Week 11: Burn Injuries PDF

**Week 11: Burn Injuries** **Burns** - - - - - - - - **Classification of Burn Wound Depth** - - - - - **Burn Wound Depths** - - - - - - +-----------------------------------+-----------------------------------+ | **First Degree Burn**...

**Week 11: Burn Injuries** **Burns** - - - - - - - - **Classification of Burn Wound Depth** - - - - - **Burn Wound Depths** - - - - - - +-----------------------------------+-----------------------------------+ | **First Degree Burn** | - | | | | | **What is an example of a first | | | degree burn?** | | | | - - - | | | | | | | | | | | | - - | | | | | | | | | | | | - - | | | | | | | | | | | | - | +===================================+===================================+ | **Second Degree Burns** | **Superficial partial-thickness | | | injury** | |  | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | **Deep partial-thickness injury** | | | | | | - - - | | | | | | Takes weeks to heal | | | | | | - - | +-----------------------------------+-----------------------------------+ | **Hypertrophic Scarring** | | +-----------------------------------+-----------------------------------+ | **Third Degree Burns** | **Full-thickness injury** | | | | |  | - - - - - | | | | | | | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Fourth Degree Burns** | - - - | +-----------------------------------+-----------------------------------+ | **Use Your Clinical Judgement** | | | | | | A person arrives at the emergency | | | department with a burn injury. | | | The burn area is covered with | | | thin-walled, fluid-filled | | | blisters and is very painful. The | | | nurse suspects this is a: | | | | | | - - - - | | +-----------------------------------+-----------------------------------+ | **How do we estimate the extent | - | | of burn injury?** | | +-----------------------------------+-----------------------------------+ | | - | | | | | |  | +-----------------------------------+-----------------------------------+ | **Answer:** | **Total Body Surface Area** | | | | | | - - | | | | | | | | | | | | - - | | | | | | | | | | | | - - | +-----------------------------------+-----------------------------------+ **Burn Injury Phases** 1. - - - 2. - - - - - +-----------------------------------+-----------------------------------+ | **Immediate (Acute) Consequences | | | of Major Burn Injury** | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - | | | | | | | | | | | | - - | | +===================================+===================================+ | **Cardiovascular Response to Burn | - | | Injury** | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ | **Cellular response to burn | - - | | injury** | | | | | | | | | | - - | +-----------------------------------+-----------------------------------+ | **Metabolic Response** | - - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ | **Other Metabolic Response** | **Sympathetic nervous system** | | | | | | - | | | | | | **Cortisol, glucagon, insulin | | | levels elevated** | | | | | | - | | | | | | **Changes in lipid metabolism** | | | | | | - | | | | | | **Glucose and lactate altered** | | | | | | - | | | | | | **Hepatic response** | | | | | | - | | | | | | | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Hypermetabolic State** | **Related to increase and | | | resetting of thermal regulatory | | | set point** | | | | | | - | | | | | | | | | | | | - | | | | | | **Cytokines, oxygen free | | | radicals, chemotactic substances, | | | eicosanoids** | | | | | | - | | | | | | **Inflammatory response** | | | | | | - | | | | | | | | | | | | - - | +-----------------------------------+-----------------------------------+ **Alterations in Body Metabolism: A Summary** **Immunologic Response** - - - - - - - - - - - - - - **Cellular and Immunologic Alterations**  **Evaporative Water Loss** - - - - - - - **Severe Burn Injury Complex Response: The Big Picture** +-----------------------------------+-----------------------------------+ | **Burn Injury : Treatment** | | | | | | - | | | | | | | | | | | | - - - | | | | | | | | | | | | - | | +===================================+===================================+ | **Fluid Resuscitation in Burn | - | | Injuries** | | | | | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ | **Direction of Fluid and | - - | | Electrolyte Shifts** | | | | | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - | | | | | |  | +-----------------------------------+-----------------------------------+ **Fluid Resuscitation: Parkland Formula** - - - - - - - - - - - - - - - **Systemic Response to Burn Injury** - - - - - - - +-----------------------------------------------------------------------+ | **Use Your Clinical Judgement** | | | | A nurse is assigned to care for a client with a 40% deep | | partial-thickness injury. Which parameter will the nurse closely | | monitor to best assess adequate fluid resuscitation? | | | | - - - - | +-----------------------------------------------------------------------+ **Pharmacotherapy of Burn Injuries** 1. +-----------------------------------+-----------------------------------+ | **Non-opioid analgesics:** | | | | | | **ACETAMINOPHEN** | | +===================================+===================================+ | **Indications** | - | +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | - | +-----------------------------------+-----------------------------------+ | **Desired