Question

18-year-old girl admitted for severe burns following her rescue from a burning house. She 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 and excessive smoke inhalation. In the emergency room, she was conscious and answered the questions properly. She had blisters in her anterior of her chest and anterior part of her right arm and forearm. Also she had sever burn in her both lower limbs (anterior and posterior of both sides) that turn the limbs dark brown. She had pain in her chest and arm but no pain in her lower limbs. Answer the following questions; a) Which type or types of burn does she have? (2 points) b) Why she doesn’t have pain in lower limbs? (1 points) c) Why you must estimate the surface area of the body is affected? (2 points) d) How you estimate the affected area of burn? (1 point) e) Why you must estimate the affected area in this patient? (1 point) f) What are the two life threatening conditions in this patient? (2 points)

Answer 1

a) 1.Second degree superficial burns is present over chest and arms and forearm as blisters are formed over there which is seen on secondary superficial burns .

2 .Deep burns ( Third degree and fourth degrees) seen in lower limbs as limb is dark brown .

b) Pain is lost in Deep burns as the nerve fibres are destroyed no pain sensation can be carried out so pain less

C)Total body surface area burnt decides the resuscitation with fluids crystalloid like Ringer lactate immediately as as more surface area is burnt it may lead to Hypovolemic shock and immediate resuscitation with Iv fluids is required to prevent death .

d)Estimated area of burn calculated by Wallace formula rule of 9 .

Face -- 9% burns

Chest abdomen --- 18 % burns

Back of abdomen and chest --18% burns

Legs front --18% and back --- 18 % burns

Arm + forearm front --9% and back of arm and forearm -- 9%

Perineum --1 % of burn

e) This pateint is suffering from severe burns and chest -9% and arm and forearm _9% and both lower limbs --36 %

So total of 54 % superficial to deep burns requiring immediate resuscitation with Ringer lactate by modified parkland formula so we can prevent the pateint go in Hypovolemic shock and death .

Total fluids = 4 x total body surface area burnt x body weight in kg

Volume is calcukate half the fluids is given in 8 hr and remaining in 16 hrs

F)Life threatening condition most common cause of death .

1)Immediate - Asphyxia >>Neurogenic shock

2)Early phase - Hypovlemic shock

3)Late phase - Septic shock.Overall also septic shock