Burn Case Scenario

1
Burn Case Scenario

• Lee Faucher
• Sarah Larson
• Kim Maerz

2
Setting the scene

• You are one of a two person crew with same
  training. No driver. Nearest burn center 3
  hours by ground. Nearest trauma center 15
  minutes by ground. Two air ambulances could be
  requested. No weather problems.

3
Page (T -8 minutes)

• Please respond to structure fire, City fire
  already present. One patient extricated from
  building.

4
Arrival (T 0)

• Find one 30 year old male with burns to face,
  bilateral upper extremities, chest and back.
  Moaning to pain, not responsive to verbal stimuli.

5
Begin assessment of patient

• Do you need help?
• Is there an airway concern?
• Does he need an IV?

6
At scene ( T 2 minutes)

• Fire fighters bring out three more victims from
  the building
• 5 year old, not breathing, no pulse, minimal
  burns
• 12 year old, crying in pain, answers questions,
  burns to bilateral arms and hands
• 32 year old, answers questions, only areas not
  burned is chest and back

7
Now what?
8
Patients needing help

• 30 year old male with burns to face, bilateral
  upper extremities, chest and back. Moaning to
  pain, not responsive to verbal stimuli.
• 5 year old, not breathing, no pulse, minimal
  burns
• 12 year old, crying in pain, answers questions,
  burns to bilateral arms and hands
• 32 year old, answers questions, only areas not
  burned is chest and back

9
Primary Triage

• 30 year old male with burns to face, bilateral
  upper extremities, chest and back. Moaning to
  pain, not responsive to verbal stimuli.

10
Primary Triage

• 5 year old, not breathing, no pulse, minimal
  burns

11
Primary Triage

• 12 year old, crying in pain, answers questions,
  burns to bilateral arms and hands

12
Primary Triage

• 32 year old, answers questions, only areas not
  burned is chest and back

13
Patient classification after triage

• 30 year old male with burns to face, bilateral
  upper extremities, chest and back. Moaning to
  pain, not responsive to verbal stimuli.
• 5 year old, not breathing, no pulse, minimal
  burns
• 12 year old, crying in pain, answers questions,
  burns to bilateral arms and hands
• 32 year old, answers questions, only areas not
  burned is chest and back

Priority 1
Dead
Priority 2
Priority 2
14
Priority 1 patient 30 year old male with burns
to face, bilateral upper extremities, chest and
back. Moaning to pain, not responsive to verbal
stimuli.

• Airway
• Breathing
• Circulation

15
Priority 1 patient

• How much do you need to do to make him good
  enough and stable for transport?

16
Priority 2 patient12 year old, crying in pain,
answers questions, burns to bilateral arms and
hands

• What is the potential for airway problem?
• How soon will resuscitation need to be started?
• How much do you need to do to make him good
  enough and stable for transport?

17
Priority 2 patient32 year old, answers
questions, only areas not burned is chest and
back

• What is the potential for airway problem?
• How soon will resuscitation need to be started?
• How much do you need to do to make him good
  enough and stable for transport?

18
Dead patient5 year old, not breathing, no
pulse, minimal burns

• Should you do something?

19
September 11, 2001

• 820am
• American Airlines Flight 77 Departed Washington
  Dulles at 820am
• 58 passengers, crew of 6
• 938am
• A 757-200 crashes into the Pentagon

20
Patient Admissions
Patient Gender TBSA Arrival
1 F 0 lt1
2 F 21 lt1
3 M 22 lt1
4 F 66 lt1
5 M 49 lt1
6 F 68 lt1
7 M 41 7
8 M 42 10
9 M 32 28
10 M 10 31
21
Start getting the burn off

• 23 excision and grafting procedures done in the
  first 96 hours
• Supplies delivered by car from as far away as
  Dallas, TX

22
Products consumed
IV Fluids 141 Liters
Silvadene cream 950 Jars
Burn Dressing Gauze 2006 packs
4X4 gauze 18,490
Kerlix gauze 3108 rolls
Ace Bandages 2111
Allograft 26,700 sq cm
Synthetic skin 30,365 sq cm
Autograft 22,087 sq cm
PRBCs 269 units
23
Post-Burn Weeks
24
Outcomes
Patient Gender TBSA Age TBSA Mortality Risk Outcome
1 F 0 32 N/A Survived
2 F 21 74 11 Survived
3 M 22 61 4 Survived
4 F 66 115 62 Survived
5 M 49 100 41 Survived
6 F 68 109 44 Died
7 M 41 80 15 Survived
8 M 42 71 9 Survived
9 M 32 63 1 Survived
10 M 10 82 23 Survived