DAVAO MEDICAL SCHOOL FOUNDATION, INC.

– COLLEGE OF MEDICINE
Department of Surgery
Name: Gotera, Chloe Lynn M.
Batch/Section: NMD 4 Group 4
Date: November 23, 2022
Preceptor: Dr. Angelica Mary Joan A. Labradores
DAY 1 ACTIVITY
History and Physical Examination
Diagnosis

Case:
Around 12AM, a 40/M was trapped for about 15 minutes inside his room in a burning building in and was then rescued by 911 and was brought to the Emergency room on a stretcher.
Past medical history: Unremarkable
Surgical history: Unremarkable
Family history: Unremarkable
Personal history: Computer programmer, 5-pack year smoker, alcoholic beverage drinker

General Survey Vital Signs Skin HEENT Neck

Physical GCS 15, Awake, ambulatory, in 130/80 Patient sustained burns on left Soot stained face with Trachea midline
Examination mild respiratory distress 105bpm upper extremity, circumferential and singed eyebrows and nasal No mass
Findings 21cpm anterior surface of the left thigh hair. Pinkish palpebral No enlarged cervical nodes
Weight: 70 kg 36.7C was noted with weeping blisters and conjunctive
Height: 167 cm 98% O2 saturation were very painful to touch. The
cheeks, perioral areas, neck and
chest are noted to be erythematous
and tender.

Lungs Heart Abdomen Genitalia/Rectum Extremities Neuro

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Department of Surgery
th
Equal chest Tachycardic, PMI at 4 Non-distended, soft, no palpable No external lesions, Good No edema, full pulses bilateral, GCS 15 (E4V5M6)
expansion, Clear ICS MCL, Distinct heart mass, tenderness on palpation on tone, no mass or lesion, No no limitation of movements of 3mm EBRTL
Breath sounds, no sound, no murmur right flank. blood on examining finger all extremities, (+)tenderness No localizing signs
wheezes, no stridor upon movement of the left No sensory cut off
upper extremity and left thigh, 5/5 Motor strength
(-) paresthesia

Instructions:
● Use Schwartz’s Principles of Surgery 11th edition, Sabiston Textbook of Surgery 21st Edition, MIMS, and Bate’s Guide to Physical Examination and History Taking as your
reference for this case.
● Indicate the reference and page number in the column provided for your answers.

ENUMERATE THE SALIENT FEATURES - CASE-BASED MANIFESTATIONS

40 year old, Male

5 pack year smoker, Alcoholic beverage drinker

Trapped for about 15 minutes inside his room in a burning building, rescued by 911 and was brought to
the ER

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 DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
GCS 15, Awake, Mild respiratory distress

130/80 Hypertensive
105bpm Tachycardic

21cpm Tachypneic

Patient sustained burns on left upper extremity, circumferential and anterior surface of the left thigh was
noted with weeping blisters and were very painful to touch. The cheeks, perioral areas, neck and chest
are noted to be erythematous and tender.

Soot stained face with singed eyebrows and nasal hair.

tenderness on palpation on right flank

(+) tenderness upon movement of the left upper extremity and left thigh

Lungs: Clear breath sounds, no wheezes, no stridor

Genitalia: No external lesions

Extremities: no edema, full pulses, no limitation of movements of all extremities, (+) tenderness upon
movement of the left upper extremity and left thigh, no paresthesia

