this powerpoint file is a supplement to the video presentation. some of the educational content of...

This PowerPoint file is a supplement to the video presentation. Some of the educational content of

this program is not available solely through the PowerPoint file. Participants should use all

materials to enhance the value of this continuing education program.

EMS/Nursing

Toni Galvan, MSN, RN, CCRN, CENCharge Nurse II

Medical Intensive Care UnitCovenant Health System

Lubbock, Texas

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Burns: Part 1

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1. Identify incidence and measures for prevention of burns.

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Objectives

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2. Indicate types of burns and physiological responses.

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Objectives

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3. Identify fluid replacement measures used in the treatment of burns.

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Objectives

Annual Incidence450,000 requiring medical

treatment3,500 fire and burn deaths45,000 hospitalizations

Annual IncidenceCost: millions to billions in

dollars, immeasurable in emotional distress to victims and families

Where Burns HappenMajority in home: 86%

#1: careless cigarettes also water >140° F,

cooking surfaces, combustibles, space heaters, chemicals, unsafe electrical wiring, etc.

Where Burns Happen Industry: 10%Street/highway: 8%Farm and other/unknown:

16%

Financial/Community Impact

Care is specialized, expensive [$3,000-5,000 per day in burn intensive care unit (BICU)]


Victim off work, non-productive for weeks to months

Family roles are disturbed for weeks to years


Prevention is cheaper and easier!

Mortality/Morbidity in BICUs

Survival rate: 94.8%Gender: 70% male, 30%

femaleEthnicity: 63% Caucasian,

17% African-American, 14% Hispanic, 6% other

Mortality/Morbidity in BICUs

Admission cause: 42% fire/flame, 31% scald, 9% contact, 4% electrical, 3% chemical, 11% other

Prevention of BurnsHot water heaters: <120° FBath water: about 100° FAnti-scald devices on bath

and shower headsSupervision of small children

and elders

Prevention of BurnsGrab bars in showers for

impaired mobilityNO children in cooking areaWhile cooking, all pot

handles and electric cords out of reach

Prevention of BurnsSafety handles/knobs on

stovesDo not use open flame

heatersMeals: hot items in center of

table

Prevention of BurnsMeals: non-slip placemats

with toddlersMeals: no tablecloths with

toddlers or when anyone using crutches or wheelchairs

Prevention of BurnsHot liquids

don’t carry while carrying child

not on low tablesWheelchair: use a tray to

carry hot foods/drinks

Prevention of BurnsMicrowave

use extreme caution with plastic wrap and hot containers

stir all food before servingFires: no gasoline, aerosols,

or plastic

Prevention of BurnsCarburetors: don’t prime

with gasolineOpen flames: don’t combine

with gasoline/kerosene

Prevention of BurnsElectrical

use extreme care if in doubt, don’t touch don’t use questionable

outlets

Prevention of BurnsChemical

use protective gear with all never combine bleach and

ammonia or products containing them

Prevention of BurnsChristmas trees

never leave lights unattended

use mini-lights onlySmoke alarms: check battery

monthly

Prevention of BurnsChildren playing with fire:

NODon’t refuel a hot lawn

mower engine

Prevention of BurnsSunscreen, hats, long

sleeves for prolonged exposure

Routinely check fireplaces, heaters/furnaces

Prevention of BurnsUse cool mist vaporizers

with children/disabled/eldersFlameproof/retardant clothes

for sleep, Halloween, etc.Supervise kids carefully

around open flames

Mortality EstimatesMortality estimate: %TBSA +

age Inhalation injury:

2(%TBSA + age)TBSA: total body surface

area (burned)

Estimate SeveritySize (%TBSA)DepthLocation (hands, feet,

genitalia, face more severe)Age [<2 years (yrs) and

>65 yrs more severe]

Estimate SeverityPast medical history (chronic

disease)Concomitant injuries

Minor vs. MajorMinor: treat at homeModerate: community

hospitalMajor: burn unit

Minor vs. MajorMinor: 2nd degree <15% or 3rd

degree <3% with no other concerns

Moderate: 2nd degree 25-35% or 3rd degree <10% on trunk only

Minor vs. MajorMajor: 2nd degree >35% or 3rd

degree >10% or face/hands/feet/genitalia or inhalation injury or concomitant injuries or electrical or most chemical burns

Anatomy and Functions of Skin


First barrier to infectionPrevent loss of body fluidControl body temperature


Excretory organSensory organVitamin D production Identity (cosmetic, etc.)

