F&E,+Burns


 * Fluid and Electrolytes & Burns **

Homeostasis body’s attempt to maintain equilibrium.

Body fluids, electrolytes, and acid base buffers – release or absorption of hydrogen ions to maintain a stable blood ph. media type="youtube" key="B658Yn3INYc" width="560" height="315"

**Acidosis** – blood ph < 7.35 **Alkalosis** – blood ph > 7.45

Intracellular – fluid inside cells
 * Fluids: **

Extracellular- fluid between the cells and outside the blood and lymph vessels (primarily saline)

Intravascular – within vessels and lymph

Electrolytes affect formation and retention of water in the body. Sodium – 136-146 mEq/L newborns 139 – 146 mEq/L infants 135 – 148 mEq/L child <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">135 – 146 mEq/L adult

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Potassium – <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">3.0 – 6.0 mEq/L newborns <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">3.5 – 5 mEq/L infants – adults

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Chloride – <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">97 – 110 mEq/L infant <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">98 – 111 mEq/L child <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">95 – 106 mEq/L adult

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">**Infants** (70-75% of weight) have a higher percentage of body water than adults (50-60% of body weight), so they require higher fluid intact and are more susceptible to dehydration.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">**During illness** (vomiting, diarrhea, hemorrhage) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Extracellular fluid is lost first. Infants have a higher proportion of fluid in extracellular areas so easily dehydrated. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Infants have > body surface area lose more insensible water loss through skin and lungs <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Infants have a higher metabolic rate <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Infants immature kidneys cannot concentrate urine.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Measure Intake and Output <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Assess lab values <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Assess vital signs <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Monitor urine specific gravity <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Examine history <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Either calculate replacement needs or limit fluids and administer diuretics
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Nurse Actions: **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Causes of electrolyte imbalance: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Excessive sodium bicarbonate or baking soda <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diarrhea, vomiting, n/g suctioning, <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diuretics, water intoxification, <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Malnutrition, DKA <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Excessive sweating, burns <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Renal disease, cystic fibrosis
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hypo-natremia – **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Excessive intake of sodium or increased water loss <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">(Normally causes ADH release which stimulates thirst)
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hyper-natremia – **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Decreased dietary intake, loss of gastric fluid <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Excessive renal secretion, sweating
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hypo- kalemia **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Crushing injuries, burns, tissue necrosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hemolysis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Renal failure <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Severe dehydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Too rapid infusion of IV potassium
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hyperkalemia **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">**Potassium**: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Never push <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Never give more than 40mEq/kg/hr <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Rate not to exceed 1 mEq/kg/hr

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hormones affecting fluid balance: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Antidiuretic hormone and secreted by the posterior pituitary causing renal tubules to reabsorb water. Secreted when hypovolemic – increases vascular volume and decreases urine output <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Aldosterone – mineralcorticoid secreted by adrenal cortex causes body to reabsorb Na and secrete K. *It is excreted when the body needs to retain fluids.

media type="youtube" key="4r1G_oLH-Pw" width="560" height="315" <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">10% glucose in water or D10W <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dextrose 5% in normal saline or D5 0.9% NaCl <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dextrose 5% in 0.45 NS <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dextrose 5% in RL
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">IV fluids **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hypertonic solutions: **<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Used to pull fluid into the vascular space from intracellular. Causes fluid shift, cells to venous. This causes cells to shrink. Can be used for cerebral edema. Mannitol is a common hypertonic solution. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Ringers lactate (RL) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Normal saline (NS) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dextrose 5% in water <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dextrose 5% in 0.2% NS
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Isotonic solutions: **<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Used to replace fluid losses to expand intravascular volume. No fluid shift.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">**Hypotonic solutions:** Used to dilute extracellular fluid and rehydrate cells. Fluid shifts from ECF to cells. <span style="font-family: "Times New Roman",Times,serif; font-size: 16.9px;">These fluids are often used for dehydration. <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Water <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">0.45% sodium chloride or 0.45% NS <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">0.33% NaCl

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">1-10 kg – 100 ml/kg – <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">2.5 kg infant = 250 ml <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">10 kg infant 1,000 ml
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Replacement Intake for 24 hours: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">10-20 kg – 1,000 ml for first 10 kgs then + 50 ml/kg <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">11 kg infant = 1,050 ml <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">13 kg infant = 1,150 ml <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">20 kg infant = 1,500 ml

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">>20 kg – 1,500 ml + 20ml/kg <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">21 kg infant = 1,520 ml <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">30 kg infant = 1,700 ml

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Infant 2 ml/kg/hr <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Children 1 ml/kg/hr <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Adults ½ ml/kg/hr
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Minimum Urine output **

//**<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">*Dehydration can cause a hyper concentration of electrolytes **// //**<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">*Fluid overload can cause a hypo concentration of electrolytes **//

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Caused by any condition that decreases respiratory effort: //<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Slowed respirations = increase in CO2 = increase in carbonic acid - increase CO2 = decrease ph // <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Causes: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Chronic respiratory disease <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">CNS depression <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Pneumothorax <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Neuromuscular disease
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Respiratory Acidosis: **

//<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">When CO2 is too low = decrease in CO2 (decrease carbonic acid) = increase in ph // <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hyperventilation <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Anxiety <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Sepsis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Heart failure <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hepatic failure <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fever or hypermetabolic states <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Salicylate poisoning
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Respiratory Alkalosis: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Causes: **

