Burn

1. Dr. Poonam Jaiswal
DNB General Surgery Department
JLNH & RC, Bhilai

2. 80 year female patient (private N4)
Presented to casualty with A/h/o burn by lamp
at her home at Rajnandgaon on 26.10.2022 at
11.00 am.
Pt. Received in Burn Unit at 3.15 pm
26.10.2022 from casualty
C/O DIFFICULTY in breathing
Pain on the burn area
Past history = k/c/o BA, h/o steroid use, h/o
taking meals once a day only
26.10.2022

3. O/E = Pt. conscious oriented
LEAN THIN built ,
afebrile
P/R = 90 bpm
Bp = 160/70 mmhg
RR = 28/min
SpO2 = 98%
CVS = S1 S2 +
CNS = E4 V5 M6
RS = B/L AE
P/A =Soft non tender
No Guarding / Rigidity
26.10.2022

4. LE

5. TREATMENT GIVEN
RX High Protein diet
IVF 4 RL in 8 hrs
4 RL in next 16 hrs
IV Inj PCM 1gm 8/hrly
IV Inj Pantop 40 mg 12/hrly
IV Inj Sodabicarbonate
IV Inj Effcorlin 100 mg stat
Syp Sucralfate 2 tsp tds
Neb with asthalin 8/hrly
Urgent referral to chest physician in V/O difficulty in
breathing
-advice nebulisation with budanape 0.5 mg 12/hrly, HRCT
Thorax
in 500 iv heparin 20cc in each RL

6. INVESTIGATION
Hb -7.9
TLC -9000
PLT -270000
Na – 138
K – 5.1
Urea – 25
Creat – 1
TP – 6.3
Alb – 3.5
Glu – 123

7. High Protein Diet
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
Inj Meropenam 1gm 8/hrly
Inj Levoflox 1gm 8/hrly
IV Albumin 20% 100ml along with NS
Inj deriphyline 1 amp 12/hrly
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
Pt. conscious
oriented
O/E : Facial
Edema +oedema
of burnt area
HRCT - Thorax
reveals : few tiny
subpleural
parenchymal
nodule in right
upper lobe and
right lower lobe
Hyperinflation of
both lungs.
27.10.2022

8. O/e Dyspnoea
Tachypnoea
PR = 118 bpm
BP = 120/80
mmhg
SPO2 = 94% at
RA
Burn area -
Green Soakage +
High Protein Diet
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
Inj Meropenam 1gm 8/hrly
Inj Levoflox 1gm 8/hrly
IV Glutamic acid 100 ml
Inj deriphyline 1 amp 12/hrly
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly
PRBC TRANSFUSION
31.10.2022
Call to Chest Physician
for review
Chest Physician Advice
CST + T.montelukast 1HS
Tab Levocet 1 HS

9. O/e Dyspnoea
Tachypnoea
PR = 118 bpm
BP = 120/80
mmhg
SPO2 = 94% at
RA
LE Green
Soakage +
High Protein Diet
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
Inj Meropenam 1gm 8/hrly
Inj Levoflox 1gm 8/hrly
IV Glutamic acid 100 ml
Inj deriphyline 1 amp 12/hrly
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale
6/hrly
01.11.2022

10. O/E GC not
satisfactory
Oral Intake poor
Vital Stable
Pt initially not willing
RT,but agreed on
counselling
Investigation
Urea – 60
03.11.2022
RX CST
High Protein Diet RT feeding 100 ml 3/hrly
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 5lakh u 8/hrly
Inj Meropenam 1gm 8/hrly
Inj Levoflox 1gm 8/hrly
IV Glutamic acid 100 ml
Inj deriphyline 1 amp 12/hrly
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly
Chest Physiotherapy

11. O/E - GC not satisfactory
Oral Intake poor
PR 148bpm , SPO2DROPPED
TO 69 ,pt put on NRM O2
4L/min
O/E WOUND DEEP AND GREEN
URGENT PHYSICIAN CALL
GIVEN
ECG AF WITH FAST VR
ABG SHOWS
UNCOMPENSATED
RESPIRATORY ACIDOSIS
Investigation
Hb – 9gm/dl
TLC – 18900
Plt – 210000
Urea – 71
Na – 136
K – 3.5
04.11.2022
RX CST
HIgh Protein Diet RT feeding 100 ml 3/hrly
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 5lakh u 8/hrly
Inj Levoflox 1gm 8/hrly
IV Glutamic acid 100 ml
Inj deriphyline 1 amp 12/hrly
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly
Chest Physiotherapy
2.0 FFP Transfusion
Omit Inj Meropenam
IV Inj. Tazar 4.5 gm 8/hrly/E//Hh

