The Burned Patient

  • Gerald Scheinman


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.


Body Surface Area Fluid Resuscitation Burned Area Fluid Replacement Inhalation Injury 
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© Birkhäuser Boston Inc. 1989

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  • Gerald Scheinman

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