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TASK/QUESTION
What are additional information in the history
that you need to ask in this case?
What are the life threatening conditions that
you need to address during the Primary
Survey?
What is the significance of inhalational injury
and how to assess this in the patient?
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Department of Surgery
ANSWER REFERENCE
(source, page no.)
Schwartz's Principles
of Surgery 11th ed
Is the patient experiencing chest pain?
pg 251-262
Is the patient experiencing headache?
Is the patient experiencing cough? Presence of sputum?
Immunization status?
Ask for the source of burn? Flame burn? Scald burn?
Is it an indoor (inhalational injury component) or outdoor incident?
Ask for comorbidities
Any concomitant trauma? Hx of fall? Nahulugan ng kahoy? Manage trauma frst
Is the patient alone sa room?
P&S Hx: Allergies?
Inhalation Injury (Dyspnea, hoarseness of voice, wheezing, stridor), rapid and severe airway edema, hypothermia,
compression syndrome, carbon monoxide poisoning, circulatory shock, Dehydration
 Inhalation injuries are commonly seen in tandem with burn injuries and are known to increase mortality in
burned patients. Smoke inhalation is present in as many as 35% of hospitalized burn patients and may triple
the hospital stay compared to isolated burn injuries. Smoke inhalation causes injury in two ways: by direct
heat injury to the upper airways and inhalation of combustion products into the lower airways. Direct injury to
the upper airway causes airway swelling that typically leads to maximal edema in the first 24 to 48 hours
after injury and often requires a short course of endotracheal intubation for airway protection. Combustion
products found in smoke, most commonly from synthetic substances in structural fires, cause lower airway
injury. These irritants cause direct mucosal injury, which in turn leads to mucosal sloughing, edema, reactive
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 DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
bronchoconstriction, and finally obstruction of the lower airways. Injury to both the epithelium and
pulmonary alveolar macrophages causes release of prostaglandins, chemokines, and other inflammatory
mediators; neutrophil migration; increased tracheobronchial blood flow; and, finally, increased capillary
permeability. All of these components of acute lung injury increase the risk of pneumonia and ARDS
following an inhalation injury.

 Inhalation injury decreases lung compliance96 and increases airway resistance work of breathing.97
Inhalation injury in the presence of burns also increases overall metabolic demands.98 The most common
physiologic derangement seen with inhalation injury is increased fluid requirement during resuscitation.
Since severe inhalation injury may result in mucosal sloughing with obstruction of smaller airways,
bronchoscopy findings including carbon deposits, erythema, edema, bronchorrhea, and a hemorrhagic
appearance may be useful for staging inhalation injury.

 Inhalation injury is known to increase mortality in burned patients. Mortality for inhalation injury has been
reported to be as high as 25%, with this increasing to 50% in patients with ≥20% TBSA burns.

 Look for signs of respiratory distress (clinical presentations): hoarse voice, wheezing, or stridor, subjective
dyspnea.

 Bronchoscopy

What are the signs of impending respiratory  Signs of impending respiratory compromise include a hoarse voice, wheezing, or stridor; subjective dyspnea Schwartz 11th ed
compromise? is a particularly concerning symptom and should trigger prompt elective endotracheal intubation. Chap 8, page 251

What is your complete diagnosis for this Flame burn 13.5% TBSA Superficial-Deep partial thickness involving the left upper extremity circumferential and Case
patient? Answer on the table provided below anterior left thigh, to consider Inhalation injury and compartment syndrome

What is your TBSA? Show how to calculate to confirm, each lower extremity is 18% (9% ant, 9% posterior), each upper extremity is 9% (4.5% anterior, Schwartz 11th ed
the TBSA in this patient. 4.5% posterior) Chap 8, page 252

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 DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
since our patient has burns in the left upper extremity circumferential = 9%
left anterior thigh = 4.5%

% TBSA= 13.5%

What IV Fluids will you give to this patient?  Lactated Ringer’s Solution Schwartz's Principles
And How will you do your resuscitation? of Surgery 11th ed
 2cc/kg/%TBSA
pg 251-262
 2cc x 70 x 13.5 = 1890cc

 1890 cc/2 = 945 to be given in the first 8 hours after burn at 118 cc/hr

 Remaining 945 to be given subsequently for 16 hours at 60cc/hr

Do you need to give antibiotics to this  No antibiotic given because in the first 24 hours the burn is still sterile. Sabiston 21st ed
patient? Chap 20

What other diagnostic test/procedure do you ● Radio imaging test (X-ray) helps in identifying other injuries that the patient might have during the incident. Schwartz's Principles
need to do to rule out other injuries for this Serum electrolytes might also be requested so show the degree of dehydration of the patient. ECG can be of Surgery 11th ed
patient? helpful in ruling out electrical burns. Other tests include carboxyhemoglobin, ABG, and full blood examination. pg 251-262
Explain in sentence form.

