Mrs. J. is a 70-year-old woman who sustained a thermal burn injury in a house fire. An electric heater ignited her bedspread while she was asleep. She was trapped in the room for approximately 15 minutes before being rescued by firefighters. Questions 1. Once Mrs. J. is removed from the fire, what priorities are essential in her initial management? 2. She has singed nose hair and is coughing up sooty sputum. The emergency department is 15 minutes away. Based on this assessment, what should the paramedics do? 3. What diagnostic tests and assessments do you anticipate once Mrs. J. reaches the emergency department? 4. Mrs. J. weighs 65 kg. She has burned an estimated 30% of her body. What is her estimated fluid requirement during the first 24 hours? 5. How much fluid will be given in the first 8 hours after the injury? 6. Given Mrs. J.’s age, what are important assessments during aggressive fluid resuscitation? 7. Mrs. J. has circumferential, white, leathery burn wounds on both arms. What type of burn wound does she have? What assessments should be performed? What type of surgical treatment and wound care should be expected during the resuscitative phase, and later in the acute care phase? 8. What type and route of pain medication should be administered to Mrs. J.?
1. ANS: Essential priorities in her initial management:
Generally burns are minor injuries which occur at work or home. These could be heat burn, electrical burn, chemical burn, friction burn, cold temperature burn, and radiation burn. Burns cause severe skin damage and affect cells to die. A thermal bum refers to the bums resulting from contact with heated objects such as fire, steam, boiling water and hot object. It causes injury to the layers the skin.
Priorities which are essential in her initial management are maintenance of airway, circulation and breathing, and prevention of burn shock. Also the prevention from infection and treatment of wound infection are to the next priorities.
2. ANS: As patient has signed nose hair and coughing sputum, provide airway and breathing support-Use of NRB mask or ET tube, if patient is not breathing-ventilate the patient. For recovering burn shock elevate the patient’s legs 12 inch off the ground and administer humidified oxygen. Administer IV fluid if transport time will be longer than 30 min and fluid resuscitation is indicated, in this case given as 15 minutes-fluid requirement handled by ED team. This case is a severe burn case as American Burn Association defines a severe burn as one that involves 25 percent total body surface area.
3. ANS: Diagnostic tests- Perform a rapid initial assessment of respiratory and cardiovascular status. Fiberoptic bronchoscope helps in diagnosing acute inhalation injury, incubating patients with inhalation injury, and administering supplementary oxygen. Check for carboxyhemoglobin (COHb) level. Also query for tetanus status-provide if not up to date.
4. ANS: Fluid requirement- She has burned an estimated 30% of her body, severe burn, fluid requirement during the first 24 hours is needed. Required fluid is lactated Ringer (LR) solution. Severe burn victims should have at least two lines in place; if necessary, venous catheters may be placed through burned skin.
Calculation of fluid needs: The Parkland formula for calculating fluid needs for burn victims in the first 24 hours.
As the body weight is 65 kg and TBSA is 30%
Total amount of the solute will be= 4 X 65 X 30 ml
Hence the estimated fluid requirement during first 24 hours post burns is 7.8 liters.
5. ANS: Fluid resuscitation is one of the ways to restore and maintain oxygen delivering to tissue of the body and also to maintain the loss of sodium, protein, and water. It also prevents bum shock without causing edema. Parkland formula is frequently use for fluid resuscitation. Fluid resuscitation earned out intravenously. It provides fluid replacement by calculating the amount of solution to infuse during first 24 hours post burn at 4 ml/kg/% TBSA. Half of the calculated amount is administrated over first 8 hours and remaining half in next 16 hours.
In the first 8 hours the amount of solution will be given= 3.9 liters.
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Mrs. J. is a 70-year-old woman who sustained a thermal burn injury in a house fire....
Mrs. J. is a 70-year-old woman who sustained a thermal burn injury in a house fire. An electric heater ignited her bedspread while she was asleep. She was trapped in the room for approximately 15 minutes before being rescued by firefighters? questions 1. How much fluid will be given in the first 8 hours after the injury? 2. Given Mrs. J.’s age, what are important assessments during aggressive fluid resuscitation? 3. Mrs. J. has circumferential, white, leathery burn wounds on...
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