Severe burns are life-threatening injuries very difficult to heal. Multidisciplinary treatment is necessary due to complicated pathophysiological cascades induced by massive tissue destruction.   Children and elderly people are especially endangered in being burnt.  We present case of 73 years old woman with massive burn injury of >90% body surface

Agnieszka Budny

Jakub Kempisty

Katarzyna Baranowska-Kempisty

Michał Hys

Rafał Rutyna

Journal of Education Health and Sport

Directory of Open Access Journals

Hys Michał,  Kempisty Jakub,  Budny Agnieszka, Baranowska-Kempisty Katarzyna, Rutyna Rafał.  Massive burn >90% of bodysurface  –  case  report. Journal  of  Education,  Health  and  Sport.  2019;9(2):362-366.  eISNN  2391-8306.  DOIhttp://dx.doi.org/10.5281/zenodo.2577937http://ojs.ukw.edu.pl/index.php/johs/article/view/6622The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017).1223 Journal of Education, Health and Sport eISSN 2391-8306 7© The Authors 2019;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in anymedium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 30.01.2019. Revised: 30.01.2019. Accepted: 25.02.2019.Massive burn > 90% of body surface – case reportMichał Hys[1], Jakub Kempisty[2], Agnieszka Budny[3],Katarzyna Baranowska-Kempisty[4], Rafał Rutyna[1][1]I  Chair  of  Anaesthesiology  and Intensive  Therapy  with  Clinical  Paediatric  Department,Medical University of Lublin[2] Chair of Urology and Oncologic Urology, Teaching Hospital No 1 in Rzeszow[3] St. John`s Cancer Center in Lublin[4] Chair of Otolaryngology, Teaching Hospital No 1 in RzeszowAbstract:Severe burns are life-threatening injuries very difficult to heal. Multidisciplinary treatment isnecessary  due  to  complicated  pathophysiological  cascades  induced  by  massive  tissuedestruction.    Children and elderly people are  especially  endangered in being burnt.   Wepresent case of 73 years old woman with massive burn injury of >90% body surface. 362Key words: burns, shock, mortality, critical care, acute respiratory distress syndrome.  Case report: A 73 years old woman was admitted to the Emergency Department  with severe burn injuriescaused by the explosion of the furnace. >90% of patient’s body surface was covered in 2/3degree burn injury.  In the ED patient was monitored, patient’s trachea was intubated andcentral  venous  catheter  was  placed  in  right  internal  jugular  vein  with  use  of  ultrasound.Immediately, crystalloid fluids infusion started in accordance with Parkland formula. Patientwas admitted to the Intensive Care Unit directly from the ED with acute respiratory failureand multiple  organ failure.  Patient  was unconscious and there was impossibility  to assesspupil reaction due to swelling. Patient’s airway was also injured by inhalation of hot air andtoxic gases. Acute respiratory distress syndrome aroused dynamically causing problems withmechanical  ventilation.  Plateau  pressures  eventually  increased  to  50cmH20.  Continuousinfusion of noradrenaline and dobutamine was initiated because of cardiovascular distress.Hemodynamic  monitoring  was  started  to  assess  cardiac  index  and  systemic  vascularresistance.  Continuous  venovenous  hemodiafiltration  was  implemented  to  replace  renalfunction.  Broad-spectrum  antibiotic  intravenous  therapy  was  initiated.  Tissue  destructioncaused  elevation  of  myoglobin  to  >1000ng/ml  (stand.  0.0-110  ng/ml).   As  a  result  ofnumerous surgical consultations bedside electrocoagulation escharotomy on the front and theside of the chest and abdomen was performed. A reduction in pressure in the airways to avalue  approximately   35  cmH20  and  improvement  in  patient  ventilation  was  achieved.Reduction in fraction of inspired oxygen to 0.5 was possible.363Pic. 1. Acute respiratory distress syndrome caused by burn inhalational injury. Patient’s condition started to deteriorate 12 hours after admission to the ICU. Low chest andlung compliance led to increase in inspiratory pressure. The circulatory system was unstable,thus continuous infusion of noradrenaline and dobutamine in increasing doses was obligatory.Metabolic acidosis with significant increase in blood lactates concentration remained resistantto  treatment.  Coagulation  disorders  and  anemia  required  transfusion  of  blood  products.Fasciotomy  of  four  limbs  was  performed  due  to  progressing  compartment  syndrome.364Unfortunately,  despite  multidisciplinary  treatment  patient’s  condition  deterioratedsignificantly in the next 3 hours, leading eventually to decrease in blood pressure and cardiacarrest.  Because of  severe electrolyte,  coagulation  and metabolic  disturbances  resuscitationwas ineffective. Pic. 2. Escharotomy  of IIIo burn injuryDiscussion:Burn and fires account for more than 300,000 deaths each year worldwide. Despite these bignumbers, the majority of burns are not fatal. Higher mortality rate is observed in children andelderly  people  especially  in  low-income regions[1].  Uncontrolled  heating  devices  such aswood or coal furnaces are vulnerable to malfunction exposing users to severe burn injuries.Age is a direct contributor to increased burn mortality, and dealing with burn injury in thesetting of multiple medical comorbidities presents a difficult challenge [2,3]. Severe burns aredangerous  because  of  complicated  pathophysiological  dynamics.  Electrolyte  disturbances,coagulation disorders and abnormal fluid distribution are treatment challenges[3,4]. Metabolicacidosis treatment require efficient oxygen administration and distribution with gasometry-controlled  mechanical  ventilation.  Impaired  renal  function  have  to  be  replaced  withcontinuous  hemodiafiltration.  Tissue  oedema  can  lead  to  compartment  syndrome  andeventually  severe  limb  ischemia.  Fasciotomy  is  most  efficient  treatment[6].  Chest  wall365dismissed compliance caused by hardened necrotic tissue restrict effective ventilation. Thus,escharotomy of  chest  and abdomen wall  is  necessary to  maintain  ventilation  and oxygensupply.  After a burn lesion, Acute Respiratory Distress Syndrome (ARDS) may occur viadirect lung injury due to inhaled smoke and fumes or mediated by the inflammatory responseassociated with the burn or its infectious complications[3,5]. ARDS is associated with highermortality  rate  among  burnt  patients,  especially  in  those  requiring  mechanical  ventilation.Multidisciplinary treatment team including critical care specialists and surgeons is needed toheal  patients  with  severe  burn  injuries.  Rapid  and  continuous  access  to  operation  room,laboratory,  critical  care  equipment   and  hemodynamic  monitoring  is  crucial.   Fast-trackdiagnostics  and  rapid  treatment  are  needed  to  decrease  mortality  rate  in  massive  burnpatients[5,6].  References:[1]Peck M. D. Epidemiology of burns throughout  the world.  Part  I:  Distribution and riskfactors. Burns, 2011 , 37 , 1087 – 1100. [2] Sharmila D, Maham R. Epidemiology of burn injuries: Highlighting cultural and socio-demographic aspects, Intern Rev of Psych, 2009 ,21:6, 505-511.[3] Gibran NS, Heimbach DM. Current status of burn wound pathophysiology. Clin PlastSurg. 2000 Jan;27(1) 11-22. PMID: 10665353.[4] Bonate P.L. Pathophysiology and Pharmacokinetics Following Burn Injury. Clin Pharmacokinet. 1990, 18: 118. [5] Silva L, Garcia L, Oliveira B, et al. Acute respiratory distress syndrome in burn patients:incidence and risk factor analysis. Ann Burns Fire Disasters. 2016;29(3):178-182.[6] Yowler C. J, Fratianne R. B. Current status of burn resuscitation. Clin. Plast. Surg. 27: 1,2000366