What are the 3 Zones of tissue burn injury?  The zone of coagulation is the most severely burned portion and is typically in the center of the wound. As Schwartz 11th ed
What is the importance of these in relation to the name implies, the affected tissue is coagulated and sometimes frankly necrotic, much like a full Chap 8 page 253
burn injury? thickness burn, and will need excision and grafting.

 Peripheral to that is a zone of stasis, with variable degrees of vasoconstriction and resultant ischemia, much
like a second degree burn. Appropriate resuscitation and wound care may prevent conversion to a deeper
wound, but infection or suboptimal perfusion may result in an increase in burn depth. This is clinically

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Department of Surgery
relevant because many superficial partial-thickness burns will heal with nonoperative management, and the
majority of deep partial-thickness burns benefit from excision and skin grafting.

 The outermost area of a burn is called the zone of hyperemia, which will heal with minimal or no scarring and
is most like a superficial partial thickness burn or first-degree burn.

Do you need to ADMIT the patient or treat the  Admit patient Schwartz's Principles
patient as an OUT-PATIENT. of Surgery 11th ed
ANSWER IN SENTENCE FORM AND FILL UP  We will admit this patient to administer fluid resuscitation and initial management. We also need to monitor
for possible inhalation injuries of the patient. pg 251-262
THE FORM PROVIDED BELOW. WRITE THE
PRESCRIPTIONS OF MEDICATIONS
ORDERED ON THE TABLE.

What are the indications to refer and admit to  Partial thickness burns greater than 10% total body surface area (TBSA) Schwartz 11th ed
a burn center? Chap 8
 Burns that involve the face, hands, feet, genitalia, perineum, or major joints

 Third degree burns in any age group Sabiston 21st ed

Chap 20
 Electrical burns, including lightning injury
Surg Platinum 2018
 Chemical burns

 Inhalation injury

 Burn injury in patients with preexisting medical disorders that could complicate management, prolong
recovery, or affect mortality

 Any patient with burns and concomitant trauma (such as fractures) in which burn injury poses the greatest
risk of morbidity or mortality. In such cases, if the trauma poses the greater immediate risk, the patient may
be initially stabilized in a trauma center before being transferred to a burn unit. Physician judgment will be
necessary in such situations and should be in concert with the regional medical control plan and triage
protocols

 Burned children in hospitals without qualified personnel or equipment for the care of children

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Department of Surgery
 Burn injury in patients who will require special social, emotional. or rehabilitative intervention

***The preceptor may have the option to add more questions or revise the task in the table.

Diagnosis

Flame burn 13.5% TBSA Superficial-Deep partial thickness involving the left upper extremity circumferential and anterior left thigh, to consider Inhalation injury and compartment
syndrome

Epidemiology In 2017, approximately 400,000 people were burned in the United States, of whom 3400 died. The epidemiological trends from 2001 to Sabiston Textbook
2017 demonstrate that the U.S. population has increased from 285,000,000 to 326,000,000 people, a nominal 14% increase. of Surgery pg. 484
Correspondingly, the incidence of burns decreased from 520,000 to 403,000, a 23% decrease. Fatal burns also decreased from 3800
deaths in 2001 to 3400 deaths in 2017 (10% decrease).1 From these data, we conclude that the number of burns has decreased per
capita over this time period at an appreciable rate; however, burns remains a real public health threat, as these changes seem to be
leveling off at about 125 recorded burns per 100,000 people.

Risk Factors Gender: Females have slightly higher rates of death from burns compared to males according to the most recent data. This is in WHO
contrast to the usual injury pattern, where rates of injury for the various injury mechanisms tend to be higher in males than females.

