Burn Guest Speaker Notes

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Burn Guest Speaker Notes:

Legacy Health- Oregon Burn Center

only burn center in Oregon

16 beds

Offers site therapy, pharmacy, and family centered care

Money comes from grants!

OBC Staff Includes

physicians, nurses, pharmacy, social services

PT and OT

Chaplain services

Psychiatry

Nutrition

Child life and art therapy

Burn occurrence facts:

most burns happen in the home

we have a HUGE lack of beds for burn patients

About 1/3 of persons involved in a catastrophic event such as 9/11 will have suffered from burns

WE DON'T USE 1-4TH DEGREE ANYMORE, THINK OF SKIN THICKNESS

SUPERFICIAL BURN:

involves epidermis, needs no intervention

SUNBURN!

rehydrate

lotion when skin dries out

not counted in burn percentage!

PARTIAL THICKNESS:

Still blanches, may extend to dermis

>10% TBSA means transferral to burn unit

xeroform

FULL THICKNESS:

burn through epidermis, dermis and SQ tissue

non-blanchable

no feeling

bright red-leathery look: hemoglobin released from damaged red blood cells

Use sylvadine

may use metahoney- comes from a specific bee that are isolated to only pollinate the tea tree

MUSCLE OR BONE- 4th Degree

requires surgeries

to muscle and bone

charred appearance

wrap in sylvadine, give high amounts of pain medications

Types of burns:

FLAME BURN:

wipe off before figuring percentages

SCALD BURN:

tar, hot water, hot liquids, oil

ELECTRICAL BURN INJURIES:

electrical injury or electrical shock

ALWAYS CALL A BURN CENTER!

there may be deep hidden tissue damage

may lose limbs or multiple limbs d/t compartment syndrome

Need to know voltage, time of contact

neurological injury may show up 2 weeks later, have to report potential right away

ARC INJURY: type of electrical burn

a type of electrical explosion or discharge that results from a low-impedance connection through air to ground or another voltage phase in an electrical system."trauma trumps burn"

current does not pass through the tissue

high heat short duration

no hidden tissue damage

Volts most common

High voltage can cause RESPIRATORY OR CARDIAC ARREST AND CAN LEAD TO BONE BREAKS!

CHEMICAL BURNS:

"Rule of Palm":

Area as big as the palm is 1% body surface area

Rule of 9's:

see chart below

INHALATION INJURY:

causes most morbidity among burn patients

Examples:

carbon monoxide poison: may have cherry red sin, O2 sats are normal, cyanosis and tachypnea are not usually present. Give 100% oxygen to decrease carbon monoxide in blood. Take ABG's and get carboxyhemoglobin level.

Inhalation above the glottis: most damage occur above vocal cords, results in edema that occludes airway, early intubation is necessary.

Injury below the glottis: almost always chemical, chemicals adhere to smoke particles and cause direct damage to epithelium of large airways. Takes about 3-5 minutes for death to occur. Need to continually reassess.

Initial Management of Inhalation injury:

give 100% oxygen at 15L

consider intubation

Primary survey:

Airway: assess and reassess need for ET intubation. If they have any indication at all of inhalation injury!

Breathing: listen to breath sounds, apply high flow O2 at 15 L 100% NRB mask, monitor chest wall in the presence of torso burns

Circulation: establish IV access-2 sites if possible , monitor blood pressure, assess and monitor frequently circumferentrially burned extremities, use Koband instead of tape! Decrease or absence of pulses?

An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar. (helps with breathing)

Disability: burn injuries should be alert and oriented!!!!! If not: consider associated injuries!!!! and past medical history!

Exposure: remove all jewelry, maintain body temperature and keep patient convered (CLEAN, WARM AND DRY)

Secondary Survey:

Head to toe assessement

most important is circumstances of injury

how it occurred?

inside/outside?

gasoline or other fuel involved?

explosion?

Scald, flame, electrical or chemical?

Electrical: voltage?

Chemical: what chemical?

History Mnemonic: "SAMPLE IT"

Signs and Symptoms

Allergies

Medications?

Previous Medical history

Last time ate or drank

Events leading up to the injury

Immunizations

Tetanus

"Fluid creep": excessive fluid resuscitation

Excessive Fluid Resuscitation:

too much fluid equals edema formation, will cause swelling around muslce and you may lose limbs if a fasciotomy is not performed.

Inadequate fluid resuscitation:

kidneys can shut down

Guidelines for fluid resuscitation:

< 5 years old start LR at 125 ml?hr

5-14 LR at 250 ml/hr

15 and > LR at 500 ml/hr

<10 kg d5LR maintenance

titrate fluid by urine output

adult: want 30-50 ml/hr

children less than 30 kg: 1 ml/kg/hr

quick calculation from Ibs to Kg: Divide by two and subtract 10% of kg

"Burn Conversion": waiting a week or 2 to see what the burn does before initiating a skin graft.

Necrotizing fasciatis:

Steven's Johnsons Syndrome:

Myoglobinuria/Rhabdomyolysis:

breakdown in muscle results in myoglobin release

myoglobin is toxic to kidneys

many patients have to go onto dialysis temporarily

Facts about caring for burn patients:

third leading cause of death for burn patients is hypovolemia

DON't use ICE! Can cause frostbite, restricts circulation, decreasing healing and blood flow

COOL water can be used for 5 minutes! If you are still hot you are burning. Use water to stop the burning process. If it HURTS it means it's not that deep and it's going to heal on it's own! This is a GOOD SIGN!

MIneral oil to take off tar

Always use universal precautions to protect ourself when coming into contact with chemical burns. Get the clothes off and run under cool water for a long time (may be hours!)

"solution to pollution is dilution"

"Wizer" smartphone app to look up chemical facts

After burning of victim is stopped. Take off ALL PIERCINGS AND JEWELRY because after burns fluid moves from vascular space to interstitial space and may cause swelling

Remove clothes and cover them up with a CLEAN, WARM, and DRY blanket

SCALD prevention for kids:

don't drink hot liquids while holding children

turn handles of pots and pans back or use back burners

stir and test foods before serving

never put bottles in the microwave

turn water heater down to 120 degrees

always run cold water first, then add hot water

always supervise children in the bathroom, and ELDERLY (decreased sensitivity to temperatures)

Flammable Liquids:

do not pour lighter fluid on something already lit! BBQ coals once a fire has started

don't add rule to a hot lawnmower or motor bike

don't use gasoline as a cleaning agent

don't use gasoline around any device with a heating element- including drop lights

"Shake and Bake"

BHO: Butane, hone oil: "Hash"

1 container can blow up a whole home

Method to make really strong pot

Child Abuse

"sock burn"

curling irons

call CARNES NW

Treatment of burns:

Sylvadine: used for deep burns

stop burning process

monitor VS

Insert Foley Cath

Fluid resuscitation

Assess perfusion

Monitor ventilation

stay on top of pain management

emotional assessment of patient AND self

monitor urine myoglobinuria

monitor body temp

prevent unnecessary contamination of injury

used to clean burns with water and john sons baby soap (milk soap will do)

pain medications is IV or IO only!!! for first 24 hours b/c they might throw up oral meds

CLEAN, WARM, AND DRY! Don't put the wrong topicals on anybody! If unsure just keep clean, warm, and dry.

Look up ABA Transfer Criteria!!!