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Discussion

what is the prognosis?

I work in a level 1 trauma center. (very very new here) I had my first burn pt yesterday. This pt had 2nd and 3rd degree burns to 45% of pt's body. Full circumferential trunk, arms, hands. No face involvement. Airway fine. Anyhow, it was a very sad case d/t the age of pt. We shipped to the closest burn unit asap.

I am wanting to know what you do when this type of pt gets to you. I know the rule of fluid replacement. Does this pt get debridement right away? What about pain control? infection? nutrition? tx? How long does it take (best case scenario) to heal from burns like this?

Thanks in advance

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Well if the burns are truly third degree and truly circumfrential, pulses should be assessed hourly and intra-abdominal pressures should also be monitored. Esharotomies will probably be needed to the arms, trunk, fingers. Surgical debridement would probably take place after the intial resuscitation period of 24 hrs. At my unit this patient would be intubated profilactically, especially with the expected edema of the resuscitation with a burn of that size and severity. The patient would be place on morphine and versed gtts, LR for resuscitation in addition to a continuous ascorbic acid infusion for the first 24 hrs, prevacid, albumin 25% (post resusciation). This patient could easily stay 6 months in the unit and could also easily die depending on age and comorbidities.

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