Rivera, Beatrice Nicoli I.

BSN 3-Y1-2

A cook in a restaurant was rushed to the emergency department after sustaining burns on
the face, entire torso, anterior right upper extremity, and anterior right lower extremity
including the genitalia. Answer the questions pertinent to the patient's condition.

1. Compute for the total body surface area affected by the burns.

Face 4½ %
Entire Torso 18%
Anterior Right Upper Extremity 4½ %
Anterior Right Lower Extremity 9%
Genitalia 1%
Total: 37%

2. Using parkland formula, compute for the fluid resuscitation for the patient on:
a. First 8 hours: 4810 ml
● 200.3/201 gtts/ml
b. Second 8 hours: 2405 ml
● 100.2/101 gtts/ml
c. Third 8 hours: 2405 m
● 100.2/101 gtts/ml
3. What acid-base imbalance will the patient be predisposed to in the initial stages of burns?
- Patients with extensive burns suffer an accumulation of fixed acids due to the prominent
sympathico-adrenergic effect in the initial stages of trauma. This metabolic acidosis is due
partly to cellular hypoxia and the increasing breakdown in renal and hepatic function.
Elevated potassium levels in the serum can cause metabolic acidosis as a result of reduced
tissue perfusion and tissue hypoxia caused by severe volume depletion from consumption and
tissue damage.

4. What is the priority in the different phases of burn management?

a. Emergent phase:The emergent phase begins with the onset of burn injury and lasts until the
completion of fluid resuscitation or a period of about the first 24 hours. The priority of client care
involves maintaining an adequate airway and treating the client for burn shock.
b. Acute phase: The acute phase of burns is defined as a period extending from the onset of burns
with shock to the time taken for wound epithelialization. Attention is given to removing the eschar
and other cellular debris from the burned area. Debridement is one of the processes used to remove
the eschar, then the wound is treated with a topical antibiotic and a dressing is applied.
c. Rehabilitative phase: This is a period when patients slowly regain a sense of competence while
simultaneously adjusting to the practical limitations of their injury. The goal in this phase is to guide
and help the client get back to his preinjury life but also to help them adjust with the changes that the
injury brought.

5. Part of the management for burn patients is the administration of Proton-pump

inhibitors (PPIs) - e.g. Omeprazole. What is the rationale behind the inclusion of the
said drug to the therapeutic management of burn patients?
- Burn patients are at increased risk of developing gastrointestinal stress ulcers (Curling's
ulcers) and should routinely be initiated on stress ulcer prophylaxis with either proton-pump
inhibitors or histamine H2 receptor blockers. Omeprazole is used to prevent GI ulcers due to
burns. Ulcer prophylaxis may be discontinued once resuscitation is complete and full dose
oral or enteral feeding has been established.

References:

Caring for the Client with Burns

https://www.pearsonhighered.com/assets/samplechapter/0/7/8/9/078973706X.pdf

Medical and Surgical Care of Critical Burn Patients: A Comprehensive Review of Current
Evidence and Practice

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9754771/#:~:text=Burn%20patients%20are%20at%2
0increased%20risk%20of%20developing%20gastrointestinal%20stress,or%20histamine%20H2%20r
eceptor%20blockers.

“Off-Label” Medicine Use In Burned Children: Three-Year Retrospective Study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126370/#:~:text=In%20our%20study%2C%20sucra
lfate%20and,significantly%20associated%20with%20GI%20ulcers.