Burn Case Scenario

Lee FaucherSarah Larson

Kim Maerz

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.

Page (T = -8 minutes)

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

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.

Begin assessment of patient

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

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

Now what?

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

Primary Triage• 30 year old male with

burns to face, bilateral upper extremities, chest and back. Moaning to pain, not responsive to verbal stimuli.

Primary Triage

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

Primary Triage

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

Primary Triage

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

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

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

Priority 1 patient:

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

Priority 2 patient:12 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?

Priority 2 patient:32 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?

Dead patient:5 year old, not breathing, no pulse, minimal burns

• Should you do something?

September 11, 2001• 8:20am

– American Airlines Flight 77 Departed Washington Dulles at 8:20am

– 58 passengers, crew of 6

• 9:38am– A 757-200 crashes

into the Pentagon

Patient AdmissionsPatient # Gender % TBSA Arrival

1 F 0 <1

2 F 21 <1

3 M 22 <1

4 F 66 <1

5 M 49 <1

6 F 68 <1

7 M 41 7

8 M 42 10

9 M 32 28

10 M 10 31

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

Products consumedIV Fluids 141 LitersSilvadene cream 950 JarsBurn Dressing Gauze 2006 packs4X4 gauze 18,490Kerlix gauze 3108 rollsAce Bandages 2111Allograft 26,700 sq cmSynthetic “skin” 30,365 sq cmAutograft 22,087 sq cmPRBCs 269 units

Post-Burn Weeks

0

5

10

15

20

25

30

35

1 2 3 4 5 6 7 8 9 10 11 12 13 14

OR Hours# Operations

OutcomesPatient # Gender %

TBSAAge + TBSA

Mortality Risk

Outcome

1 F 0 32 N/A Survived2 F 21 74 11 Survived3 M 22 61 4 Survived4 F 66 115 62 Survived5 M 49 100 41 Survived6 F 68 109 44 Died7 M 41 80 15 Survived8 M 42 71 9 Survived9 M 32 63 1 Survived10 M 10 82 23 Survived