Massive burn > 90% of body surface – case report

Hys, Michał

Kempisty, Jakub

Budny, Agnieszka

Baranowska-Kempisty, Katarzyna

Rutyna, Rafał

Akademicka Platforma Czasopism

English

Hys Michał, Kempisty Jakub, Budny Agnieszka, Baranowska-Kempisty Katarzyna, Rutyna Rafał. Massive burn >90% of body surface – case report. Journal of Education, Health and Sport. 2019;9(2):362-366. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.2577937

http://ojs.ukw.edu.pl/index.php/johs/article/view/6622

https://pbn.nauka.gov.pl/sedno-webapp/works/905710

 

 

 

 

 

The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017).

1223 Journal of Education, Health and Sport eissn 2391-8306 7

 

© The Authors 2019;

This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.

(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

 

The authors declare that there is no conflict of interests regarding the publication of this paper.

 

Received: 30.01.2019. Revised: 30.01.2019. Accepted: 25.02.2019.

 

 

 

 

 

 


 

Massive burn > 90% of body surface – case report


 

Michał Hys[1], Jakub Kempisty[2], Agnieszka Budny[3],

Katarzyna Baranowska-Kempisty[4], Rafał Rutyna[1]


 

[1]I Chair of Anaesthesiology and Intensive Therapy with Clinical Paediatric Department, Medical University of Lublin

[2] Chair of Urology and Oncologic Urology, Teaching Hospital No 1 in Rzeszow

[3] St. John`s Cancer Center in Lublin

[4] Chair of Otolaryngology, Teaching Hospital No 1 in Rzeszow


 

Abstract:

Severe burns are life-threatening injuries very difficult to heal. Multidisciplinary treatment is necessary due to complicated pathophysiological cascades induced by massive tissue destruction. Children and elderly people are especially endangered in being burnt. We present case of 73 years old woman with massive burn injury of >90% body surface.


 


 

Key words: burns, shock, mortality, critical care, acute respiratory distress syndrome

NEUROSURGERY ENTHUSIASTIC WOMEN SOCIETY

Massive burn >90% of body surface – case report

http://www.ojs.ukw.edu.pl/index.php/johs/article/download/6622/8343

Massive burn > 90% of body surface – case report

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

Akademicka Platforma Czasopism

NEUROSURGERY ENTHUSIASTIC WOMEN SOCIETY