Question

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 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?

4. What type and route of pain medication should be administered to Mrs. J.?

Answer 1

1.Thermal burns are usually caused by flash,flame ,scald or contact with hot objects.As soon as the patient arrives ,usually with >15% TBSA .The type of fluid replacement is determined by size and depth of the burn,age of the patient and individual considerations such as dehydration in the preburn state or preexisting chronic illness.Fluid replacement is accomplished with crystalloid solutions ,colloids or a combination of the two.The Brooke and Parkland formulas are most commonly used.

Fluid resuscitation with Parkland formula are'

4ml RL per kg bodyweight per% of TBSA burns=total fluid replacements for first 24 hr after burn.

1/2 of total in first 8 hr

.For a 70kg patient with 50% TBSA burn=4ml*70kg*50%TBSA.

=14000ML

=14L in 24hr

1/2 of total in first 8hr=7000ml (875ml/hr).

2 Assessment of the adequacy of fluid replacement is best made by the use of more than one parameter.Urine output is the most commonly used parameter.Assessment parametrs include the following.

• Urine output 30 to 50ml/hr in an adult;75 to 100ml/hr in electric burn patient with evidence of hemoglobinuria.
• Cardiopulmonary factors-BP(Systolic>90mm Hg).pulse rate >120b/mt.BP is most accurately measured by an arterial line.Peripheral measurement is often invalid,because of vasoconstriction and edema.

3 She is having Full-thickness wounds,because it will be dry and waxy white to dark brown/black and will have only minor,localized sensation because nerve endings have been destroyed.Cleansing and gentle debridement using scissors and forceps can occur in the hydrotherapy tub ,cart shower or patient bed/stretcher.Extensive surgical debridement should be performed in the operating room .During debridement ,necrotic skin is removed .Releasing escharotomies and fasciotomies can be carried out in the emergent phase,usually in burn units by burn physicians.Care should be taken to accomplish the procedures as quickly and effectively as possible.

4 Analgesics are ordered to promote patient comfort .Early in the post burn period IV pain medications are given because GI function is slowed or impaired due to shock or paralytic ileus and IM innjections will not be absorbed adequately in burned or edematous areas,causing pooling of medications in the tissues.When fluid mobilization begins,the patient could be inadvertently overdosed from the interstitial accumulation of previous IM medications