Question

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.We can determine the size of burns using rule nine .Percentage of total body surface area is an indicator of burns size.The rule of nine was introduced in the late 1940's as a quick assessment tool for estimating burn size in the adult.The basis of rule of nine is that the body is divided into anatomic section and each of which represent 9% of total body surface area .Here body has divided as follows'

Head-9%,Right arm-9%, Left arm-9%,chest-9%,abdomen-9%,Upper back-9%,lower back-9%,right thigh-9%,left thigh-9%,right leg below knee-9%left leg below knee-9%,

By adding all together,these section account for 99%.The genetalia make up .ast 1% of total body surface area(TBSA)

So lets calculate the body surface area of the given person affected by burns.

Face-9%+

Entire torso-(chest,abdomen,upper back ,lower back)-9+9+9+9+9=36%

Anterior right upper extrimity-9%

Anterior right lower extrimity-9%

Genetalia-1%

Total-55% Total body surface area is affected in the given patient

2.IV fluid resuscitation is generally required in apatent with burns affecting more than 15% of TBSA.The goal of fluid resuscitation is to maintain vital organ perfusion while avoiding complications related to either inadequate or excessive fluid adminisration.one of the formulas to assess the fluid requirement in burnss patients is parkland formula.

Park land formula (total fluid requirement in 24 hrs) -4ml*TBSA(Total Body Surface Area affected by burns) *Body Weight.

The 50% of the total fluid requirement calculated by parkland formula given in 1st 8 hours.

Remaining fluids (50%) given in next 16 hours.(8+8)

3.Fliuid and electrolyte imbalances

• Hyponatremia,hypernatremia,and hyperkalemia are common electrolyte imbalances affect burn injured client at different points in recovery process.
• Hematocrit levels are elevated in the first 24 hours after injury,demonstrating hemoconcentration from the loss of intravascular fliud.
• Evaporative fluid loss through burn is 4 to 20% greater than normal and it remains elevated untill the wound closure are obtained and it will result in organ perfusion.if intavascular space is not replenished with IV fluids hypovoleic shock can occur which may lead to death.
• if the patient receive inadequate fluid replacement patient will have decreased urine output.
• Urine sample shows usually dark amber, concentrated urine,elevated specific gravity ,(these are the characteristics of dehydration)
• Blood test shows elevated blood urea nitrogen (BUN) levels untill the patient is adequately hydrated.

4.Priority in the different phases of burns management

Emergency phase

Assess the burns severity

Treat minor burns

Monitor airway and breathing

Prevent hypovolemic shock

Prevent aspiration

Minimize pain and anxiety

Wound care

Acute Phase

Prevent infection

Provide metabolic support

Minimize pain

Provide wound care

Maximize function

Provide psychological support

Rehabilitative Phase

Minimize functional loss

Provide psychological support

4. Most of the patients with burns have gastrointestinal dysfunction which may result in intestinal ilelus and also there is chance for developing ulcers .so such patients are treated with protone pump inhibitors to prevent emesis,aspiration ect.