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Old 09-17-2012
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Default Management of burns patient

A 26-year-old man presents to the emergency
department with burns on his chest. He had a
fi ght with his girlfriend and she threw boiling
water at him, splashing his chest and arms. The
burns occurred about an hour ago, and are distributed
on the upper third of his left anterior
trunk and cover most of his left proximal arm.
The patient’s temperature is 37.4°C (99.4°F),
blood pressure is 127/74 mm Hg, pulse is 80/
min, respiratory rate is 18/min, and oxygen satu-
ration is 99% on room air. The burns are quite
painful, swollen, and erythematous, with blister
formation. The application of pressure produces
blanching and is quite painful. Which of the
following is the most appropriate management?

(A) Admission to hospital and intravenous antibiotic
administration
(B) Cleaning and dressing of the burns, and
analgesics as needed
(C) Lubricant application and analgesics as
needed
(D) Referral to a burn center
(E) Surgical evaluation for debridement and
grafting
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  #2  
Old 09-17-2012
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i think B........
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Old 09-17-2012
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Quote:
Originally Posted by K06100 View Post
A 26-year-old man presents to the emergency
department with burns on his chest. He had a
fi ght with his girlfriend and she threw boiling
water at him, splashing his chest and arms. The
burns occurred about an hour ago, and are distributed
on the upper third of his left anterior
trunk and cover most of his left proximal arm.
The patient’s temperature is 37.4°C (99.4°F),
blood pressure is 127/74 mm Hg, pulse is 80/
min, respiratory rate is 18/min, and oxygen satu-
ration is 99% on room air. The burns are quite
painful, swollen, and erythematous, with blister
formation. The application of pressure produces
blanching and is quite painful. Which of the
following is the most appropriate management?

(A) Admission to hospital and intravenous antibiotic
administration
(B) Cleaning and dressing of the burns, and
analgesics as needed
(C) Lubricant application and analgesics as
needed
(D) Referral to a burn center
(E) Surgical evaluation for debridement and
grafting
Im thinking of B. No indication for admission, surgical debridement & referral to burn unit. Pt is young with 2nd degree burn& of less than 20% of total body surface area
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Old 09-17-2012
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Dangerous girl friend ;-)

(A) Admission to hospital and intravenous antibiotic
administration

As there are blisters. So chances of blister rupture and infection. So antibiotic prophalxis.



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Old 09-18-2012
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The correct answer is B. The burns described
here are superfi cial partial-thickness burns (also
called second-degree burns, affecting the epidermis
and portions of the dermis), involving
approximately 10% of his body surface area
(BSA) according to the “rule of nines” (anterior
trunk represents 18% BSA total, so one-third =
6%, and each arm represents 9%, so one-half =
4.5%). Pain, swelling, and blistering helps distinguish
partial-thickness burns. These burns
can be managed in the ambulatory setting, with
appropriate cleansing, debridement if necessary,
dressing, and appropriate pain management.
These burns should heal in 1 to 3 weeks with
minimal scarring, but may potentially result in
pigmentation changes. First-degree burns, such
as the typical sunburn, affect the epidermis only.
Tissue is erythematous and blanches to pressure,
and damage is minimal. Healing occurs
spontaneously. Third-degree burns, or full-thickness
burns, affect the entire epidermis and dermis.
The area of the burn itself is painless,
though surrounding tissue is usually tender due
to adjacent areas of partial-thickness burn. The
skin may be charred or white in color, with visible
blood vessels. Healing is slower than with
less severe burns, because sweat glands and
hair follicles (the source of skin stem cells) are
destroyed. Fourth-degree burns involve underlying
muscle and/or bone.
Answer A is incorrect. Intravenous antibiotics
are indicated for treatment of infected burns.
There is no proven benefi t associated with prophylactic
intravenous or oral antibiotic treatment
of burn patients.
Answer C is incorrect. Analgesics (and antihistamines
for pruritus) are used to symptomatically
treat superfi cial or fi rst-degree burns.
These burns can be distinguished from superfi
cial partial-thickness or second-degree burns
by the absence of blister formation. Lubricants
and moisturizers (including aloe vera) may also
provide symptomatic relief; however, they are
recommended only for fi rst-degree burns and
second-degree burns smaller than 2–3 inches
in diameter.
Answer D is incorrect. Criteria for referral to
a burn center include a partial-thickness burn
covering at least 20% total BSA in an adult, at
least 10% in a child <10 years old, or at least
10% in an adult at least 50 years old; or a fullthickness
burn of at least 5% BSA at any age.
Special circumstances indicating referral to a
burn center include inhalational injury; suspicion
of abuse; signifi cant burns to face, genitalia,
or joints; and signifi cant associated injuries
(i.e., fractures). This patient does not meet
these criteria.
Answer E is incorrect. Surgical evaluation for
debridement and grafting is indicated if burns
become infected, or if necrotic tissue is present
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