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Burn Nursing Care from EMS to ICU: an overview

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

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  1. 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!

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

  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. RESUSCITATION • 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 DEGREESuperficial…. “sunburn” • Clean • PAINFUL!! • Topical • Bacitracin • Vaseline gauze • Xeroform • KEEP MOIST

  21. SECOND DEGREEPartial Thickness - Superficial • Debride • Dressing • Silvadene • Sulfamylon/Mafenide • Acticoat • Monitor

  22. SECOND DEGREEPartial Thickness - Superficial • Debride • Dressing • Silvadene • Sulfamylon/Mafenide • Acticoat • Monitor

  23. SECOND DEGREEPartial Thickness - Superficial • Debride • Dressing • Silvadene • Sulfamylon/Mafenide • Acticoat • Monitor

  24. SECOND DEGREEPartial Thickness - Superficial • Debride • Dressing • Silvadene • Sulfamylon/Mafenide • Acticoat • Monitor

  25. THIRD DEGREEFull Thickness • Excise early • 24-48 hours • Graft • Mepitel/Xeroform • Wound vacs • Assessment • Day 3 • Day 5

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

  27. SUMMARY • WARM • RESUSCITATION • PAIN MEDICATION • CLEAN • DRY WWW.AMERIBURN.ORG UNM Burn Center: from tragedy… hope!

  28. 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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