Question

History: Tracy Moore, a 29-year-old white female, was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns. Vitals at the scene were as follows: HR = 110, BP = 150/90; R = 22, Temperature 100.1, SPO2 = 96% on Room Air. You are given the following information about her burns.

a. The back of her head is painful and sensitive to touch, the area is white with moderate edema and her hair is missing in places.

b. Her right hand is black and brown with minimal sensation and the burn extends up the front and back of her right arm to her shoulder.

c. Her right leg is red with no blisters and extremely painful. There is moderate edema. The burn is covering the back of her leg from her ankle to her buttocks.

1. What is the Total Body Surface Area burned based on the Rule of Nines for burns a, b, and c?

2. For each of the burns in a, b, and c indicate the type of burn based upon its description.

3. What type of pain management will Tracy require for each of the burns? Explain your answers.  

4. Name two complications Tracy is at risk for due to her specific burns and discuss how you will manage these complications.

Answer 1

1--Total body surface area burned is - back of the head (4.5%),front and back of right arm to shoulder (9%),back of right leg from ankle to buttock ( 9% + 4.5%)

As per rule of nines for burns total body surface area burned is 27%.

2--From the given information burn A can be considered as a second degree burn because patient has pain in head and very sensitive to touch and the affected area is white in colour.These are certain symptoms of third degree burn.Burn B can be considered as a 4th degree burn because burned area looks brown and black in colour and the patient has only minimal sensation over the area.Burn C is a first degree burn because the area is red in colour with no blisters and the patient has pain also.

3--Intravenous fluid therapy is the important management to burns.Pain management includes assessment of pain.In case of burns pain may vary from mild to excruciating.First degree burns can be treated with skin care products such as aloe vera cream or antibiotic ointment.Pain can be managed with acetaminophen.Third degree burns management includes skin grafting,iv antibiotics and iv fluid therapy to replace fluid.Opiates are the common medication used for burns as a pain management.NSAIDS are also used.Sleep medications,antidepressants are the other mode of pain management.Apart from all these medication behavioral approaches,cognitive relaxation techniques,counselling are also very helpful in management of pain.

4--Infection is one of the most common complication of burn.Micro organism can enter the body through broken skin and cause infection.It can be prevented by iv antibiotics and antibiotic creams.Keep the wound clean and dry.Burn wounds must be cleansed with antibacterial cleansing agent twice daily.Hydrotherapy also facilitate cleansing and debridement of the burned area.

Tetanus is the another complication of burns of all levels.Tetanus is a bacterial infection.It affects the nervous system and gradually leading to problems with muscle contraction.It can be prevented by Tetanus toxoid injection.

Other complications includes hypovolemia (treated by iv fluid therapy),hypothermia,keloids etc.