Question

L.M., a 28-year-old woman who was involved in a house fire. She was sleeping when the fire started and managed to make her way out of the house through thick smoke. The emergency medical system crew initiated humidified oxygen at 15L/min per non-rebreather mask and started a 16-gauge IV with lactated Ringer's solution. On arrival in the ED, her vital signs are 100/66, 125, 34, Spo2 93%. She appears anxious and in pain.

1. As you perform your initial assessment, you note burns on L.M.'s right anterior leg, left anterior and posterior leg, and anterior torso. Using the rule of nines, calculate the extent of S.M.’s burn injury.

2. Because you are concerned about possible smoke inhalation, what will you assess for in L.M.?

3.

Laboratory Test Values upon admission

Hgb         20 g/dL Hct           51% K              4.9 mEq/dL Na            133 mEq/dL Cl             100 mEq/dL Glu           159 mg/dL BUN         28 mg/dL Crt            1.0 mg/dL

Interpret L.M.'s laboratory results.

4. Because of her significant burn injury, S.M. is at high risk for infection. What measures will you institute to prevent this?

Answer 1

1.Right anterior leg=9%

Left anterior and posterior leg :9+9=18%

Torso=9%

Total:9+18+9=36%

SM has 36% burns

2.The following things has to be assessed in LM

• Inspection:
  • assess the oral cavity for blisters swelling ,nares for the deposit of any soot , this can cause damage throat by thermal effect and block airway
• Lungs:Auscultate for breath sounds
  • In case if the lung is damaged due to thermal effect it can cause stridor
  • If the damage is because of chemicals it can cause wheezing due to constriction or damage to the trachea or bronchus
• Assess the skin for  cyanosis due to lack of oxygen if the cells are damaged
• Neurological assessment headache ,disorientation can occurs in 36% burns

3.Ths raised hemoglobin level is called as carboxyhemoglobin.The carbondioxide released attaches to the hemoglobin as a result the hemoglobin can release the necessary oxygen needed resulting in suffocation

The HCT levels are increased because the fluids from the blood cells are released leading to fluid deficiency simultaneously increasing the number of red blood cells

The sodium which is low can cause  confusion ,disorientation, etc., due to fluid loss

The glucose and BUN levels are increased

4.The measures to prevent infection are

• Strict aspectic procedures ,as the skin is exposed the chance of infection is high
• Meticulous handwashing ,to prevent cross infection
• Isolation ,as the patient's immunity is low
• Antibiotics, to prevent any infection
• To control blood sugar to normal range ,as it can interfere with wound healing