Burn Nursing Care from EMS to ICU: an overview Amanda Richard, RN, CNS, CCRN Adrienne Costello, RN, CCRN UNM Burn Center Adult & Pediatric Injury from tragedy… hope!
Course Objectives Identify the 3 main concerns for burn patients. Discuss interventions to prevent each of these. Address adequate pain management strategies. Resuscitation evaluation. Basic review of wound care for each stage of admission.
3 CONCERNS FOR A BURN PATIENT Hypothermia Pain Infection These are the 3 main concerns we are going to discuss for the burn patient. Each step of the process in the health care system has a part in treating or preventing these issues.
HYPOTHERMIA Easier to prevent than treat Increases metabolic and oxygen demands Proportional to degree of injury Tissue ischemia When burn patients are allowed to chose their own environment temperatures, they opt for ambient temp of about 32/90. This minimized the metabolic expenditure. However, their CNS is trying to get them higher – increasing metabolic demand.
AT THE SCENE Warm the rig Keep patient covered Pain medication per protocols Avoid IV access in burn unless necessary We are going to assume that the ABC’s have been addressed in each of these phases as have been discussed in previous lectures.
ER OF TRANSFERRING FACILITY Warm room Adult – minimum of 80 degrees Children – minimum of 85 degrees Warm IV fluids and blood products Remove clothing Place in dry dressing/sheet If you have warning of the patient coming – make sure to warm the room
ER OF TRANSFERRING FACILITY Pain is inversely proportional to burn degree Pain is often severe IV route only Morphine/Fentanyl Anxiolytics Dosage
ER OF TRANSFERRING FACILITY Debridement not necessary Dry dressing/sheet Limit flow into room Asceptic technique with all procedures Avoid IV access through burns unless necessary UNM Burn Center
PRIOR TO TRANSFER… Make sure the family sees the patient prior to transporting to the burn center!!
ARRIVAL TO THE BURN CENTER Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting Bair Hugger
ARRIVAL TO THE BURN CENTER Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting
ARRIVAL TO THE BURN CENTER Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting
ARRIVAL TO BURN CENTER Morphine/Fentanyl drip Ativan/Propofol drip Riker scale Plan on increasing dosage over time Dosage
ARRIVAL TO BURN CENTER Clean lines Limit flow in room Precautions Daily tubbing Daily dressings Family education Nutrition
Or…. How to give more fluid than you ever thought possible. RESUSCITATION Or…. How to give more fluid than you ever thought possible.
RESUSCITATION
RESUSCITATION Fluid resuscitation goals maintain vital organ function avoid excessive or insufficient fluids
RESUSCITATION Formulas are guidelines Monitor urine output Labs Monitor vital signs Monitor distal pulses Warm Warm Warm Special Circumstances The goal of fluid resuscitation after burn injury is to mainatain vital organ perfusion while avoiding inadequate or excessive therapy. Special Cirsc – Inhalation, delay in initiation, additional trauma, electrical, extreme ages.
DRESSINGS AND WOUND CARE Burn Nursing
FIRST DEGREE Superficial…. “sunburn” Clean PAINFUL!! Topical Bacitracin Vaseline gauze Xeroform KEEP MOIST
SECOND DEGREE Partial Thickness - Superficial Debride Dressing Silvadene Sulfamylon/Mafenide Acticoat Monitor
SECOND DEGREE Partial Thickness - Superficial Debride Dressing Silvadene Sulfamylon/Mafenide Acticoat Monitor
SECOND DEGREE Partial Thickness - Superficial Debride Dressing Silvadene Sulfamylon/Mafenide Acticoat Monitor
SECOND DEGREE Partial Thickness - Superficial Debride Dressing Silvadene Sulfamylon/Mafenide Acticoat Monitor
THIRD DEGREE Full Thickness Excise early 24-48 hours Graft Mepitel/Xeroform Wound vacs Assessment Day 3 Day 5
Adult & Pediatric Injury Resources For Tubbing RT 2 RN’s PT/OT Tech Supplies Adult & Pediatric Injury
UNM Burn Center: from tragedy… hope! SUMMARY WARM RESUSCITATION PAIN MEDICATION CLEAN DRY WWW.AMERIBURN.ORG UNM Burn Center: from tragedy… hope!
Amanda Richard, RN, CNS, CCRN Adrienne Costello, RN, CCRN Questions… one child burned, is one child too many! Amanda Richard, RN, CNS, CCRN Adrienne Costello, RN, CCRN UNM Burn Center Adults & Pediatrics from tragedy… hope!