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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.

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burn nursing care from ems to icu an overview

Burn Nursing Carefrom 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
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
3 CONCERNS FOR A BURN PATIENT
  • Hypothermia
  • Pain
  • Infection
hypothermia
HYPOTHERMIA
  • Easier to prevent than treat
  • Increases metabolic and oxygen demands
  • Proportional to degree of injury
  • Tissue ischemia
at the scene
AT THE SCENE
  • Warm the rig
  • Keep patient covered
  • Pain medication per protocols
  • Avoid IV access in burn unless necessary
er of transferring facility
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 facility7
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 facility8
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
PRIOR TO TRANSFER…

Make sure the family sees the patient prior to transporting to the burn center!!

arrival 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 center11
ARRIVAL TO THE BURN CENTER
  • Room warmed
  • Continue warm fluids
  • Minimize exposure
  • Hot line
  • Cool guard
  • Lighting
slide12

ARRIVAL TO THE BURN CENTER

  • Room warmed
  • Continue warm fluids
  • Minimize exposure
  • Hot line
  • Cool guard
  • Lighting
arrival to burn center
ARRIVAL TO BURN CENTER
  • Morphine/Fentanyl drip
  • Ativan/Propofol drip
  • Riker scale
  • Plan on increasing dosage over time
  • Dosage
arrival to burn center14
ARRIVAL TO BURN CENTER
  • Clean lines
  • Limit flow in room
  • Precautions
  • Daily tubbing
  • Daily dressings
  • Family education
  • Nutrition
resuscitation
RESUSCITATION

Or…. How to give more fluid than you ever thought possible.

resuscitation17
RESUSCITATION
  • Fluid resuscitation goals
    • maintain vital organ function
    • avoid excessive or insufficient fluids
resuscitation18
RESUSCITATION
  • Formulas are guidelines
  • Monitor urine output
  • Labs
  • Monitor vital signs
  • Monitor distal pulses
  • Warm Warm Warm
  • Special Circumstances
first degree superficial sunburn
FIRST DEGREESuperficial…. “sunburn”
  • Clean
    • PAINFUL!!
  • Topical
      • Bacitracin
      • Vaseline gauze
      • Xeroform
  • KEEP MOIST
second degree partial thickness superficial
SECOND DEGREEPartial Thickness - Superficial
  • Debride
  • Dressing
    • Silvadene
    • Sulfamylon/Mafenide
    • Acticoat
  • Monitor
second degree partial thickness superficial22
SECOND DEGREEPartial Thickness - Superficial
  • Debride
  • Dressing
    • Silvadene
    • Sulfamylon/Mafenide
    • Acticoat
  • Monitor
second degree partial thickness superficial23
SECOND DEGREEPartial Thickness - Superficial
  • Debride
  • Dressing
    • Silvadene
    • Sulfamylon/Mafenide
    • Acticoat
  • Monitor
second degree partial thickness superficial24
SECOND DEGREEPartial Thickness - Superficial
  • Debride
  • Dressing
      • Silvadene
    • Sulfamylon/Mafenide
    • Acticoat
  • Monitor
third degree full thickness
THIRD DEGREEFull Thickness
  • Excise early
    • 24-48 hours
  • Graft
  • Mepitel/Xeroform
  • Wound vacs
  • Assessment
    • Day 3
    • Day 5
resources for tubbing
Resources For Tubbing
  • RT
  • 2 RN’s
  • PT/OT
  • Tech
  • Supplies

Adult & Pediatric Injury

summary
SUMMARY
  • WARM
  • RESUSCITATION
  • PAIN MEDICATION
  • CLEAN
  • DRY

WWW.AMERIBURN.ORG

UNM Burn Center: from tragedy… hope!

questions
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!