Burn Injury Case Study (60 min)
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Mr. Travis is a 32 year old male who presents to the ED after sustaining severe 2nd and 3rd degree burns in a house fire. The below diagram estimates his wounds. He weighs 85 kg and is 5’11”.
Using the Rule of Nines, estimate the Total Body Surface Area Burned (TBSA %).
- Half of the head/neck – 4.5%
- Top half of front torso – 9%
- Top half of back – 9%
- Full top half of right arm – 4.5%
- Full top half of left leg – 9%
- Half of front abdomen – 4.5%
- Half of lower back – 4.5%
- TOTAL – 45%
Calculate the total fluid volume required for resuscitation in the first 24 hours using the Parkland Burn Formula.
- 4 x 45% x 85 kg = 15,300 mL in 24 hours
- Give ½ in the first 8 hours = Start fluids at 956 mL/hr
What is the TOP nursing priority for Mr. Travis?
- Fluid resuscitation to prevent hypovolemic shock
- Mr. Travis’s vitals are: BP 90/48, HR 108, Temp 97.2, Pain 10/10.
You note circumferential burns around the Right Upper Arm and soot around the mouth with singed nose hairs, plus some facial swelling.
What are your main concerns for complication(s)?
- Airway due to possible/likely inhalation burns and airway swelling
- Compartment syndrome due to circumferential burns around right arm
Physiologically, explain the alterations in Mr. Travis’s vital signs.
- He is likely hypovolemic due to the loss of fluids from the burns, hence the low BP and high HR
- He is hypothermic because of his inability to regulate temperature due to skin loss
How will you know if fluid resuscitation is effective?
- Fluid resuscitation should be titrated to urine output of at least 0.5 mL/kg/hr or 30-50 mL/hr
- If excess urine output, slow fluids
- If not enough, speed up fluids
- Mr. Travis is intubated for airway protection and taken to the OR for surgical debridement of his burns. He is then transferred to the Burn ICU
What are priorities for daily care of Mr. Travis?
- Infection prevention and meticulous wound care – sterile dressing changes
- Pain control – PCA if able
- Manage ventilator and respiratory needs until able to be extubated
- Maintain temperature and hemodynamics
Mr. Travis will need skin grafts. How will you explain autologous skin grafts to Mr. Travis and his family?
- Autologous skin grafts are performed by taking a slice of healthy tissue from somewhere else on the patient’s body, for example, his right thigh that isn’t burned, and then running it through a meshing device.
- This allows it to be stretched over the wound and secured in place, then the skin will grow in around the graft.
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Nursing Case Studies
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
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Burn Case Study
A kitchen grease fire ignites causing 2nd and 3rd degree burns in patient Anna Sites. 40,000 hospitalizations occur each year in the United States from burn related injuries (American Burn Association, 2013). In this case, we’ll explore the assessment, pathophysiology, and treatment of a major burn and subsequent shock.
Module 1: Burn
Anna Sites was cooking a meal for her boyfriend. She was frying bacon to add...
Burn - Page 1
Firefighters and paramedics arrived quickly on the scene. Emergency responders...
Burn - Page 2
The patient was started on an IV drip of 3-5 mg/10 minutes of morphine for pain...
Burn - Page 3
Lab tests were ordered including a CBC, chemistry panel, urinalysis, and carboxyhemoglobin...
Burn - Page 4
Seven days following Anna's admission to the burn unit...
Burn - Page 5
Case Summary
Summary of the Case
Burn - Summary
Answers for the Case Questions
Burn - Answers
Professionals
Health Professionals Introduced in Case
Burn - Professionals
Additional Links
Optional Links to Explore Further
Burn - Links
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Partial thickness or second degree burns. Based on the nurse's understanding of the Parkland Formula, which rate correctly describes the time the fluid is given to the client? The nurse administers the first half of the fluid from the time the burn occurred over 8 hours, and the second half over the following 16 hours.
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Burn Case Study. A kitchen grease fire ignites causing 2nd and 3rd degree burns in patient Anna Sites. 40,000 hospitalizations occur each year in the United States from burn related injuries (American Burn Association, 2013). In this case, we'll explore the assessment, pathophysiology, and treatment of a major burn and subsequent shock. ...
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