Question

A 38-year-old male patient was brought in to a Level 1 trauma center after being involved in a house explosion with resultant fire. It was reported that patient was barbecuing when the substance caught on fire, causing the entire house to be engulfed in flames. When the fire department arrived on scene, the pt. was found unconscious. He had sustained significant thermal injuries.

Pt was intubated pre-hospital for “airway protection” out of concern for inhalation injury with facial burns.

Initial evaluation revealed a Caucasian man, orally intubated with diminished bilateral breath sounds.

VS; HR: 140, BP: 90/50, O2: 93% (on 100% FIO2), T: 94.0 F, Weight: 110 Kg

There is readily apparent full-thickness burns to the face, neck, anterior torso, bilateral arms, and bilateral legs.

ABG: 7.25, CO2: 50, HCO3: 15, O2: 91%

4. Using the rule of 9, estimate the percentage of burn loss on this patient. Estimate the total amount of Fluid Resuscitation you will be giving to this patient in the first 24 hours.

5. Concerning labs are as follows:

Na: 119

K: 6.0

Lactic Acid: 12.0

Provide an explanation as to why the above labs are either expected or unexpected.

Answer 1

4)The rule of 9,estimated percentage of total body surface area(TBSA)in an adult is head and neck (9%),anterior torso(18%),posterior torso(18%),bilateral arms(18%),lower extrimities(36%),perinium(1%).Total 100%.

Here,percentage of burn loss is 81%.

Currently the most popular formula provides for the volume of an isotonic solution to be administered during first 24hours in a range of 2 to 4ml per kg% of TBSA burned.

so,2*110*81 TBSA=17820ml per 24 hours.

5)sodium deficit.With diuresis,sodium is lost with water,existing sodium is diluted by water influx.

Hyperkalemia,the acidosis and high glucose levels in the blood work together to cause fluid and pottassium to move out of the cells into the blood circulation,another cause is tissue destruction.

high lactic acid level,it indicates lactic acidosis and sepsis.