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Questions and Answers
What is the primary goal of fluid resuscitation in the management of burn injuries?
According to the Parkland formula, what is the recommended fluid type for the first 24 hours after a burn injury?
Which of the following is a common psychological change observed in patients with severe burns?
What is the primary indicator of possible inhalation injury in a burn victim?
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Which of the following nursing diagnoses is most likely to be observed in a patient with severe burns?
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Which of the following is a key component of the Parkland formula for fluid resuscitation in burn patients?
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Which of the following is NOT one of the key emergency interventions for a patient with a chemical burn?
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What is the primary goal of the 'tubbing' or hydrotherapy procedure in burn management?
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Which of the following is the correct sequence for the initial management of an electrical burn?
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Which of the following is the most appropriate initial management for a patient with a minor thermal burn?
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What is the primary purpose of documenting the patient's weight upon admission for a burn injury?
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Which of the following is the primary goal of the 'tangential excision' procedure in burn management?
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Which of the following is NOT a triage criteria for major burns?
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A patient presents with a deep second-degree burn covering 18% of their BSA. How would this burn be classified according to the triage criteria?
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What is the recommended initial fluid resuscitation for a patient with a major burn covering 40% of their BSA?
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Which of the following is a characteristic of a deep second-degree burn?
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In the case of an electrical burn, which of the following emergency interventions is NOT recommended?
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Which of the following documentation elements is NOT essential when caring for a burn patient?
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Study Notes
Initial Assessment and Interventions
- Counting of the first eight hours starts from the time of burn injury
- Minor burns: run the area over water or apply a cold compress, but not directly on the wound
- Pain management: administer medications such as Diclofenac, Tramadol, Nalbuphine, or Morphine
- Tetanus Prophylaxis: administer ATS and TT
- Antibiotics administration: necessary for preventing infections
- Debridement: remove devitalized tissue
- Wound care: apply antimicrobial agent (SILVER SULFADIAZINE), and use a WET to WET DRESSING, covered with dry sterile gauze on top
Emergency Interventions
- Draw blood samples for CBC, ABG, BUN, Crea, and Serum Electrolytes
- Monitor vital signs, I and O, and CVP
- Insert NGT and IFC
- For electrical burns: perform 12 L ECG, and treat fatal dysrhythmias according to ACLS protocol
- For chemical burns: irrigate the wound with copious amounts of water or Plain NSS
- Do not use a weak base (Sodium Bicarbonate) to neutralize burns caused by strong acids
Burn Management
- Nutritional and Surgical Management: DIET: NPO until NABS, but small amounts of isotonic enteral tube feedings can be started within 24 hours to maintain GI function
- HYDROTHERAPY: facilitate cleansing and debridement of the burned area, and promote daily assessment of BSA and ROM exercises
- ESCHAROTOMY: removal of non-viable tissue (eschar)
- TANGENTIAL EXCISION: a procedure using a special blade to slice off thin layers of damaged skin until live tissue is evidenced by capillary bleeding
- BIOLOGICAL DRESSINGS: allograft (cadaver skin)
Systemic Changes in Burns
- Gastrointestinal changes: decreased peristalsis and gastric distention due to SNS response, leading to constipation and risk of gastric and duodenal ulcers
- Psychological changes: body image disturbance, fear, ineffective coping, and hopelessness
Inhalation Injury Assessment
- Monitor for signs and symptoms of carbon monoxide poisoning: headache, visual changes, confusion, irritability, nausea, ataxia, and collapse
- Inspect the oral cavity for blistering lips, singed nasal hair, soot in oropharynx, and dark gray or black sputum
- Listen for hoarseness and crackles (stridor and drooling may indicate intubation)
- Obtain ABG and Carboxyhemoglobin levels
Fluid Therapy
- Use the Parkland Formula for fluid resuscitation
- Administer Plain Lactated Ringer's Solution for the first 24 hours post-burn
- Administer Colloid (5% Albumin) for the second day
- Calculate fluid requirements based on the burn size and weight of the patient
Burn Size and Assessment
- Use the Rule of Nines to estimate the percentage of burned surface area (BSA)
- Major burns: third-degree burns on more than 10% BSA, or second-degree burns on more than 25% adult BSA or 20% child BSA
- Moderate burns: third-degree burns on 2-10% of BSA, or second-degree burns on 15-25% of adult BSA or 10-20% child BSA
- Minor burns: third-degree burns less than 2% of BSA, or second-degree burns on less than 15% of adult BSA or 10% child BSA
Triage Criteria
- Major burns: consider triage criteria for major burns, including third-degree burns, electrical burns, and burns in high-risk patients
- Moderate burns: consider triage criteria for moderate burns, including third-degree burns on 2-10% of BSA, or second-degree burns on 15-25% of adult BSA or 10-20% child BSA
- Minor burns: consider triage criteria for minor burns, including third-degree burns less than 2% of BSA, or second-degree burns on less than 15% of adult BSA or 10% child BSA
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Description
Test your knowledge on the emergency interventions for burn injuries, including time of counting the first eight hours, pain medications, tetanus prophylaxis, antibiotics administration, debridement, and application of antimicrobial agents. Questions may cover running the area over water, cold compress application, clothing stuck to the skin, and more.
