Question

Module 1 Case

This case was written by David A. Sandmire, MD and was edited for content for use in this class.

Chief Complaint: 8-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house.

History: A 13-year-old 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 and excessive smoke inhalation.

In the emergency room, the patient was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU).

The patient regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.

The patient began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was complete, and she was back on solid foods, her antibiotics were discontinued, and she was discharged from the hospital with a rehabilitation plan for both physical and occupational therapy at home, as well as twice-weekly visits by a nurse.

Questions:

1. Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?

Answer 1

1 possible treatment in this case

Patient is suffering from second and third degree of burn

Based on skin thickness and degree of burn

• Child's age, overall health, and medical history

• Extent of the burn

• Location of the burn

• Cause of the burn

• child's tolerance for specific medications, procedures, or therapies

Further treatment is decided

1. Early cleaning and debriding i.e. removal.of dead s skin and deadtissue from burn area
2. Intravenous (IV) fluids containing electrolytes.
3. Intravenous (IV) or oral antibiotics
4. Antibiotic ointments or creams
5. nutrition aupplement
6. Skin grafting
7. Pain management by pain killer
8. Cosmetic treatments like plastic surgery

Answer 2

Treatment improve patient condition by

burn care focuses on the six “Cs”: clothing, cooling, cleaning, chemoprophylaxis, covering and comforting

Pain medication give relief from.pain

Antiobiotic help in control of bacterial infectiom especially staphylococcus

I.v. saline help in prevent of dehydration by burn

After treament it leave scar after 2 to 3 week of healing which is collagenous protein and sometime in case of excessive burn more scar formed that is called hypertrophied scars

Answer 3

Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. Lao mucous membrane of thoracic cavity around lungs are also affected which cause unstable respiratory rate and cardiac activity

And also she is prone to bacterial infections like staphylococcus infection and also prone to bed sores

With impact in abdominal area it leads to indigestion of food and also cause deformities in limbs