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Case History 3: Severe Burn Injury
Chief Complaint: 8-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house.
History: The 8-year-old white female, was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns and excessive smoke inhalation.
In the emergency room, the patient was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her entire right arm. Her vital signs were quite unstable: blood pressure = 55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40 breaths / min; temperature 101.5 degrees Farhenheight. She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU).
The patient regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.
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