The higher risk for females is associated with open fire cooking, or inherently unsafe cookstoves, which can ignite loose clothing. Open
flames used for heating and lighting also pose risks, and self-directed or interpersonal violence are also factors (although understudied).

Age: Along with adult women, children are particularly vulnerable to burns. Burns are the fifth most common cause of non-fatal
childhood injuries. While a major risk is improper adult supervision, a considerable number of burn injuries in children result from child

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Department of Surgery
maltreatment.

Regional factors: There are important regional differences in burn rates. -Children under 5 years of age in the WHO African Region have
over 2 times the incidence of burn deaths than children under 5 years of age worldwide. -Boys under 5 years of age living in low- and
middle-income countries of the WHO Eastern Mediterranean Region are almost 2 times as likely to die from burns as boys living in the
WHO European Region. -The incidence of burn injuries requiring medical care is nearly 20 times higher in the WHO Western Pacific
Region than in the WHO Region of the Americas.

Socioeconomic factors: People living in low- and middle-income countries are at higher risk for burns than people living in high-income
countries. Within all countries however, burn risk correlates with socioeconomic status.

Other risk factors: There are a number of other risk factors for burns, including:
-occupations that increase exposure to fire;

-poverty, overcrowding and lack of proper safety measures;

-placement of young girls in household roles such as cooking and care of small children;
-underlying medical conditions, including epilepsy, peripheral neuropathy, and physical and cognitive disabilities;

-alcohol abuse and smoking;

-easy access to chemicals used for assault (such as in acid violence attacks)

-use of kerosene (paraffin) as a fuel source for non-electric domestic appliances;

-inadequate safety measures for liquefied petroleum gas and electricity

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Department of Surgery
Pathophysiology ● Local Changes

- Thermal burns, in particular, cause damage to the skin and occasionally underlying structures through abrupt temperature change that
exceeds biologic tolerance. This leads to membrane disruption, protein denaturation, and necrosis. The injury extends from the skin
surface to deeper structures in a first-order logarithmic distribution depending on the temperature of the burning agent and duration of
exposure.9 Severe burns to the skin reaching over 280°F induce a Maillard-type reaction with changes in consistency and color
common with flame full-thickness burns. Burns that induce necrosis of the surface with temperatures below 280°F, such as scald burns
from hot water, have a different appearance and texture and are commonly mistaken for partial-thickness burns.

● Systemic Changes
- Inflammation and Edema: Burns induce a massive increase in inflammation in response to the injury, in the wound first that is then
generalized to all other tissues. The Glue Grant Investigators demonstrated that over 80% of the genes in circulating immune cells are
radically changed following severe injury, including burns.15 The changes involve most, if not all, cellular functions and pathways and
was termed a “genomic storm.” This breadth and degree of change was not anticipated by the investigators, identifying that circulating
leukocytes are radically activated in the response to severe injury with dramatically increased expression of genes in the inflammatory,
innate immunity, and antiinflammatory spheres

● The 3 primary mechanisms that lead to injury in smoke inhalation are thermal damage, asphyxiation, and pulmonary irritation. The
combination of these mechanisms can explain the pathophysiologic responses that alter the airway microenvironment with
parenchymal damage and predispose smoke inhalation victims to respiratory insufficiency.

Thermal damage

-Thermal damage is usually limited to the oropharyngeal area, in part due to the poor conductivity of air. In addition, heat dissipation in
the upper airways and laryngeal reflexes help protect the lower lung areas from direct thermal injury. Animal experiments have shown
that 142°C inhaled air cools to 38°C by the time it reaches the carina. Steam, volatile gases, explosive gases, and the aspiration of hot
liquids provide some exceptions, as moist air has a much greater heat-carrying capacity than dry air.