effects** | - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | **(very rare at therapeutic | | | dose)** | | | | | | - - | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **NSAIDS:** | | | | | | **IBUPROFEN** | | +===================================+===================================+ | **Indications** | - | +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | - | +-----------------------------------+-----------------------------------+ | **Desired effects** | - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - | +-----------------------------------+-----------------------------------+ 2. +-----------------------------------+-----------------------------------+ | **Opioids:** | | | | | | **MORPHINE** | | +===================================+===================================+ | **Indications** | - | +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | - - | +-----------------------------------+-----------------------------------+ | **Desired effects** | - - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - - - - - - | +-----------------------------------+-----------------------------------+ 3. +-----------------------------------+-----------------------------------+ | **Barbiturate and | | | barbiturate-like agents:** | | | | | | **DIAZEPAM** | | +===================================+===================================+ | **Indications** | - | +-----------------------------------+-----------------------------------+ | **Mechanism of Action** | - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ | **Desired effects** | - | +-----------------------------------+-----------------------------------+ | **Adverse Effects** | - | +-----------------------------------+-----------------------------------+ **Burn Injuries in Children** - - - - - - - - - - - - - **Burn Injuries in Young Children** - - - - - - - - - +-----------------------------------+-----------------------------------+ | **Child Abuse** | | +===================================+===================================+ | **Can occur at any age** | - | +-----------------------------------+-----------------------------------+ | **Abuse is suggested with** | - | | | | | | | | | | | | - - - - - | +-----------------------------------+-----------------------------------+ **Burns Suggesting Nonaccidental Trauma** - - - - +-----------------------------------------------------------------------+ | **Burn Pattern Typically Seen After Forced immersion in hot water** | +-----------------------------------------------------------------------+ **How to Assess Severity of Injury in Children** - - - - - - -  +-----------------------------------+-----------------------------------+ | **Other Important Factors in | | | Assessing Severity of Injury** | | +===================================+===================================+ | 1. | - - - | +-----------------------------------+-----------------------------------+ | 2. | | +-----------------------------------+-----------------------------------+ | 3. | - - | +-----------------------------------+-----------------------------------+ | 4. | - | +-----------------------------------+-----------------------------------+ **Major Burn Trauma in Children** +-----------------------------------+-----------------------------------+ | **Integument** | - - - | | | | | | | | | | | | - | +===================================+===================================+ | **Cardiovascular System** | - - - | +-----------------------------------+-----------------------------------+ | **Pulmonary System** | **Manifestations** | | | | | | - | | | | | | **Small degree of edema** | | | | | | - | | | | | | **Fatigue, related to increased | | | work of breathing** | | | | | | - | | | | | | **Soft cartilage of pediatric | | | airway** | | | | | | - | | | | | | **Increased pliability of rib | | | cage causes** | | | | | | - | | | | | | **Adult airway VS Pediatric | | | airway** | | | | | |  | +-----------------------------------+-----------------------------------+ | **Renal System** | - | | | | | | | | | | | | - | | | | | | | | | | | | - | | | | | | | | | | | | - - - | +-----------------------------------+-----------------------------------+ | **Gastrointestinal System** | - - | | | | | | | | | | | | - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ | **Immune Function** | - - | | | | | | | | | | | | - - | | | | | | | | | | | | - | | | | | | | | | | | | - - | | | | | | | | | | | | - | +-----------------------------------+-----------------------------------+ **Burn Shock in Children** - - - - - **Burn Injury in Children: Fluid Resuscitation** - - - - - **Burn Injury in Children: Nutritional support** - - - - - - - - - - - **Burn Injury in Children: Surgical Interventions** +-----------------------------------+-----------------------------------+ | - |  | +===================================+===================================+ | - | | +-----------------------------------+-----------------------------------+ **Burn Injury in Children: Wound Management** +-----------------------------------+-----------------------------------+ | - - |  | +===================================+===================================+ | - - - | | +-----------------------------------+-----------------------------------+ **Burn Injury in Children: Comfort Management** - - - - - **Burn Injury in Children: Recovery & Rehabilitation** **Recovery** - - - - - - **Rehabilitation** - - - - - - -