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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.

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Presentation on theme: "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."— Presentation transcript:

1 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!

2 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 3 CONCERNS FOR A BURN PATIENT Hypothermia Pain Infection

4 HYPOTHERMIA Easier to prevent than treat Increases metabolic and oxygen demands Proportional to degree of injury Tissue ischemia

5 AT THE SCENE Warm the rig Keep patient covered Pain medication per protocols Avoid IV access in burn unless necessary

6 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

7 ER OF TRANSFERRING FACILITY Pain is inversely proportional to burn degree Pain is often severe IV route only Morphine/Fentanyl Anxiolytics Dosage

8 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

9 PRIOR TO TRANSFER… Make sure the family sees the patient prior to transporting to the burn center!!

10 ARRIVAL TO THE BURN CENTER Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting Bair Hugger

11 ARRIVAL TO THE BURN CENTER Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting

12 Room warmed Continue warm fluids Minimize exposure Hot line Cool guard Lighting ARRIVAL TO THE BURN CENTER

13 ARRIVAL TO BURN CENTER Morphine/Fentanyl drip Ativan/Propofol drip Riker scale Plan on increasing dosage over time Dosage

14 ARRIVAL TO BURN CENTER Clean lines Limit flow in room Precautions Daily tubbing Daily dressings Family education Nutrition

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

16 RESUSCITATION

17 Fluid resuscitation goals –maintain vital organ function –avoid excessive or insufficient fluids

18 RESUSCITATION Formulas are guidelines Monitor urine output Labs Monitor vital signs Monitor distal pulses Warm Warm Warm Special Circumstances

19 DRESSINGS AND WOUND CARE Burn Nursing

20 FIRST DEGREE Superficial…. “sunburn” Clean –PAINFUL!! Topical Bacitracin Vaseline gauze Xeroform KEEP MOIST

21 SECOND DEGREE Partial Thickness - Superficial Debride Dressing –Silvadene –Sulfamylon/Mafenide –Acticoat Monitor

22 SECOND DEGREE Partial Thickness - Superficial Debride Dressing –Silvadene –Sulfamylon/Mafenide –Acticoat Monitor

23 SECOND DEGREE Partial Thickness - Superficial Debride Dressing –Silvadene –Sulfamylon/Mafenide –Acticoat Monitor

24 SECOND DEGREE Partial Thickness - Superficial Debride Dressing Silvadene –Sulfamylon/Mafenide –Acticoat Monitor

25 THIRD DEGREE Full Thickness Excise early –24-48 hours Graft Mepitel/Xeroform Wound vacs Assessment –Day 3 –Day 5

26

27 Resources For Tubbing RT 2 RN’s PT/OT Tech Supplies Adult & Pediatric Injury

28 SUMMARY WARM RESUSCITATION PAIN MEDICATION CLEAN DRY UNM Burn Center : from tragedy… hope!

29 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!


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