Main Problems

1. Sustaining burn at head, face, bilateral upper extremities, scattered posterior and anterior torso,
buttocs, left upper thigh (approximately 80% TBSA)
2. Initial treatment had done 4L NS 0,9% , 1,5 hour post burn

PF
1. TTV: HR 118x/mins, BP 132/77 mmHg, RR 16x/mins (without ventilator), Temp 36,1*C rectal →
tachycardia with increased BP. RR still 16, suspect circumferential injury leads to decrease RR.
2. Urine clear yellow , 42 ml/hour
3. Radial pulses 2+, bilateral (​0 indicating no palpable pulse; 1 + indicating a faint, but detectable
pulse; 2 + suggesting a slightly more diminished pulse than normal; 3 + is a normal pulse; and 4 +
indicating a bounding pulse.)
4. Weight 82 kg

Lab
1. Na= 146 → increase (range 134-145) ----> increased due to blood loss, for re-perfusion to tissue
and from Normal Saline resuscitation.
2. K= 4,2 → normal (range 3,5-5,0)
3. Cl= 111→ increase (range 95-105) ----> idem with Na
4. Ca= 8,6 → normal (range 8,5-10,2)
5. Mg= 2,1 → normal (range 1,5-2,5)
6. PO4= 2,5 → normal (range 2,5-4,5)
7. BUN= 22 → increase (range 6-20) ----> increased BUN without Cr indicate slight kidney impairment,
become normal later with treatment
8. Cr= 0,9 → normal (range 0,6-1,2)
9. Hb= 9,8 → decrease (range 12-13) ----> anemia e.c. suspect blood loss/water loss due to burn
injury
10. Hct= 29 → decrease (range 36-48)
11. Blood Gas Analysis
- pH= 7,31 → acidosis
- PCO2= 45 → upper limit (due to burned environment)
- PO2= 29 → decrease (due to hypoxic environment while injured)
- HCO3= 26 → upper limit (due to compensation)
Conclusion → (on going compensation) Uncompensated Acidosis Respiratory (e.c. Hypoxia and CO
accumulation)

Treatment (from case)

1. Fluid Resuscitation with RL (Parkland formula - 4 mL/ BW /%TBSA) 15,744 mL → resuscitation for
burn injury
2. Bronchoscopy due to burn inhalation → immediately for diagnosing burn inhalation, leads to
inflammation and irritation.
3. Aerosol heparin → for decreasing blood coagulation in respi tract.
4. Recalculate Burning TBSA with Rule of Nine, estimated 48% TBSA (vs 80% referring to hospital)
5. Admission for split thickness skin grafts to all areas of full-thickness burn.
6. Extubated 1 week after surgery , discharged after 4,5 week post admision
Case Explaination
Rule of Nine

Burn Injury Degree

Parkland Formula