Case Study
ALM # 3 BURNS
Case Presentation:
21 y/o male involved in industrial fire. Patient was welding a steel structure when a spark from the torch ignited a barrel of flammable material that was inadvertently placed in his work area. Patient sustained full-thickness burns over the upper half of his chest and circumferential burns to bilateral arms. Patient also sustained superficial partial-thickness burns to face, neck and bilateral hands. His entire abdomen, upper half of his back and front of his upper legs sustained deep partial-thickness burns.
Patient was transported to small community hospital where two IV lines were started; a Foley catheter and NG tube were inserted, and humidified O2 at 3L/min via NC. He was given mannitol 12.5g IV before being transported to a major burn center. VS pre-transport were as follows:
BP- 136/84 mm Hg
HR-96 bpm
Resp-24/min
Temp 37.2 º C (oral)
Pre-burn weight was 72 kg (160lb). He was received in the burn unit approximately 4 hours after sustaining burn injury. At admission to the unit, patient was alert and oriented and VS were:
BP- 140/90 mm Hg
HR- 110 bpm
Resp- 24/min
Temp- 36.1 º C (oral)
Lungs sounds clear in all fields on auscultation with an occasional productive cough of a small amount of carbon-tinged sputum. Voice was becoming hoarse. Absent bowel sounds with NG tube draining dark yellow-green liquid. Peripheral pulses were obtained with Doppler as they could not be palpated manually. Foley catheter draining burgundy-colored urine. Urine output total since insertion 4 hours ago =280ml. Fluid resuscitation efforts since the burn injury included 4L of lactated Ringer’s solution through the IV lines.
Labs as follows:
CBC-----
WBC- 12
RBC- 3.48
Hgb-12.8
Hct 52%
ABGs on 3L O2----- pH 7.37
PCO2-35
PO2-105
HCO3-18
SPO2-99%
BMP----
Na+- 151
K+-5.2
Cl-112
BUN 22
Creat 1.6
Additional labs:
Myoglobin 90ng/ml
Carboxyhemoglobin 6%
UA----
Specific gravity 1.040
Glucose +1
Case Presentation:
21 y/o male involved in industrial fire. Patient was welding a steel structure when a spark from the torch ignited a barrel of flammable material that was inadvertently placed in his work area. Patient sustained full-thickness burns over the upper half of his chest and circumferential burns to bilateral arms. Patient also sustained superficial partial-thickness burns to face, neck and bilateral hands. His entire abdomen, upper half of his back and front of his upper legs sustained deep partial-thickness burns.
Patient was transported to small community hospital where two IV lines were started; a Foley catheter and NG tube were inserted, and humidified O2 at 3L/min via NC. He was given mannitol 12.5g IV before being transported to a major burn center. VS pre-transport were as follows:
BP- 136/84 mm Hg
HR-96 bpm
Resp-24/min
Temp 37.2 º C (oral)
Pre-burn weight was 72 kg (160lb). He was received in the burn unit approximately 4 hours after sustaining burn injury. At admission to the unit, patient was alert and oriented and VS were:
BP- 140/90 mm Hg
HR- 110 bpm
Resp- 24/min
Temp- 36.1 º C (oral)
Lungs sounds clear in all fields on auscultation with an occasional productive cough of a small amount of carbon-tinged sputum. Voice was becoming hoarse. Absent bowel sounds with NG tube draining dark yellow-green liquid. Peripheral pulses were obtained with Doppler as they could not be palpated manually. Foley catheter draining burgundy-colored urine. Urine output total since insertion 4 hours ago =280ml. Fluid resuscitation efforts since the burn injury included 4L of lactated Ringer’s solution through the IV lines.
Labs as follows:
CBC-----
WBC- 12
RBC- 3.48
Hgb-12.8
Hct 52%
ABGs on 3L O2----- pH 7.37
PCO2-35
PO2-105
HCO3-18
SPO2-99%
BMP----
Na+- 151
K+-5.2
Cl-112
BUN 22
Creat 1.6
Additional labs:
Myoglobin 90ng/ml
Carboxyhemoglobin 6%
UA----
Specific gravity 1.040
Glucose +1