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Department of Surgery
Asphyxation
-Tissue hypoxia can occur via several mechanisms. Combustion in a closed space can consume significant amounts of oxygen,
decreasing the ambient concentration of oxygen to as low as 10-13%. For victims in that setting, the decrease in fraction of inspired
oxygen (FIO2) leads to hypoxia, even if they have adequate circulation and oxygen-carrying capacity. If sufficiently severe, hypoxia can
lead to multiorgan dysfunction, which substantially raises morbidity and mortality.

Pulmonary irritation
-Pulmonary injury from smoke inhalation is characterized by both hyperinflation and atelectasis. Debris from cellular necrosis,
inflammatory exudate, and shed epithelium combine with carbonaceous material to narrow airways that are already compromised by
edema. Reflex bronchoconstriction further exacerbates the obstruction.Both inspiratory and expiratory resistance are increased, and
the premature closure of small airways occurs, producing hyperinflation and air trapping. Surfactant production and activity are both
impaired, leading to alveolar collapse and segmental atelectasis. Low-pressure pulmonary edema plays an important role in the
development of lung injury from smoke inhalation. Damage to the alveolar capillary membrane increases its permeability, and
intravascular leakage into the pulmonary interstitium ensues. Eventually, increased lymphatic flow may be overwhelmed, resulting in
alveolar edema. Alveoli fill with thick, bloody fluid. Loss of compliance, further atelectasis, and increasing edema can result in severe
ventilation-perfusion mismatch and hypoxia.

Prognosis Even with the best efforts at prevention, the presence of the systemic inflammatory syndrome that is ubiquitous in burn patients may Sabiston Textbook
progress to organ failure. It was found that approximately 28% of patients with greater than 20% TBSA burns develop severe multiple of Surgery pg. 484
organ dysfunction, of which 14% will also develop severe sepsis and septic shock.

Others found that 40% of deaths after severe burn were related to organ failure, which universally involved the renal system with on
average at least three other systems. The general development begins in the renal or pulmonary systems and can progress through the
liver, gut, hematologic system, and central nervous system. The development of multiple organ failure does not predict mortality,
however, and efforts to support the organs until they heal are justified.

PLEASE READ: If you decide to admit this patient, kindly fill-up the admitting form. Otherwise, if you decide to manage the case as an outpatient, fill-up the outpatient form following the
SOAP format.

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COMPLETE ADMITTING
IMPRESSION
ADMITTING ORDER
Admit patient under the service of Dr. Angelica Labradores
Secure consent
Decide which AREA/SECTION IN
THE HOSPITAL you will admit the
patient
e.g. Admit patient in a private room
Choose which INTRAVENOUS
FLUID is appropriate for the patient;
show the solution in computing the
rate
e.g. IVF PNSS 1 liter at 80cc/hr
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DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
ADMITTING ORDER FORM
Flame burn 13.5% TBSA Superficial-Deep partial thickness involving the left upper extremity circumferential and anterior left thigh, to consider
Inhalation injury and compartment syndrome
Rationale Reference
(source, page no.)
● Admit patient in a burn unit ICU ● To pptovide appropriate support and monitoring Schwartz's Principles of
Surgery 11th ed pg 251-
262
Start IVF PLR 1L at 118 cc/hr for the first 8 hours then LR is used because it the closest to plasma in terms of Schwartz's Principles of
shift to 60cc/hr for the next 16hr components Surgery 11th ed pg 251-
262
2cc/kg/%TBSA
-2cc x 70 x 13.5 = 1890cc 2cc is recommended to avoid excessive fluid administration
that may cause life threatening effects like hypothermia
-1890 cc/2 = 945 to be given in the first 8 hours after
burn at 118 cc/hr
-Remaining 945 to be given subsequently for 16 hours at
60cc/hr
12

