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unit4
Burns Assessment
Stage and Extent of Burn
Dyspnea
Singed Nasal Hairs
Pain
Initial Decrease Urinary Output
Paralytic Ileus
Signs of Inadequate Hydration
Shock
Hypothermia
Hyperkalemia
2 mins
Burns Considerations
Maintain Body Temperature
Increased Risk of Infection
Venous Thromboembolism (VTE) Prophylaxis
Curling's Ulcer
Excision and Grafting
Adequate Nutrition
Contractures
2 mins
Burns Interventions
Ensure Airway Patency
O2
IV Fluid Replacement
Dry Sterile Dressing
Debridement
Elevate Burned Limbs
Analgesics
Silver Sulfadiazine
Escharotomy
2 mins
Rule of 9's for Burns
Total Body Surface Area (TBSA)
Head
Anterior Torso (18%)
Chest
Abdomen
Posterior Torso (18%)
Upper Back
Lower Back
Extremities
Posterior Leg (each)
Anterior Leg (each)
Each Arm
Genitalia 1%
2 mins
Stages of Burn Care
Phase / Stage 1
Resuscitative/Emergent Phase
Injury to Return of Capillary Permeability
48-72 hours
IV Fluid Replacement
Phase / Stage 2
Acute Phase
Diuresis to Near Wound Closure
Phase / Stage 3
Wound Closure to Return of Optimal Level
2 mins
Types of Burns
Superficial Thickness
Sunburn
Superficial Partial Thickness
Blisters
Blanching
Deep Partial Thickness
Little or Non-blanching
Full Thickness
Waxy White, Yellow or Black
Decreased Pain
2 mins
Silver Sulfadiazine (Silvadene) and Mafenide Acetate (Sulfamylon)
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