12. O/E - GC not satisfactory
Oral Intake poor
PR = 130 ml bpm
BP = 140/70 mmhg
RR = 23/min
CVP 15 cm H2O
SPO2 100% at O2 NRM 4
lt/min
Wound infected Soakage +
Cardiologist call given in v/o
cardiac status and echo
Pus C/s = Sterile
2D - Echo 60 EF
Dilated LA, Other Chamber
normal
Mild AR, MR
Collapsing more than 50 %
Cardiologist Advice – RX CST
Tab Cardarone 200 mg TDS
7 days 200mg BD × 7
days 200mg OD
05.11.2022
High Protein Diet RT feeding 100ml/3 hrly
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 5lakh u 8/hrly
IV INJ PIPTAAZ 4.5 gm 8/hrly
Inj Vancomycin 500 mg 8/hrly
Inj Lasix 20 mg OD
Inj Pantop 40mg OD
IV Inj. Pantaglobin 50 ml
Tab Evabrdine ½ BD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly

13. O/E - GS Critical
PR 112/min
BP 160/80
SPO2 100% with NRLM at 10
lt/min
UOP=100 ml
Investigation
HP – 8.5 TLC – 22200
PLT – 158000 Urea – 92
Creat – 1.4 TGL – 280
TP – 5.5 ALB – 2.9
LDH – 588
Call given to Chest Physician
in v/o falling SPO2
Tachypnoea & Dyspnoea
Call given to Nephrologists in
v/o Low UOP
Chest physician advised CST
06.11.2022
High Protein Diet
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 5lakh u OD
Inj Pantop 40mg OD
INJ LASIX 20 mg OD
Tab CARDARONE TDS
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly

14. O/E - GS Critical
PR 112/min
BP 160/80
SPO2 100% with NRM at 10
lt/min
UOP=100 ml
Investigation
CRP – Negative
07.11.2022
High Protein Diet
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 5lakh u OD
PIPTAAZ 4.5gm OD
Inj Pantop 40mg OD
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly
Chest Physiotherapy

15. 08 am O/E - GS Critical
PR 112/min
BP 160/80
SPO2 100% with NRLM at 10 lt/min
GC poor
PR 118/min bpm
BP 120/70 mmhg
CVP 16 cm of H2O
UOP 100ml Pain on the burn area
Investigation
HB - 6.8, TLC – 13.8, PLT -114000
Urea 98, Creat-2.2 CK-80
CKMB19, LDH – 438
Urine C/s Sterile
Blood C/s Sterile
11 am O/e by Nephrologists
Urine Cola Color
? RHABOMYLYSIS leading to ATN
Advice U-R/M, U-C/S
Urine myoglubine
CK, CKMB, LDH. KFT, Serum
electrolyte, ABG,USG ABD + Pelvis
08.11.2022
RX CST
High Protein Diet RT feeding 100 ml 3/hrly
IV NS 1.0 + 50 ml Soda Bi carb + 500U
Heparin
IV Inj Polymxin 2.5lakh U OD
IV INJ PIPTAAZ 4.5 gm iv OD
Inj Effcorline 100ml 12/hrly
Inj Pantop 40mg OD
Tab CARDARONE TDS 200 mg
Propped up position
Chest Physiotherapy
NEB with Salbutamol and Flohale 6/hrly
Chest Physiotherapy

16. 1.55 pm call received from burn
unit to doctor on duty
o/e – Pt. unconscious with
abnormal breathing
pulse feeble
BP = N/R
RS = B/L AE reduced
Pupil sluggish responsive
In spite of all CPR measure pt.
succumbed to her illness on
08.11.2022 to 2.25 pm
08.11.2022
Adv
IV Inj Adrenaline 1amp stat
IV Inj Effcorline 1amp stat
IV atropine 1 amp stat
Code blue activated
CPR
O2 inhalation intranasally

17. CONCLUSION
80 years female patient admitted on 26.10.2022 with A/H/O 30% burn injury
by lamp. Inspite of all CPR measures pt. was succumbed to death on
08.11.2022 @ 2.25 pm.
Cause of Death
30% burn injury with septicemia with MODS with bronchial asthma with
sudden cardiac arrest

19. THANKYOU