Question

A 143 lbs 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.

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

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

a.First 8 hours

b.Second 8 hours

c.Third 8 hours

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

What is the priority in the different phases of burn management

a.Emergent phase: _______________

b.Acute phase: ___________________

c.Rehabilitative phase: _____________

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

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

Total Body Surface Area calculated

• Face = 9%
• Entire torso = 18%
• Anterior right upper extremity = 4.5%
• Anterior right lower extremity = 9%
• Genitalia = 1%

Total Body Surface Area = 9% + 18% + 4.5% + 9% + 1%

= 41.5%

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

Weight of the patient = 143lbs

1 lbs = 0.454kg

Therefore,

Patient weight = 143 0.454kg

= 65kg

According to Parkland formula,

Fluid resuscitation = 4 weight of the patient % of his body surface area

= 4 65kg 41.5 %

= 10790ml

10,790ml of fluid replacement within 24hours

a) First 8hrs = Half of the total amount = 5395ml

b) Second 8hrs and third 8hrs = Remaining fluid is delivered in the next 16hrs

ie, 5395ml over 16hrs

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

During the initial stages of burns, intravascular volume is lost in burned and unburned tissues. This is due to an increase in vascular permeability, increased interstitial osmolar pressure in burn tissue and cellular edema.

Hyponatremia is frequent and the restoration of sodium losses in the burn tissue is therefore essential hyperkalemia is also characteristic of this period because of the massive tissue necrosis.

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

i) Emergent Phase

• Monitor hemodynamic status, including central venous pressure, to determine fluid status.
• Monitor laboratory results relevant to fluid balance (e.g., hematocrit, blood urea nitrogen [BUN], albumin, total protein, serum osmolality, and urine specific gravity levels) to detect changes in fluid/electrolyte balance.
• Keep an accurate record of intake and output to monitor fluid loss and gain.
• Maintain IV solution containing electrolyte(s) at constant flow rate (as appropriate) to prevent fluid overload or excessive electrolyte levels.
• Monitor for manifestations of electrolyte imbalance to detect early changes in electrolyte balance.
• Weigh patient daily and monitor trends to detect early changes in fluid balance.
• Consult physician if signs and symptoms of fluid and/or electrolyte imbalance persist or worsen to provide additional therapy as needed.

ii) Acute Phase

• Use emergent phase interventions as necessary.
• Promote oral intake to promote normal fluid intake and patient comfort.

iii) Rehabilitative Phase

• Determine the impact of the pain experience on quality of life (e.g., sleep, appetite, activity, cognition, mood, relationships, performance of job, and role responsibilities) to plan long-term pain management.
• Assist patient and family to seek and obtain support to manage residual pain.

• Refer for diet teaching and planning to meet long-term nutritional needs.

• Monitor appropriateness of diet orders to meet daily nutritional needs to prevent excess weight gain.

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?

One of the risk factors for stress ulcerations include burns greater than 30%. In this patient, burns is 41.5%. That's why proton pump inhibitor is administering to prevent the risk for stress ulceration.