Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Nursing
Transcript
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 HYPOTHERMIA • Easier to prevent than treat • Increases metabolic and oxygen demands • Proportional to degree of injury • Tissue ischemia AT THE SCENE • Warm the rig • Keep patient covered • Pain medication per protocols • Avoid IV access in burn unless necessary 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 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 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 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 Resources For Tubbing • • • • • RT 2 RN’s PT/OT Tech Supplies Adult & Pediatric Injury SUMMARY • • • • • WARM RESUSCITATION PAIN MEDICATION CLEAN DRY WWW.AMERIBURN.ORG UNM Burn Center: from tragedy… hope! 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!
