CASE STUDY-BIOBRANE IN PARTIAL THICKNESS BURNS

Case Study-Biobrane in Partial Thickness Burns

Case Study-Biobrane in Partial Thickness Burns

Introduction

Burn-related injuries account for over 1 million emergency room visits, 50 000 acute admissions, and 4000 deaths in the USA annually. Children below 15 years of age account for approximately a third of burn admissions and burn deaths. Burns are second only to motor vehicle crashes as the leading cause of death in children older than 1 year. Flame burns account for about a third of pediatric burns and frequently involve inhalation injury.

Although burns directly affect the skin, large burns alter the physiologic function of almost all other body organs and create increased risk of infection and death directly related in magnitude to burn size.

Case history

A 4-year-old boy and his 80-year-old grandmother were victims of an accidental house fire. While the grandmother succumbed to her injuries en route to hospital, the boy was brought to hospital by the paramedics. He had been responsive, but drowsy, at the scene of the accident. Upon arrival at the emergency department, he became unresponsive to commands, but moved all four extremities to pain. A Broselow length-based resuscitation tape was used to estimate his weight at 20 kg. His initial vital signs were: heart rate 174 b min-1, BP 88/40mm Hg, respiratory rate of 50 breaths min-1, tympanic temperature 38.8 oC. His cervical spine was immobilized in an appropriately sized cervical collar. He was administered 100% oxygen via a non-rebreathing face mask and his transcutaneous oxygen saturation (SpO2) was 99%. He had flame burns involving chest, abdomen, both his upper extremities, face, and parts of his lower extremities. He coughed up dark, carbonaceous sputum. In view of his unresponsiveness and possible inhalation injury, the on-call anesthesiologist was consulted to help with airway management. Intravenous access could not be obtained, so a right tibial intra-osseous needle was placed. Fluid therapy with Ringer's lactate solution was commenced. Following pre-oxygenation, a rapid sequence induction was performed by the anesthesiologist, using ketamine 40 mg (2 mg kg-1) and succinylcholine 30 mg (1.5 mg kg-1).

He was intubated with a 4.5mmuncuffed oral endotracheal tube and mechanically ventilated with 100% oxygen (O2).

He was monitored with continuous ECG, NIBP at 5 min intervals, SpO2, and end-tidal CO2. A double lumen CVP line was placed in his right subclavian vein and an arterial line was placed in his left dorsalis pedis artery. Intra-osseous access was then discontinued. Blood was sent for complete blood count, electrolytes, urea, creatinine, arterial blood gases (ABG), carboxyhemoglobin levels, coagulation profile, and cross-matching. Continuous infusions of morphine and midazolam were started, and the rates adjusted as tolerated hemodynamically. A nasojejunal tube was placed and the position of the tube confirmed with abdominal X-ray.

Table 1: Findings on Admission

His bladder was catheterized with a Foley catheter. AP and lateral films of his cervical spine and a chest X-ray did not reveal any bony abnormalities.

Secondary survey revealed that he had suffered second- and third-degree burns to 52% of his total body surface area (TBSA) involving most of ...