Identify appropriate DIET plan for
this patient
e.g. NPO
Identify the DIAGNOSTICS TESTS
that you think are appropriate and
necessary for the management of
this case and what are your
expected findings.
e.g. complete blood count and
imaging studies
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DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
● NPO for now ● Should take nothing by mouth until it becomes clear that Schwartz's Principles of
they will not require tracheal intubation because of Surgery 11th ed pg 251-
significant respiratory or hemodynamic compromise. 262
● Since we consider a compartment syndorme, NPO for
possible fasciotomy
● CBC with diff To check for anemia and WBC count
White Blood Cells are abnormally high. White cells in the
blood are elevated during inflammation and trauma. Under
the differential results we see the type of white cells that are
high are neutrophils. Neutrophils help fight infection and are
the first to the site with inflammation.
Red Blood Cells are slightly low as is the Hemoglobin due to
the trauma of the burn.
The hematocrit (Hct) is the percentage of the volume of the
whole blood that is made up of red blood cells. In burns, the
patient has lost a lot of fluid from leaky blood vessels (see
Systemic Effects of Burns in the Case Study Workbook).
There are more red cells than fluid so the hematocrit is high.
You can think about this if you make up a packet of Kool
Aid. If you dilute the Kool Aid with 2 qts of water, it tastes
about right; it's normal. If I dilute the Kool Aid with 1 cup of
water, it's very concentrated. Think of the hematocrit as
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 DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
describing how concentrated the Kool Aid is, only in this case
we're talking about how concentrated the blood is. If there's
not a lot of fluid in the vessels, the blood is very
concentrated. The hematocrit goes up.

● Xray To rule out other trauma related injuries Schwartz's Principles of

Surgery 11th ed pg 251-
262
to detect fluid accumulation, position of the ET tube (if
intubation is required), or atelectasis caused by large-volume
fluid resuscitation

● Bronchoscopy To check for inhalation injury Schwartz's Principles of

Surgery 11th ed pg 251-
The role of bronchoscopy in most hospitals has been limited 262
to obtaining lavage fluid for culture and assessing the degree
of airway injury, which has been shown to be predictive of
outcome. Severe inhalation injury, which is characterized by
pulmonary edema, bronchial edema, and secretions, can
occlude the airway and lead to atelectasis and pneumonia.
Aggressive use of bronchoscopy is highly effective in
removing foreign particles and accumulated secretions that
worsen the inflammatory response and impede ventilation.

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Department of Surgery

● Serum electrolytes (Na, K, Mg, Ca) Sodium, potassium and glucose are the commonly affected Schwartz's Principles of
electrolytes in burn patients. Their imbalances change over Surgery 11th ed pg 251-
time as the burn evolves. 262

Low sodium: shift to ECS

High Potassium: cell lysis and tissue necrosis

● Creatinine Creatine is a breakdown product from muscles. Because of Schwartz's Principles of

the damage to the muscles from the burn, creatine kinase is Surgery 11th ed pg 251-
released into the bloodstream. 262

● Glucose The glucose value is elevated. The body is under extreme Schwartz's Principles of
stress. Glucose stores are released from the liver and new Surgery 11th ed pg 251-
glucose is made. This extra glucose is needed as energy for 262
the body to heal.

Check for nutrition

● Cyanide Level Done if unexplained lactic acidosis occurs; Schwartz's Principles of

Surgery 11th ed pg 251-
patients with smoke inhalation are at risk for cyanide toxicity

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Identify the MEDICINES
appropriate for this case
e.g. Amoxicillin 500 mg/tab 1 tab
TID
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DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
262
● ECG Done at baseline before fluids are started because cardiac Schwartz's Principles of
arrhythmias may occur during early stages of resuscitation Surgery 11th ed pg 251-
for large burns 262
● BUN This is a breakdown product from protein and also reflects Schwartz's Principles of
kidney damage. Surgery 11th ed pg 251-
262
● Silver sulfadiazine 1%, cerium nitrate 2.2% ● prophylaxis against burn wound infections Schwartz 11th ed Chap 8
p 257
(Flammacerium) apply 2-3mm thick directly onto the
wound or on a sterile gauze dressing and applied at Sabiston 21st ed Chap 20
least once 24 hourly after removal of the old cream p 495
MIMS Chap 16 p 629
● Benzocaine 10mg ● effective topical antimicrobial. Schwartz 11th ed Chap 8
p 257
Apply thinly three times a day ● It is effective even in the presence of eschar and can be
MIMS Chap 16 p 649
used in both treating and preventing wound infections;
the solution formulation is an excellent antimicrobial for
fresh skin grafts
16

