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Chapter 29: Trauma and Warfare

A 30-year-old woman was in a motor vehicle accident in which his car exploded. She has sustained burns on her anterior and posterior chest and abdomen and circumferential burns around her right upper extremity. What percentage of burns does the patient have?

A. 27%

B. 36%

C. 45%

D. 54%

C. 45%

As shown in Figure 29-8, the anterior trunk represents 18%, the posterior trunk represents 18%, and anterior and posterior right upper extremities represent 9%. The patient has a total of 45% TBSA burned. Choices A, B, and D are incorrect.

 

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Figure 29-8. Body diagram for estimation of total burned surface area (% TBSA) in adults, using the rule of nines (numbers are for anterior only and posterior only). (Reproduced with permission from Friedstat J, Endorf FW, Gibran NS. Burns. In: Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE, eds. Schwartz’s Principles of Surgery. 10th ed. New York, NY: McGraw-Hill; 2015.)

A 59-year-old woman is pulled out of a burning building and arrives in the emergency department (ED). Her past medical history is unknown. Her vital signs are as follows: BP of 120/80 mmHg, HR of 80 beats/min, respiratory rate (RR) of 18 breaths/min, and oxygen saturation of 98% on nonrebreather. She is arousable to painful stimulation and her clothes have some charred edges. No burns are noted. Her oral pharynx shows some redness but no edema. Her lungs are clear to auscultation. What would you do next?

A. Intubate

B. Watch and observe

C. Administer steroids

D. Administer antibiotics

A. Intubate

Inhalation injury is found in 8% to 15% of burn patients with a mean mortality rate of 56% in 2 series. The history and physical findings of smoke exposure, facial burns, singed nasal vibrissae, and carbonaceous secretions can suggest but not confirm inhalation injury. Fiberoptic bronchoscopic (FOB) inspection can confirm injury with the presence of erythema, mucosa edema, gray mucosal discoloration, erosions, or desquamation. However, a negative FOB finding does not exclude the presence of inhalation injury, since this is a dynamic process, and a repeat FOB is sometimes warranted to see progression of disease and/or to exclude the presence of parenchymal disease. Acute upper airway obstruction can be suggested by serial nasopharyngeal examination revealing edematous obliteration of aryepiglottic fold, arytenoid eminences, and interarytenoid areas. Nebulized heparin (5000–10,000 units every 4–6 hours) with ...

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