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Adult Burn - Case Review - Part 1

Flames Fire Red At Night Campfire Burning 2020484

This is the first of a 3-part blog that will follow the clinical course of a 68-year-old female who was rescued (in dramatic fashion) from a house fire. In the early hours of a random Tuesday, a fire has started in the attic space of a large house built in the 1970s. At the time of the fire, the house was occupied by 3 adults. Upon arrival of the first engine, 2 adults met them in the driveway saying they haven't seen their sister. She was in the upstairs bedroom.  The engine going into rescue mode, went straight upstairs and found her. She was alert and coughing, but unable to get out of the house on her own. The fire continued to grow and was approaching them rapidly...in fact, the crew describes the carpet as “melting under their feet”. They had no choice but to grab the patient and bail out of the window on the second story. They had no sooner made it out of the window when the room flashed over and was completely engulfed in flames.  The crew and patient were able to get down a ladder that was brought to the window.  Once on the ground, the patient was able to ambulate with assistance to a waiting gurney. The ALS ambulance crew and a firefighter paramedic quickly loaded the patient. 

A: Intact, soot in mouth and posterior pharynx

B: 20 times per minute, lungs sounds reveal course rhonchi in all fields

C: Strong radial pulse, clammy

Physical exam:

HEENT: soot in and around mouth and nose. Partial thickness burn to left ear

Chest: as above. no burns noted, = rise and fall, SPo2 89% NRB ETCo2 50 (NC)

ABD: soft and non-tender

Pelvis: Intact, no trauma noted

Extremities: partial thickness burn to left forearm (approx 2%) no deficits noted, moves all extremities well.

Patient is feeling SOB, but does admit she is a 2 pack a day smoker and she tells you she is no more SOB than usual. She says she has history of COPD.

You have a burn center 20 mins away...

Community hospital 8 mins away...

For this first blog, please discuss your pre-hospital treatment plan and considerations. Include the hospital destination and rationale, any procedures you want to do as well as any other comments or clinical information you would like to know.

 

Peer Review

I think that Mike has a good case going here.  This patient certainly has a strong case for needing intubation.  I would intubate this patient, however, not so sure I’d transport directly to the closest hospital.  It would depend on capabilities and how long it would take for critical care transport to perform an interfacility transport to a more appropriate facility.  The other question that needs to be posed is what is the likelihood of inhalation burns?  The patient should probably be seen in a burn center despite not having real significant burns on assessment.  She may present fine for now, but these types of patient’s airways get away from providers quickly. 

–Klint W. Kloepping, FP-C, C-NPT, AAS 

 

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