A cook in a restaurant was rushed to the emergency department after sustaining burns on the face,

entire torso, anterior right upper extremity, and anterior right lower extremity including the genitalia.
Answer the questions pertinent to the patient’s condition.

1. Compute for the total body surface area affected by the burns.

Face 4½ %
Entire Torso 18 %
Anterior right upper extremity 4½ %
Anterior right lower extremity 9%
Genitalia 1%
Total 37 %

2. Using parkland formula, compute for the fluid resuscitation for the patient on:

Given :4 ml Lactated Ringers

143 lbs−64.86 kg∨65 kg
TBS=37 %

Solution :4 ml × 65 kg ×37 %=9 620 ml

a. First 8 hours: 4 810 ml

b. Second 8 hours: 2 405 ml

c. Third 8 hours: 2 405 ml

Example there is a given drop factor of 20 gtts/ml the IV flowrate would be:
4 810 ml 20 gtts/ml
1 st 8 hours : × =200¿ 201 gtts/ min
8 hrs 60
2 405 ml 20 gtts /ml
2 nd∧3 rd 8 hours : × =100 ¿ 101 gtts /min
8 hrs 60

3. What acid-base imbalance will the patient be predisposed to in the initial stages of burns?

Burns produces a systemic inflammatory response syndrome which initially causes metabolic
acidosis due to tissue hypoxia caused by severe volume depletion from burn and will lead to decreased
tissue perfusion. In addition, curling ulcer causes metabolic acidosis. Acute Respiratory Distress
Syndrome (ARDS) would cause respiratory acidosis. To summarize, volume depletion, sepsis & curling
ulcer would cause metabolic acidosis & ARDS would cause respiratory acidosis.
4. What is the priority in the different phases of burn management?

a. Emergent phase: the priority of client care involves maintaining an adequate airway and treating the
client for burn shock.
b. Acute phase: attention is given to removing the eschar and other cellular debris from the burned area.
Debridement is one of the process used to remove the eschar then the wound is treated with a topical
antibiotic and a dressing is applied.
c. Rehabilitative phase: the priority is on helping the client return to preinjury life but if that is not
possible, the focus is on helping the client adjust to the changes the injury has imposed.

5. Part of the management for burn patient is the administration of Proton-pump inhibitors
(PPIs) –g. Omeprazole. What is the rationale behind the inclusion of the said drug to the
therapeutic management of burn patients?

Proton-pump inhibitors is a powerful acid-reducing drugs given to patient with severe burn to
prevent curling ulcer which is a breakdown of the lining of the stomach. The severe stress decreases
blood flow to the gastric mucosa & triggers a series of changes that results in mucosal breakdown and
will increased secretion of gastric acid.