10 Questions
What is the recommended treatment for CO poisoning in patients with concurrent cyanide toxicity?
Cyanide antidote kit with sodium thiosulfate
What is the recommended fluid for initial volume resuscitation in burn patients?
Lactated Ringer's or isotonic saline
Why should succinylcholine be avoided after 24 hours of a burn?
To prevent hyperkalemia
What is the recommended rate of urine output in burn patients?
0.5-1 mg/kg/hr
What is the purpose of irrigating thermal and chemical burns with cool running water?
To minimize further tissue injury
What is the recommended treatment for superficial burns?
Topical antiseptic and sterile dressings
What is the recommended analgesic for burn victims?
Parenteral narcotics
How often should the tetanus status of a burn patient be updated?
As necessary
What is the recommended formula for estimating initial volume needs in burn patients?
4 mL/kg x %TBSA
What is the recommended duration for administering the first half of the estimated fluid volume in burn patients?
8 hours
Study Notes
Classification of Burns
- Burns can be classified into three degrees: first, second, and third
- First-degree burns: limited to superficial epidermis, heal within 7 days without long-term sequelae
- Second-degree burns: partial-thickness injuries, subdivided into:
- Superficial partial thickness: hair follicles and sweat and sebaceous glands intact, heal within 2-3 weeks with minimal scarring
- Deep partial thickness: destruction of deeper dermal structures, often require skin grafting
- Third-degree burns: full-thickness injuries, extend deep into subcutaneous tissues, leaving behind avascular and insensate skin, require skin grafting
Clinical Presentation
- History: details of the injury, mechanism of injury, and identification of victims of closed space fires
- Physical Examination:
- Primary survey to address emergent life threats
- Assessment of vital signs, inhalation injury, and circumferential burns
- Complete undressing and comprehensive secondary survey to detect concomitant traumatic injuries
- Skin exam to identify burn degree
Management
- Perform an appropriate primary survey and address emergent life threats
- Secure the airway early in patients with significant supraglottic inhalation injury
- Rule out carbon monoxide and cyanide poisoning in seriously ill patients with smoke exposure
- Calculate the total body surface area (TBSA) involved and initiate aggressive volume resuscitation in patients with burns > 20% TBSA
Treatment
- Administer oxygen via nonrebreather mask to all patients
- Administer pain medications as needed
- Treat carbon monoxide poisoning with 100% oxygen and cyanide toxicity with sodium thiosulfate or hydroxocobalamin
- Initiate aggressive volume resuscitation using the Parkland formula
- Use lactated Ringer's or isotonic saline, with colloid fluids not shown to improve survival
Wound Care
- Irrigate thermal and chemical burns with cool running water to minimize tissue injury
- Remove affected clothing to limit ongoing chemical exposure
- Brush off adherent solid chemicals before irrigation
- Apply nonadherent sterile dressings to superficial injuries
- Deeper burns require debridement of necrotic tissue and protection with topical antiseptic such as silver sulfadiazine
This quiz covers the basics of burn injuries, including thermal, chemical, and electrical burns, and their management in emergency nursing.
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