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Risk Factors: Fire/Combustion Firefighter, Industrial Worker, Occupant of burning structures, Chemical Exposure, Industrial Worker Electrical Exposure Electrician, Electrical Power Distribution Worker Accidents Explosion
2nd degree burn injury in the right side of the head, face and neck, left upper extremity and chest, right ear, with noted redness over and surrounding the area, presence of blisters on the area
Risk Factors: (patient-based) Life threatening event Incidental pouring of strong acid or base Chemical spilling (strong acid) Rule of Nines: Head = 9% (front and back) Chest(front) = 9% Chest back (right side only) = 4.5% Arm (left upper extremity front and back) = 9% Total = 31.5% 2 nd degree burn
Impaired skin integrity r/t skin and tissue damage secondary to major chemical burn 2nd degree
Body in contact with the strong acid Major burn >25% body surface area in adults
Open wound
Stimulation of the thermosensit ive pain receptors Sultamicillin 750mg TID Clindamycin 300mg BID
Inflammatory process
Site/location: Left side of the head, face and neck, left upper extremity and chest, left ear
Hyponatremia
Migration of neutrophils
Risk for infection r/t loss of protective dermal barrier secondary to destruction of skin and tissue
Hypovolemia
Pain impulse
PATHOPHYSIOLOGY OF CHEMICAL BURN Neutrophils releases lipases including phospholipase A2(produces AA from membrane phospholipids)
During admission at the ER: >Pain rated as 10/10, 10 as the highest and most painful, radiating on the head part, left upper extremity, chest and back, pain characterized as burning and pinching pain, aggravated by touch and movement >Grimacing and crying >Unable to move affected or burned area >screaming
Decreas e in BP
Peripheral vasoconstriction
Tachycardia
PAIN
thalamus
During assessment(latest) >Pain rated as 8/10, 10 as the highest and most painful, radiating on the head part, left upper extremity, chest and back, pain characterized as burning and pinching pain, aggravated by touch and movement >Grimacing >presence of numbness, tingling and burning pain on the area >with complaints of itchiness on the right arm
Peripheral resistance
Increased afterload
PATHOPHYSIOLOGY OF CHEMICAL BURN Somatic sensory cortex Acute pain r/t destruction of skin and tissues secondary to major chemical burn in jury 2nd degree WDR neuron activation = spinal cord wind up = NMDA activation
PAIN PERCEPTION
Descending system
Pain persists
Inhibitory neurons are shortlived as they are reabsorbed into the nerves