Chapter 23. Burns
A 45-year-old female presents to the hospital after falling into a fire and suffering deep partial-thickness burns to her right hand and entire arm. What is the percentage of TBSA burned for this patient?
Answer: B. According to the rule of nines, an upper extremity is 9% TBSA. Also, the patient’s hand is considered 1% of TBSA.
A 76-year-old male who weighs 80 kg suffered a 25% TBSA deep partial-thickness scald burn when a large pot of boiling water spilled onto his torso and lower extremities. He was immediately transferred to the hospital. He has been given 200 mL of lactated Ringer thus far. What is the amount of fluid needed to resuscitate this patient in the first 8 hours?
Answer: C. The Parkland formula for burn patient fluid resuscitation is total volume 4 mL/kg/%TBSA, which should be given in the first 24 hours after a burn. Half of this volume should be given in the first 8 hours after the burn injury, which includes prehospital/preadmission time. The remainder is given in the remaining 16 hours. Thus, this 80-kg patient with 25% TBSA deep partial-thickness burn should receive a total of 8000 mL of volume in the first 24 hours and 4000 mL in the first 8 hours. He received 200 mL by prehospital personnel and should receive 3800 mL for a total of 4000 mL in the first 8 hours.
A 16-year-old female is admitted to the hospital after suffering 36% deep partial-thickness and full-thickness burns to the face and torso after being involved in a house fire. She is intubated. On the second day of hospitalization, her morning arterial blood gas shows a metabolic acidosis. What is the most likely cause of her lab abnormality?
A. Respiratory rate of 14
Answer: D. Mafenide acetate can cause metabolic acidosis by inhibiting carbonic anhydrase. Silver nitrate is used for the treatment of burns and can cause methemoglobinemia. It also does not penetrate eschars. Silver sulfadiazine is known to cause transient leucopenia.