Question

BURN INJURIES

A cook in a restaurant was rushed to the emergency department after sustaining burns on the face, entire torso, anterior right upper extremity, and anterior right lower extremity including the genitalia. Answer the questions pertinent to the patient’s condition.

1. Compute for the total body surface area affected by the burns.

2. Using parkland formula, compute for the fluid resuscitation for the patient on:

a.First 8 hours

b.Second 8 hours

c.Third 8 hours

3. What acid-base imbalance will the patient be predisposed to in the initial stages of burns?

4. What is the priority in the different phases of burn management

a.Emergent phase: _______________

b.Acute phase: ___________________

c.Rehabilitative phase: _____________

5. Part of the management for burn patient is the administration of Proton-pump inhibitors (PPIs) –g. Omeprazole. What is the rationale behind the inclusion of the said drug to the therapeutic management of burn patients?

Answer 1

ANSWERS:-

1) Compute for the total body surface area affected by the burns.

* Rule of NINES is used to calculate the total body surface area (TBSA) in burns.

AREA	PERCENTAGE
Anterior & posterior head	9%
Anterior torso	18%
Posterior torso	18%
Anterior & posterior right upper arm	9%
Anterior & posterior left upper arm	9%
Anterior & posterior leg	18%
Anterior & posterior leg	18%
Genitalia	1%

** HERE THE PATIENT PICTURE IS

AREA	PERCENTAGE
Face( half of head)	4.5%
Entire torso( complete anterior and posterior torso)	36%
Anterior right upper extremity( half of 9%)	4.5%
Anterior right lower extremity( half of 18%)	9%
Genitalia	1%

TOTAL

55%

2) Using parkland formula,compute for the fluid resuscitation for the patient on:

* Parkland formula :- Ringer lactate solution 4ml X kg body weight X % TBSA burned for first 24 hours ( ** HERE THE PATIENT WEIGHT IS NOT MENTIONED )

a) First 8 hours - Half of the total amound calculated

b) Second 8 hours - Half of the remaining half of the fluid to be given

c) Third 8 hours - Other half of the remaining half of the fluid .

3) What acid- base imbalance will the patient be predisposed to in the initial stages of burns?

* Patient is predisposed to metabolic acidotic in the initial stage . In burns the patient will have loss of fluid and electrolytes, large amound of fluid id lost from the patient, there will be plasma leaks through the damaged capillaries also. This fluid loss is associated with loss of bicarbonate ions along with sodium ions causing metabolic acidosis.

4) What is the priority in the different phases of burn management:

a) Emergent phase:-  

* First aid - extinguish the flame,for ckemical burns flush the exposed area, cover the wound,

* Assessment of airway ,breathing and circulation and management like administering oxygen,

* monitoring vital signs,

* Wound assessment and initial wound care

* Calculating the total body surface area burned

* Fluid management - fluid replacement according to TBSA and urine output.

* Urinary bladder is catheterized to measure urine output.

* Maintaining body temperature by providing warm environment

b) Acute phase:-

* continue assessment and management of respiratory and circulatory functions.

* wound care and dressing with strict aseptic technique to prevent infection.

* pain management with adequate analgesics- patient experience severe pain ,so frequent assessment and interventions are required.

* Nutritional support with adequate nutrients like carbohydrate,protein,fat and other micronutrients.

* wound debridement ( removal of tissues contaminated with bacteria and foreign bodies)

* wound grafting( covering or implanting appropriate tissue like skin ,and other tissues for the purpose of healing and coveing the affected area)

* Prevention of complications like scar formation,contractures,infection etc

c) Rehabilitative phase:-

* Prevention of scars and contractures

* physical ,vocational and occupational therapies to improve the quality of life and to have a productive life.

* councelling for acceptance of situation.

5) Proton pump inhibitors like Omeperazole is given to burns patient because they reduce the gastric acid production.Burns patient ay not be able to take adequate food orally due to pain and psychological and physical stress.