Jun 2, 2022, 12:08 AM
It is crucial to managing burn injuries to accurately identify the type and extent of burned surface area for proper treatment (Giretzlehner et al., 2021). Wrong clinical decisions may arise from inaccurate approximations of the burn injuries and can lead to bad outcomes (Giretzlehner et al., 2021). In addition, bad clinical decisions in managing burn injuries may include over-resuscitation, which entails untoward complications (Giretzlehner et al., 2021). In the case presented, Joanne, of unknown age, sustained burn injuries during dinner. The scenario describes possible inhalation burn injuries and sustained second and third-degree burns to the right upper and lower extremities and anterior torso.
Giretzlehner et al. (2021) and Jeschke et al. (2020) describe that the extent of second-degree burns may have damaged the epidermal and dermal tissues. These burn injuries are painful and are associated with blister formations, and appear red to pale in color (Giretzlehner et al., 2021; Jeschke et al., 2020). Third-degree burns involve the destruction of the dermal and epidermal tissue, which may appear leathery and painless (Giretzlehner et al., 2021; Jeschke et al., 2020). In applying the rule of nines, Joanne’s injuries can be approximated as follows the right upper arm for both anterior and posterior portion can be estimated as 9%, the anterior torso, which includes the chest and abdomen, is 18%, and for the right leg, the anterior and posterior portion can be estimated as 18%. Joanne has sustained roughly 45% of the total burned surface area (TBSA) with second-degree and third-degree burns.
The principles of care in managing burn injuries follow the basic sequela to support life: airway, breathing, and circulation (Greenhalgh, 2019). Joanne may have inhalation injuries and will require proactive intubation for airway protection. Joanne was also engulfed in smoke, and carbon monoxide poisoning is a consideration and should be addressed aggressively. Lastly, determining the TBSA fluid resuscitation can be initiated using either the Parkland formula or Brooke formula. In terms of environmental and nutrition, Joanne’s needs are merely supportive and should be initiated, not overfeeding (Giretzlehner et al., 2021; Jeschke et al., 2020; Greenhalgh, 2019).
Giretzlehner, M., Ganitzer, I., & Haller, H. (2021). Technical and Medical Aspects of Burn Size Assessment and Documentation. Medicina (Kaunas, Lithuania), 57(3), 242. https://doi.org/10.3390/medicina57030242
Greenhalgh, D.G. (2019). Management of burns. N Engl J Med, 380, 2349-2359.
Jeschke, M. G., van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S., & Logsetty, S. (2020). Burn injury. Nature reviews. Disease primers, 6(1), 11. https://doi.org/10.1038/s41572-020-0145-5
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