Body Response to Burns

Local evaporation loss of heat actual fluid loss loss of first defense

against infection


Cardiovascular release epinephrine response to shock myocardial depressant

factor from inflammation


Blood damaged red blood cells

(RBCs)


Blood 3rd spacing, platelet, and

white blood cell (WBC) clumping

coagulation factors


Respiratory system if inhalation injury burn upper airway decreased chest and neck

expansion


Respiratory system if inhalation injury CO poisoning smoke inhalation acquired respiratory

distress syndrome (ARDS)


Renal potential acute renal failure

from dehydration


Renal in chemical, electrical, and

large muscle burns: myoglobinuria and risk for rhabdomyolysis


Gastrointestinal gastric dilation paralytic ileus Curling’s ulcer


Neuro: alert, active 1st 1-2 hours (hrs), then diminished level of consciousness (LOC) from hypoxia


Pain: prescribe intravenous (IV) morphine


Emotional and social diminished coping, body

image familial and work stress long and costly healing

Fluid shift in burns Inflammation opens capillary

pores causing leak of water, albumin, fibrin, electrolytes to 4-15x normal

1st 24 hrs: profound intravascular fluid and electolyte deficit; replace with IV Lactated Ringer’s (LR)

2nd 24-72 hrs: capillaries seal; prescribe IV colloid to return fluid to vascular tree

Depth of Burns

Zones of Injury for Burns

1st degree

2nd degree

3rd degree

1st Degree BurnLike very severe sunburnUsually no scarringTreat the painTreat with moisturizers

2nd Degree BurnHallmark: fluid-filled blistersBlisters

débridedon’t débridecontroversy

2nd degree scald post-débride

3rd degree with some granulation

Cause: fell into hot water

2nd and 3rd at admit

Post: minimal grafting on arms

Back: thickest skin

3rd degree; edema formation; notice lips

Edema needing intubation to protect airway

Rule of 9sAdult: TBSA estimateAdvantage: easyDisadvantage: not accurate

except 70 Kg adult

Rule of 9s Infant

Rule of PalmPatient’s palm = 1% patient’s

TBSAUsed for scattered burns

Berkow Chart

Berkow ChartAdvantage: more accurateDisadvantage: takes time,

need chartAre other systems similar?

Parkland Formula Fluid Replacement

1st 24 hrs: 4 ml LR x %TBSA x Kg = ml fluid to give 50% in 1st 8 hrs postburn 25% in 2nd 8 hrs postburn 25% in 3rd 8 hrs postburn

Parkland Example50% TBSA x 70 Kg x 4 ml LR

= 14,000 ml total 7,000 ml in first 8 hrs burn occurred at 12:00,

fluids started at 13:00

Parkland Example50% TBSA x 70 Kg x 4 ml LR

= 14,000 ml total 7,000/7 hrs = 1,000 ml/hr then 7,000 ml in remaining

16 hrs at 437.5 ml/hr

Desired OutcomeUrine output 40 ml/hrLOC acceptableMean arterial pressure (MAP)

acceptable If not, increase LR

Parkland 2nd and 3rd 24 hrs

0.35-0.5 ml plasma or albumin x Kg x %TBSA in 4th 8 hrs

And 2,000-6,000 ml 5% dextrose in water (D5W) over 24-48 hrs

Parkland 2nd and 3rd 24 hrs

Outcome urine 40 cc/hr acceptable LOC hematocrit (Hct) within

normal limits Na 140

Adequate Fluid Resuscitation

Urine output >1 cc/Kg/hr by 2nd hr

Pulmonary capillary wedge pressure 4-16 or central venous pressure 1-5 after 24 hr

