Question

1. 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) – e.g. Omeprazole. What is the rationale behind the inclusion

of the said drug to the therapeutic management of burn patients?

Answer 1

1.The total body surface area of burns can be calculated with the help of rule of nine formula

According to the formula

The entire head is estimated as 9% (4.5% for anterior and posterior).

The entire trunk is estimated at 36% and can be further broken down into 18% for anterior components and 18% for the back.

The anterior aspect of the trunk can further be divided into chest (9%) and abdomen (9%).

The upper extremities total 18% and thus 9% for each upper extremity.

Each upper extremity can further be divided into anterior (4.5%) and posterior (4.5%).

The lower extremities are estimated at 36%, 18% for each lower extremity.

Again this can be further divided into 9% for the anterior and 9% for the posterior aspect.

The groin is estimated at 1%.

Here the patient percentage calculated with above formula

Burns on the face =4.5%(entire head consider 9 here only patient got burn on face)

Entire torso=36%(including anterior and posterior trunk)

Anterior right upper extremity =4.5%(upper extremity one 9%here patient got burn on anterior right upper extremity).

Anterior right lower extrimity=4.5%(lower extrimity one 9%here patient got burn on anterior lower extrimity )

Genitalia=1%

So the total percentage of burn=4.5+36+4.5+4.5+1

=50.5%

Answer=50.5%

2.Parkland formula fluid calculation.

4ml lactated ringers solution /kgbodyweight/%TBSA burn

=Total fluid requirments for first 24hours after burn.

Application

1/2of total in first 8hour

1/4of total in second 8hour

1/4of total in third 8hour

In above question body weight has not mentioned in proper so am adding one example how to calculate it

For 70kg patient with a50 .5%of TABSA burn

4ml×70kg×50.5%TABSA burn=14140ml

=14.14L in 24hr

a)1/2 of total in first 8hr. =7070ml(883.75ml/hr)

b)1/4of total in second 8hr =3535ml(441.8ml/hr)

c)1/4of total in third hr. =3535ml(441.8 ml/hr)

3.The patient may develop metabolic acidosis due to cutaneous projections of strong acids may cause severe metabolic acidosis.

4.a)Emergent phase;maintaince of airway and treating client for burn shock.

b)Acute phas; wound care and pain management

c)Rehabilitative phase;psychosocial support and restoring maximum functional activity remains.

5.

The rational behind the use of Omeprazole in burn is to treat curling's ulcer

It is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

The drug like ompeprazole is reducing the occurance of curling ulcer and other complications due to burns.