immunologic changes
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widespread impairment of immune system skin barrier to invading organisms destroyed bone marrow depression occurs circulating levels of immunoglobins decreased
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inflammation & healing – patho – where do deficits occur
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WBCs
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inflammation & healing – patho – inflammatory cytokine cascade triggered by tissue damage
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impairs the function of lymphocytes, monocytes, and neutrophils greater risk for infections

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