388

| The Surgical Technologist | APRIL 2016 162 where tissue has an increased perfusion and likely will recover unless severe sepsis is involved. 3 Systemic Response If the total body surface area burned reaches greater than 30%, the body will undergo systemic effects such as car- diovascular, respiratory, metabolic and immunological changes. If these systemic changes occur, the patient can face hypotension, bronchoconstriction and respiratory distress as well as reducing the body’s immune response. Mechanism of Injury Burns can happen in many different ways, and each mechanism will cause a different reaction from the body. In children, 70% of burns are caused by scalding injuries, while 50% of burns in adults are caused by flame. Scald injuries tend to cause superficial or first-degree burns and flame burns tend to be full thickness or third-degree burns. Contact burns occur when the patient directly touches an object that is extremely hot, or contact with the surface was unusually long. These types of burns are noted in people with epilepsy, which alters their ability to feel the hot object. These burns tend to be deep dermal or full thickness. Electric and chemical injuries also can lead to burns and often are a result of trauma or industrial- related accidents. D I A G N O S T I C S / P R E - O P E R A T I V E T E S T S The most common diagnostic test that will be performed with burn patients is the rule of nines. This helps the phy- sician assess the percentage of burns and design a care plan based on that assessment. This assessment tool varies depending on if the patient is a child or an adult. Each burn patient will undergo a fever workup, including a CBC count, urinalysis and blood, urine and sputum cultures. These tests alert the physician if sepsis is present, and if any other underlying issues need to be addressed. Electrolytes often are monitored with large burns that require aggressive fluid resuscitation. A chest X-ray may be helpful, especially with patients who have suffered inhalation burns as well as skin burns. Burn wounds initially should be covered with dry sterile sheets, and a thorough history and physical examina- tion should be obtained. It is important to keep the patient warm by infusing warm IV f luids and raising the room temperature. The s e i nt e r vent i ons will help to ensure the patient’s temperature is maintained. 5 O P E R A T I N G R O O M P R E P A R A T I O N Along with the basic setup required for the surger y, the surg i ca l technologist will ensure the room i s warmed to an appropriate tem- perature for the surgi- cal patient, paying close attention to the patients’ age, current body tem- perature and burn per- centage, which could alter the required room temperature. The surgical technologist will work closely with the circu- lating nurse, the patient’s floor nurse, the surgeon and the anesthesiologist to determine an appropriate room tempera- ture for the patient. On average, the operating room needs Lt Cmdr Christopher Burns, US Army Institute of Surgical Research Burn Center surgeon, center, prepares a wound for surgery, while Col Evan M Renz, burn center director, left, and Spc Dennis Ortiz, operating room surgical technologist, look on during the surgery procedure at the Burn Center OR at San Antonio Military Medical Center. Courtesy US Army