BURN INJURY G. M., a 52-year-old married man, arrives at the emergency departmen

Question

BURN INJURY G. M., a 52-year-old married man, arrives at the emergency department with burns to his face neck, chest, right arm and hand, and right foot. He was burning brush on his farm when the fire went out of control. He has an 18-gauge IV with NSS running at 100 mL/hr, and he is receiving 100% humidified O2 by mask Subjective Data Complains of blurry vision and trouble swallowing States his burns are painful and that he is scared States he is a "diabetic" and has "high blood pressure" Objective Data Physical Examination Is awake, alert, and oriented, but in some distress Eyes are red, irritated Voice is hoarse; nasal hair is singed Face is reddened with blisters noted on the nose and forehead Right arm, right hand, chest, neck, and right foot have shiny, bright red, wet wounds Patient is shivering Discussion Questions 1. What are the priorities of care in the prehospital environment? How should his airway, breathing, and circulation be managed? 2. What factors place G.M. at high risk for an inhalation injury? What priority interventions can be anticipated? What pain medications might be considered to relieve his pain? Which of the criteria for burn center referral does G.M. meet for admission to the hospital burn unit? What metabolic disturbances would be expected soon after G.M.'s admission? Explain the physiologic basis for these changes How might G.M.'s co-morbidities affect his burn care and rehabilitation? What measures should be taken to support G.M.'s caregivers? Based on the assessment data presented, develop three priority nursing diagnoses. Identify any collaborative problems What are the most effective wound care strategies to manage G.M.'s burn wounds? 3. 4. 5. 6. 7. 8. 9.

Explanation / Answer

1,pre hospital environment management:

_rescuing the victim from the burning place..Stop and drop policy to be followed..stop the victim from burn faster and drop in floor with the burning side upper most..

_avoid crowding in the area..

_look at the conscious level..

_if there is lot of smoke along with the fire tie rope in waist to pull the victim out..

_the flame should be off with water

_make victim lie burning side upper most and wrap in a heavy cotton cloth

_avoid using nylon material..

_fire extinguisher will be useful to put off the fire..

_dont throw the mud or sand to putoff the fire.

_make the victim lie supine and watch for A,B,C(airway,breathing,respiration)if there is no response start(CPR)cardio pulmonary resuscitation

_cool the burn by apply cold water is effective..it may relief pain to the patient.

_remove burnt clothes from the victim'' body..ornaments should be removed.  

_dont break any blisters and don't apply any medication..

_prevent contamination

_Assess the burned area and look for any fracture..

_provide pain medication if patient can..

_if patient comfortable with sitting position provide 100% oxygen

_provide special attention for alcohol and Drug addict person..

Patient airway managed with 100%humidifier O2 by mask and circulation by 18 gauge IV with NSS running at 100ml/hr..

2,He is diabetic and has high blood pressure..start cardiac monitoring fir patient,checj his apical,carotid and femoral pulses..in case of hypertension closely observe hourly fluid intake and urinary out put and blood pressure..check his pulmonary function by checking o2 saturation..in case of diabetes patient check his glucose level every 4th hourly

3,opioids can be given..As per patient condition medication can be given.. methadone can be asminister orally..tramadoltralso can be given to promote a beneficial effect in neuropathic pain.

4, Face is reddened with blisters noted on the face and forehead..right arm,right hand,chest,neck and right foot have shiny,bright red,wet wounds..

5,Hypermetabolic and catabolic flow phase of injury..although carbohydrates in the form of glucose appear to be an important fuel source following Injury.patient having accelerated gluconeogenesis,glucose oxidation and plasma clearance of glucose..this patient having stress..this stress response due to comparison of genomic alterations in WBCs following acute lipopolysaccharide(LPS) exposure,severe burns revealed that gene expression returned to normal within 24hrs of LPS exposure...

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