Adequate Fluid Resuscitation

LOC acceptableHeart rate <110 in adults and

by age in childrenNa, Hct, K, pH normal by 24-

48 hr

Fluid OverloadUrine >200 cc/hr in 1st 24 hrs

and remaining highPulmonary edema in 1st

24-48 hrs without inhalation injury

Fluid OverloadSigns and symptoms of

congestive heart failure without preexisting condition

Burns: Part 1If you have any questions about the program you have just watched, you may call us at: (800) 424-4888 or fax (806) 743-2233.Direct your inquiries to Customer Service.Be sure to include the program number, title and speaker.

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EMS/Nursing

Release Date:

03/01/2012

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The accreditation for this program can be found by

signing in to

www.ttuhsc.edu/health.edu

EMS/Nursing

http://www.ttuhsc.edu/health.edu

This continuing education activity is approved by the Continuing Education Coordinating Board for Emergency Medical Services for 1.5 basic CEH. You have participated in a continuing education program that has received CECBEMS approval for continuing education credit. If you have any comments regarding the quality of this program and/or your satisfaction with it, please contact CECBEMS at: CECBEMS -12200 Ford Road, Suite 478Dallas, TX 75234 Phone: 972-247-4442 [email protected]

EMS

80912

mailto:[email protected]

The Texas Tech University Health Sciences Center Continuing Nursing Education Program is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

Provider approved by California Board of Registered Nursing, Provider #CEP11800, for the designated number of contact hours for each program. Provider approved by Florida Department of Health Board of Nursing, Provider #FBN2060. Provider approved by West Virginia Board of Examiners for Registered Professional Nurses, Provider #WV1998-0262RN. Iowa Board of Nursing approved provider #325. Accepted by the North Carolina Board of Nursing. Reminder to all PARTICIPANTS, certificates should be retained for a period of four (4) years.Health.edu reports Florida Continuing Education (Contact Hours) to CE Broker. This activity provides 1.5 contact hours.

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This activity is presented for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of nursing. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

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DISCLOSURE TO PARTICIPANTS

Requirements of successful course completion:

•Complete the program via video presentation, PowerPoint slides, audio presentation, and/or manuscript.

•Complete the course evaluation.

•Complete the posttest with a score of 80% or greater.

•Complete the time utilized in course completion including the posttest.

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Conflicts of Interest:

Toni Galvan, MSN, RN, CCRN, CEN has disclosed that no financial interests, arrangements or affiliations with organization/s that could be perceived as a real or apparent conflict of interest in employment, leadership positions, research funding, paid consultants or member of an advisory board or review panel, speaker’s bureau, major stock or investment holder, or other remuneration.

Commercial Support:There is no commercial support and/or relevant financial relationships related to this educational activity. Commercial support is defined as financial (or in-kind) contributions given by a commercial interest, which is used to pay all or part of the costs of a CNE activity. Relevant financial relationships are defined as financial relationships of any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner that could create a conflict of interest.

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Non-endorsement of Products:

Toni Galvan, MSN, RN, CCRN, CEN has disclosed that no significant relationships with commercial companies whose products or services are discussed in educational presentations. For speakers, significant relationships include receiving from a commercial company research grants, consultancies, honoraria and travel, or other benefits or having a self-managed equity interest in a company. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.

Off-label Use:

Toni Galvan, MSN, RN, CCRN, CEN has disclosed that no products with off-label or unapproved uses are discussed within this activity.

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Nursing

Individual programs are provided for a two (2) year period. Participants should check with their site coordinator, sign in to Health.edu’s internet site, http://www.ttuhsc.edu/health.edu or call Education Services at 1-800-424-4888 for information on the date through which this learning activity is provided. For questions or comments regarding accreditation, please call Education Services at 1-800-424-4888.To speak to a Customer Service representative, please call 1-800-424-4888.

Institutional refund is available to subscribing organizations according to Health.edu’s tuition refund policy. See your site coordinator to view this program.

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