//<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Loss of bicarbonate in stools or increase in ketones = decrease in ph // <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">DKA <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Alcoholic ketoacidosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Increase intake acids, salicylate acid <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diarrhea <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Renal failure <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Starvation <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Shock
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Metabolic Acidosis: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Causes: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Decreased body acids = Increase in ph <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Vomiting <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Prolonged NG suctioning <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Overuse of antacids <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hypokalemia <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diuretics
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Metabolic Alkalosis: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Causes: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Minimal < 3% loss of body weight <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Moderate 3-9% loss of body weight, lethargic, thirsty, eager to drink <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Severe - >9% loss of body weight, lethargic, unconscious, drinks poorly or unable to drink
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Degrees of dehydration: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">General appearance <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Illness – lethargic, pale, increase cap refil <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Increase respirations <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">I&O, wet diaper, voiding <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Weight loss *(1 kg of body weight = 1 liter of water, so 1 kg loss = 1000 ml fluid loss) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Vital signs <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Skin turgor either skin tenting or edematous <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fontanelles sunken or bulging <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Mucous membranes, Tears? <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Urine specific gravity (wet diaper urine concentration) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Labs
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Nursing assessment for Fluid and electrolyte imbalance: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Gastroenteritis – most common cause (rotavirus most common) <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diarrhea <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Stomatitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Pharyngitis, Tonsilitis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Burns <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Cystic fibrosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diabetes Insipidus <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Hemorrhage
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Dehydration causes **

//**<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Oral Rehydration Solution (ORS) is the first recommended action **// <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Pedialyte, Lytren, Infalyte, Resol, <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diluted fruit juices or soft drinks 1 part drink to 4 parts water

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Can rehydrate through NG tube, IV or intraosseous IO <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Boluses of 20ml/kg are recommended

media type="youtube" key="bN-ipx3LZVM" width="462" height="346"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fluid volume deficit <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Risk for injury <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Knowledge deficit
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Nursing Diagnosis **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fluid loss replacement <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Adequate hydration <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">No injuries from lethargy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Knowledge understanding
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Outcomes: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Heart failure, renal failure, nephrotic syndrome, Burns, allergic reactions <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">+0 - no edema <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">+1 - ¼ “ mild edema <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">+2 – ¼ - ½ “ – moderate <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">+3 – ½ - 1 “ - severe <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">+4 - > 1 – very severe
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Edema: **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Nursing Assessment/Interventions: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Assess edema, daily weights, meticulous I&O <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Elevate edematous extremities, turn q 2 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Concerns for body image concerns <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Assess respiratory status <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Med administration <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Lab values monitored <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Diuretics, fluid and sodium restriction, dietary supplementation <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Must monitor potassium since diuretics cause K loss

media type="youtube" key="2f0-Dx09RWs" width="560" height="315"
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 150%;">Burns: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">In 1940 children with burns over 30% of their body died <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">In 2000 children with burns on up to 59% of their body lived

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Initially, early stabilization cool burn, cool not ice cold water = less tissue damage <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Prevent further burn and contamination, no toothpaste, butter or honey <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Stabilization of airway, breathing, circulation and pain management <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">11th leading cause of death in children age 1-9 <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Culturally loose fitting clothing/cooking

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Thermal (most common), scalds, contact <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Electrical, inserting items in outlets, chewing on wires <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chemical, household items <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Radiation, sun
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Burn type **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What is a blister? The body's bandaid!

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Superficial – first degree, epidermis, sunburn, healing 48-72 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Superficial partial – Second degree, blister, moist painful, healing 1-3 weeks <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Deep partial thickness – Second degree, white, sensation diminished, healing in 3-4 weeks <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Full – Third degree, white, black, brown, do not heal spontaneously, heal with contraction <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Full – Fourth degree, lethal extend into muscle, fascia, bone.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Degree **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rule of Nines <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Total Body Surface Area (TBSA)
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Measuring burns: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 1: Cool, protect <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 2: Respiratory management <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 3: Fluid resuscitation with //Lactated Ringers, Parkland formula// <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 4: Close the wound either through healing secondary intention or surgical grafts <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 5: Debridement hydrotherapy, painful <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Step 6: Cleaned and antimicrobial cream Silvadene

media type="youtube" key="BDBXO9fmpmw" width="546" height="408"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Homographs – cadaver graphs <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Heterographs – pig graphs, synthetic skin <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Temporary graphs speed healing by increasing granulation tissue
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Skin graphs **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">4ml LR solution x kg of body weight x % total body surface area burned <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">½ of total given in the first 8 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">¼ is given in the second 8 hours <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">¼ is given in the third 8 hours
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Parkland Formula: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Burn Case: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">media type="youtube" key="IqdT1hfZBl0" width="560" height="315"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Interstitual fluid <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">https://youtu.be/B658Yn3INYc

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Fluids https://youtu.be/4r1G_oLH-Pw

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">Oral rehydration therapy <span style="font-family: 'Times New Roman',Times,serif; font-size: 16.899999618530273px;">https://youtu.be/bN-ipx3LZVM

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Burns <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">https://youtu.be/2f0-Dx09RWs

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Care plan <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">https://youtu.be/BDBXO9fmpmw

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Zoni's Burn https://youtu.be/IqdT1hfZBl0