Identify what will you MONITOR;
laboratory monitoring not included
e.g. Vital signs monitoring every 4
hours
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DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
Salbutamol sulphate 5mg/nebule 1 neb every 6 hours Treatment relief of inhalation injury consists promarily of MIMS Chap 16 p 171
via face mask supportive care. Routine use of bronchodilators such as
salbutamol/albuterol are recommended.
0.5ml of Tetanus toxoid Prophylaxis for infection Schwartz's Principles of
250 units of tetanus immune globulin Surgery 11th ed pg 251-
262
● VS monitoring q4 ● Monitor any sign of improvement or deterioration Schwartz 11th ed Chap 8
Sabiston 21st ed Chap 20
● Able to know appropriate management
Surg Platinum 2018
● Input and Output q hourly ● Monitor fluid balance Schwartz 11th ed Chap 8
Sabiston 21st ed Chap 20
Surg Platinum 2018
● Wound dressing ● To reduce infection ● Schwartz 11th ed
Chap 8
● Give patient a full body bath using warm water &
soap ●
● Debride the burned areas, removing dead skin and ● Sabiston 21st ed
unroofing blisters Chap 20
● Wash the burn areas with betadine soap and rinse ●
with sterile water
● Surg Platinum 2018
● Dress wounds with a topical antibacterial or another
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 DAVAO MEDICAL SCHOOL FOUNDATION, INC. – COLLEGE OF MEDICINE
Department of Surgery
dressing modality

Identify other necessary
NONPHARMACOLOGIC
INTERVENTIONS
Eg. Insert NGT; refer patient to
Surgery Service for evaluation of
right lower quadrant pain
\
Refer to Dietician, Pulmonologist, Rehabilitation
medicine for co-management
● To provide proper monitoring and management of Schwartz's Principles of
patient Surgery 11th ed pg 251-
● Pulmonologist provide focused monitoring and 262
management of a possible inhalation injury
● Rehabilitation is an integral part of the clinical care plan
for the burn patient and should be initiated on admission.
Immediate and ongoing physical and occupational therapy is
mandatory to prevent functional loss.

OUTPATIENT FORM

DAVAO MEDICAL SCHOOL FOUNDATION HOSPITAL OUTPATIENT FORM - SOAP

S - SUBJECTIVE DATA (Answer in bullet format) ●

O - OBJECTIVE DATA (Answer in bullet format) ●

A - ASSESSMENT ●

P - PLAN

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Department of Surgery
Diagnostic tests e.g. complete blood count Rationale Reference
(source, page no.)

Medicines e.g. amoxicillin 500 mg/tab 1 tab TID Rationale Reference

(source, page no.)

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Department of Surgery
●

Other non-pharmacologic interventions Rationale Reference

e.g. Low salt, low fat diet (source, page no.)

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Department of Surgery
●

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Department of Surgery

PRESCRIPTION FORM

Name of Patient: XX Age: 40 Sex: M

● This form will be used in prescribing the
drugs whether you admit the patient or Address: XX Date:
cater as an outpatient case. 11/23/22
● Include the brand name that you prefer to
use.

Example:

Amoxicillin (Himox) 500mg/tab tab # 21

sig. 1 tab 3 x a day for 7 days
1. Silver sulfadiazine cream #1

sig. Apply to affected area 1-2 times a day

2.
sig.

3.

sig.

4.

sig.

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Department of Surgery
5.
sig.

Doctor’s Name: Dr. Angelica Mary Joan A. Labradores

License #: 123 456
PTR #: 987 321

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