Question

Patient presents with severe burns covering 35% of his body when he was trapped inside a burning building. Wife informs health care team about his height, weight (6 foot tall and weighs 175lbs). What would be the initial concerns of the health care team and the measures you may take soon after arrival at the hospital?

Answer 1

Answer

The initial concern of health care team should be

Here we have to calculate percentage of burns by Rule of nines is used to establish extent of body surface burned.

Surface % of total body surface

Head and neck- 9%

Anterior trunk- 18%

Posterior trunk- 18%

Arms including hands-9% each

Legs including feet- 18% each

Genitalia- 1%

According to the estimations, the severity of burns greater than 30-40% are considered as fatal without immediate treatment.

Initial concerns of the healthcare team:-

1.The areas and depth of burns will be the primary concern. The deeper the burns the greater the damage and greater time it takes to heal.

2.Smoke inhalation injury

3.Delay in IV therapy and resuscitation may lead to rapid fluid loss in burns patient.

4.Other associated traumas may complicate the case.

Immediate Measures on arrival:-

1.Advanced burns/trauma life support treatment principles will be initiated immediately. ABC (Airway, Breathing and circulation) will be given

2.Area of burns and depth burns will be identified and assessed quickly.

3.Airway obstruction may be assessed and intubation may be done for patients with potential obstruction or higher degrees of burns.

4.Breathing will be checked. Oxygen will be supplied to the patient to prevent hypoxia due flames injury. Level of smoke inhalation injuries will be identified and treatment will be given accordingly. 100% O2 supply to reduce the levels of CO levels less than 10% in blood.

5 Circulation: IV lines will be secured in the unburnt regions. As there is rapid loss of fluid, fluid requirements increase with the greater severity of burns. IV therapy RL will be initiated. Further treatment will be calculated by identifying the depth and surface area of burns and using the resuscitation formula (that is 4 x weight in kg x % TBSA burn)

In this case it will be 4 x 79 x 35 = 11060 mL (half volume in first 8 hours rest half in later 16 hours)

Wound care is of secondary importance. Dressing the wounds with sterile dressing, and keeping the burns extremities elevated. Maintaining the temperature. Applying topical antimicrobials to prevent infection.

Skin grafting and other treatment may be applied in later management phase. Medication for pain and infection prevention will be given through IV.