Burns case study:

Erica was cooking a meal for her family. She was frying bacon to add to a pasta dish when the grease
from the bacon caught fire. Erica panicked, grabbed the boiling pasta water on the stove, and dumped
it on the grease fire. The fire exploded into a raging fire ball, scalding Erica's face and hair, and
catching Erica's shirt on fire.
Firefighters and paramedics arrived quickly on the scene. Emergency responders placed Erica on
100% oxygen, put her in a neck brace as a precautionary measure, carefully moved her and loaded
her into the ambulance. During transport, paramedics started an IV and began
administering a solution X to replace lost fluid volume.
Upon arrival to the hospital, the physician, and nursing personnel quickly assessed the extent of the
burn and determined if any other injuries were present. The patient presented
with tachypnea and tachycardia but remained conscious
Vital signs were taken and recorded:

Temperature: 38.5 C (101.3 F)

Blood Pressure: 95/60 mmHg

Pulse: 130 bpm

Respirations: 24 breaths/minute

The extent of the burns was assessed using the “rule of nines”

Erica had burns on the anterior head and neck, anterior trunk, and both anterior thighs. Using the rule
of nines, this was approximately 40% of her body.

 4% anterior head and neck

 18% anterior and posterior of both arms (9% + 9%)
 18% anterior trunk

The depth of the burns was also assessed. Full-thickness or third-degree burns were present on the
right shoulder, upper anterior right arm, and part of the anterior trunk. Second-degree burns with
blistering were present on the remaining burn areas.

The patient was started on an IV drip of 3-5 mg/10 minutes of morphine for pain

Erica was intubated and placed on mechanical ventilation to maintain an open airway. Respiratory
therapists will monitor mechanical ventilation as long as Erica needs airway support
Lab test was done revealing the following:

High blood glucose

Low albumin level

Low serum protein level

High CRP

Erica is taken to the burn ICU. Her RN inserts an NG (nasogastric) tube for feedings. Enteral feedings
will begin as soon as Erica is hemodynamically stable.

Erica’s usual weight is 78Kg- Height 167cm- Age 43 year-old

Questions:

1. What was the solution X mentioned previously? Why we normally use it and how we do
calculate its volume? (3 pts)

2. Explain the causes behind the abnormality seen in each of the vital signs mentioned above (6
pts)

3. Assessment of burns can be done through the rule of nines, briefly explain how we normally
use this rule (2 points)

4. Interpret each of the lab results done in Erica’s case (explain why some are low and others are
high) (4 pts)

5. Calculate Erica’s protein needs (1 pt)

6. Calculate Erica’s energy needs based on Curreri equation (1pt)

7. “Enteral feedings will begin as soon as Erica is hemodynamically stable” Can’t we start the
tube feeding earlier? Explain your answer (3 pts)