Burn Case Mx[1]

8/3/2019 Burn Case Mx[1]

1/21

Case Management: Scald Burn

Arcilla

Bactol

Barrenechea

Buena


2/21

Outline

Patient Profile

Initial Management

Laboratory Exam Results Definition of Types of Burns

Scald Burns Overview

Definitive Management Latest Updates


3/21

Profile

Patient is C.M

10 months old/Male

From Pasay City Chief complaint: scald burns


4/21

Profile

DOI: 11/5/11

TOI: 6:00 PM

MOI: scald burn (hot water) POI: at home, in Pasay CIty

HPI: 4 HRS PTC: Pt was in his mothers lap

drinking milk in a bottle when he allegedlyknocked over a bowl of hot water onto

himself.


5/21

Profile

Patient was then brought to OM where he was

given tetanus prophylaxis, and his wounds

were dressed with gauze.

Patient was then referred to PGH due to lack

of a burn unit there.

(-) loss of consciousness/nausea/vomiting

(-) bleeding

(-) seizures/changes in sensorium


6/21

Physical Examination (At the ER)

Vital signs

Good pulses

H

R = 124 bpm RR = 36 bpm

Temp = afebrile

Weight = 8 kg

General: awake, irritable, not in

cardiorespiratory distress


7/21


HEENT: pink palpebral conjunctivae, anictericsclerae, (-) cervicolymphadenopathy, (-) neckvein engorgement, (-) tonsillopharyngeal

congestion Chest & Lungs: equal chest expansion, clear

breath sounds (-) crackles (+) scald burns overanterior chest area

CVS: adynamic precordium, distinct S1 & S2,normal rate, regular rhythm


8/21


Abdomen: soft, globular, normoactive bowel

sounds, (-) masses palpated, (-) tenderness

Genitourinary: grossly male, (+) scald burnover pubic area above and on the dorsum of

the penis

Extremities: pink nailbeds, full and equal

pulses, (-) edema, (-) jaundice, (+) scald burns

over bilateral anterior thighs


9/21

Initial Working Impression

Scald burns, 11% TBSA, SPT

Anterior trunk

Bilateral thighs Genitalia

Patient was then referred by the SOD to Burn


10/21

Seen by Burn

Assessment of burn resident: 11% TBSA, SPT

Anterior trunk = 9%

Bilateral thighs = 0.5% each Genitalia = 1%

Plan:

Admit to ACU-Sx under Burn

NPO except meds

IVF: D5LR @ 42 cc/hr (FM + 25%)


11/21

Seen by Burn (continued)

Diagnostics:

CBC

Typing BUN, Crea, Alb, RBS, Na, K, Cl

Urinalysis

Fecalysis

PT/PTT

CXR PA upright


12/21

Seen by Burn (continued)

Dressing: SSD

Medications:

Paracetamol 80 mg IV Q4h RTC Famotidine 8 mg IV Q12h

Vitamin C OD

Multivitamins + Zinc OD

Monitor: UO Q1, maintain UO of > 8cc/hr


13/21

Seen byPedia-ER

Diagnostics: ABG

Diet: soft diet with SAP

IVF: D5LR @ 72 cc/hr x 8 hours

D5LR @ 36 cc/hr x next 6 hours


14/21

Lab Results

Blood Type: B+

Control Patient % activity INR

PT 14.0 15.6 0.93 1.13

PTT 30.6 33.9

CBC

WBC 14.20

RBC 4.93

Hgb 100

Hct 0.307

Platelet 117


15/21

Lab Results

Electrolytes

RBS 7.36

BUN 2.70

Crea 20

Alb 28

Na 137

K 4.5

Cl 111


16/21

Lab Results

URINALYSIS

Color Colorless

pH 8.0

SG 1.003

Glucose -

Albumin -

RBC 0

WBC 0

FECALYSIS

Color Yellowish-

brown

Consistency SoftRBC 0-1

WBC 1-2

P

arasites -


17/21

Scald burn: caused by hot liquids ( hot water, soups,

sauces)which are thicker in consistency, remain in

contact with the skin for a loner period of time

Flame burn: house fires, improper use of flammable

liquids, kerosene lamps, careless smoking, vehicular

accidents, clothing ignited from stove

Different Types of Burn


18/21

Flash burn (flame burn subtype): explosions of

natural gas propane, gasoline and other flammable

liquids causing intense heat for a very brief period of

time.

Contact burn: results from hot meals, plastic, glass or

hot coals; usually limited in extent but very deep



19/21

Chemical burn: caused by strong alkali or acids;

these cause progressive damage until chemical is

deactivated with reaction with tissue or reactionwith water

Acid burns: more self limiting than alkali burns;

acid tend to tan the skin creating an

impermeable barrier which limits furtherpenetration of the acid

Alkali burns: combine with cutaneous lipids to

create soap and thereby continue to dissolve

the skin until they are neutralized



20/21

Electrical burns: injury from electrical

current classified as high voltage or low

voltage



21/21

Overview of Scald Burn

Usually from hot water

A temp of 60oC can create deep partial

thickness of full thickness with in 3sec

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Burn Case Mx[1]