Burn

Question 1

A 60-year-old chef involved in a fire. He was trapped in the kitchen For 30 min. When he was brought to the ER, his pulse was 120\min And BP:90\50 mmhg. He sustained burns covering his chest and abdomen, Right and left lower limb and Right upper limb. He was in severe pain & the burns looked erythematous with blisters. There was some soot around His mouth and nose (63%) .Upon asking his friends, they said that he was able to jump From the window of the 1st floor.
Q1. What’s the degree of burn in this scenario?

Answer 1

1. 2nd degree

Question 2

Q2. Management?

Answer 2

2. ATLS protocol ABCDE - check airway if having soots – > prophylactic intubation. / Circulation – cannulas and fluids according to parkland formula/ monitor vitals, UOP

Question 3

Q3. Specific sign for airway burns & inhalational injury during Airway
assessment in burn?

Answer 3

3. Edema of tongue or lips, Soots around mouth, nasal hair burning, facial burn.

Question 4

Q4. Which fluid to give? Colloids or crystalloids? Why?

Answer 4

4. Crystaloids, as in the 1st 24 hrs pt has increase preamibility In case of giving colloid this Will aggrevate the case and increase fluids in 3 Rd space

Question 5

Q5. Mention 5 Complications of burn ?

Answer 5

5. Hypovolemic shock - sepsis - ARDS - Renal failure - constriction if burn circumferential

Question 6

Q. if pt developed pyrexia what to do?

Answer 6

Invx for sepsis and take blood culture, wound swab and urine / Abx acc. To policy and micro / Antipyretics

Question 7

Q. what are the surgical intervention in this pt?

Answer 7

Debridement, dressings and grafts acc. To degree / esharotomy
4 days later , the patient developed tachypnea with RR of 28\min & Oxygen
saturation of 88% on room air . X-ray chest done:

Question 8

Q7. Definition?

Answer 8

7. acute diffuse inflammatory form of lung injury chch by hypoxemia , decr. Compliance , diffuse pulm infiltrate , normal pawp, PaO2/FiO2 < 26.6

Question 8

Q6. Diagnosis? What other differentials do you know?

Answer 8

6. , ARDS,Pulmonary Edema, PNEUMONIA

Question 9

Q8. Causes?

Answer 9

8. Multiple truama / burn / acute pancreatitis/ sepsis/ DIC / transfusion associated with lung injury.

Question 9

Q9. Management? How to support his ventilation?

Answer 9

9. managed in ITU .. resp support – > PEEP and prone position to improve respiration. .. low dose steroids…. ABX for sepsis after C&S … Fluid replacement and use of dobutamine and dopamine for circulation support … .also we consider internal nutrition, prevention of TE , and gastric ulcer prophylaxis.

Question 10

Q. how to know the severity of ARDS?

Answer 10

By Berlin CriteriaQ.

explain Berlin Criteria?
Classify ARDS into
Mild – PaO2/FiO2 = 200-300, Mortality =27%
Mod - ————— = 100-200, M ——— = 32%
Sev - —————–= < 100 , M ————= 45 %

Question 11

Q10. What are the long-term sequelae of ARDS?

Answer 11

10. Hypoxemia, decr. Pulmonary compliance, pulm. HTN ,

Question 12

Q. how to manage circulation in this pt?

Answer 12

Acc. To ATLS protocol and giving fluid measured by parkland formula 2xTBSAxWt

Question 13

Q13. What is the best time of transfer?

Answer 13

11. After finishing the first shot of fluids after 8 hrs and the pt is showing improvement in his vital signs

Question 14

Q.Indication for transfere to burn unit?

Answer 14

All full thikness
Partial thickness (pernuim, Face and hands)
Chemical and electrical burns
inhalational burn
Superfaical > 10% adult // >5% in children

Question 15

Q. Will you give blood to this pt?

Answer 15

In acute setting Hg < 8 // or chronic Anemia < 7