Question

M.J. is a 23-year-old white woman transferred via ambulance to the hospital after a fire in her apartment. She was asleep when the fire started and managed to make her way out of the apartment through the smoke. She sustained second- and third-degree burns over the right side of her face and neck, right side of the anterior trunk, 2/3 of lower right thigh, and right arm. In the emergency department, she received a tetanus shot, morphine for pain, and 2 L of IV fluids.

Subjective Data

Single, lives alone

Attends local college part-time while working full-time as a waitress

Denies tobacco, alcohol, and drug use

Objective Data

Physical Examination

Blood pressure 190/80, pulse 88, temperature 99° F, respirations 28

Height 5’4”, weight 180 lbs

Voice is hoarse; singed nose hair

Productive cough with moderate amounts of gray sputum

Pupils equal, round, reactive to light and accommodation; right eye swollen

Heart rate and rhythm regular; no murmur

Lungs with wheezes throughout

Bowel sounds diminished in all four quadrants

Restless, complaining of pain at a level 10 on ten-scale

Urinary catheter draining burgundy colored urine

Nasogastric tube is draining yellow-green drainage

Discussion Questions

What is the difference between a second-degree (partial thickness) and third-degree (full-thickness) burn

What is the extent of M.J.’s burn injury and how is it determined ?

Calculate M.J.’s fluid requirements for the first 24 hours using the Parkland formula.

Answer 1

Ans- Second-degree burns involve the epidermis and part of the lower layer of skin, the dermis. The burn site looks red, blistered, and may be swollen and painful. Third-degree (full thickness) burns. Third-degree burns destroy the epidermis and dermis. Second-degree burns (partial thickness burns) affect the epidermis and the dermis (lower layer of skin). They cause pain, redness, swelling, and blistering. Third-degree burns (full thickness burns) go through the dermis and affect deeper tissues. They result in white or blackened, charred skin that may be numb.

Second degree burns are also called partial thickness burns. This type of burn damages the epidermis and the dermis. The dermis is the second layer of skin. Second degree burns are painful. The injured area can swell and appear red with blisters. The damaged skin usually grows back unless it becomes infected or the injury gets deeper.

Third degree burns are also called full thickness burns. This type of burn goes through the epidermis and dermis and affects deeper tissues, which may also be damaged or destroyed. The injured area can appear charred and may be black, white, or deep red in color. This area is often numb to light touch. Third degree burns don’t heal by themselves, so skin grafting is often necessary .

Burn injuries can happen in many ways. Common examples are:

• Flame: contact with fire or flame
• Flash: resulting from the heat of an explosive blast
• Scald: contact with hot liquids or hot steam
• Grease: contact with hot grease
• Contact: prolonged contact with something hot
• Electrical: electricity passing through the body and heating the skin and underlying tissue
• Chemical: contact with chemicals, such as acid or alkalis .

Parkland formula = (m) is in kilograms (kg), area (A) as a percentage of total body surface area, and volume (V) is in milliliters (mL).

V= 4.m.(A.100)

V= 4 ×23 × 50× 100

V= 460,000 ml