A 58-year-old man was brought to the emergency room with 30% second- and third-degree burns involving his chesty arms, neck, and face. He had fallen asleep while smoking in bed. Approximately 40 minutes had elapsed between the time of the fire alarm and the patient’s arrival at the hospital. He had a history of alcohol abuse. No other medical history was available.
Physical examination showed an obese man in moderate respiratory distress, with a harsh, dry cough. Eyebrows and eyelashes were singed and black soot particles were noted in the nose. The patient was able to respond to his name but was not oriented to time or place. His arms and neck had been covered with first-aid dressings.
Vital signs were: blood pressure 180/110 mmHg; pulse 115/min; respiratory rate 28/min. Laboratory data included: hemaglobin 18 gm; hematocrit 47%; SMA-6 within normal limits. Arterial blood gas analyses on room air were: pH 7.3; PaO2 56; PaCO2 38. Urine specific gravity was 1.030.
Fiberoptic endoscopy revealed some laryngeal edema and the decision was made to intubate. Venous access was achieved through both saphenous veins and fluid resuscitation was begun. The posterior tibial artery was cannulated. Sedation with morphine sulfate was adequate.
Over the next 2 hours, circulation to both hands seemed to be compromised and the patient was taken to the operating room for fasciotomy and debridement and dressing of the chest and neck wounds.
KeywordsBody Surface Area Fluid Resuscitation Burned Area Fluid Replacement Inhalation Injury
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- 4.Formosa PJ, Waxman K: Inhalation injuries in burn patients. Hosp Phys July 1986;pp 69–82.Google Scholar
- 5.Demling RH: Pathophysiology of Burn Injury. In: Trauma: Clinical Care and Pathophysiology, JD Richardson, HC Polk Jr, LM Flint, eds, Chicago: Year Book Medical Publishers, 1987, pp 121–66.Google Scholar
- 8.Lung CC, Browder NC: The estimation of areas of burns. Surg Gynecol Obstet 1944;79:352–58.Google Scholar
- 9.Wachtel TL, Long WB, Frank HA: Thermal Injuries of the Upper Respiratory Tract. In: Burns of the Head and Neck, TL Wachtel, DH Frank, eds, Philadelphia: WB Saunders, 1984, pp. 7–14.Google Scholar
- 12.Heimbach D: Inhalation Injury. In: Burns of the Head and Neck, TL Wachtel, DH Frank, eds, Philadelphia: WB Saunders, 1984, pp. 15–23.Google Scholar
- 13.Cote CJ: Burn Debridement. In: Common Problems in Pediatric Anesthesia, LC Stehling, ed, Chicago: Year Book Medical Publishers, 1982, pp 131–43.Google Scholar
- 14.Solomon JR: Pediatric Burns. In: Burns, Critical Care Clinics., TL Wachtel, ed, Philadelphia: WB Saunders, 1985;1(1):159–73.Google Scholar
- 16.Hammond JS, Ward CG: Complications of the Burn Injury. In: Burns, Critical Care Clinics, TL Wachtel, ed, Philadelphia: WB Saunders, 1985;1(1):175–87.Google Scholar
- 19.Dasco CC, Luterman A, Curreri PW: Systemic antibiotic treatment in burned patients. Surg Clin North Am 1987;67(1):57–68.Google Scholar
- 21.Ward CF: Anesthesia for Head and Neck Burn Surgery. In: Burns of the Head and Neck, TL Wachtel, DH Frank, eds. Philadelphia: WB Saunders, 1984, pp 34–55.Google Scholar
- 22.Andreoli TE: Disorders of Fluid Volume, Electrolyte, and Acid-Base Balance. In: Textbook of Medicine, 16th ed, JB Wyngaarden, LH Smith Jr, eds, Philadelphia: WB Saunders, 1982, pp. 468–94.Google Scholar
- 25.Cullen B: Anesthesia for the patient with major burns. In: American Society of Anesthesiologists Annual Refesher Course Lectures #266, 1985Google Scholar