Smoke Inhalation
Haley Copus-Use Red Text
Erica Dunnigan-Use Blue Text Kelly Mowery-Use Green Text
Smoke Inhalation
Group 2
Admitting History Fletcher Finnigan is a 10 yr old male who was brought to the ER by ambulance. He was rescued from a house fire in the middle of the night, after what is believed to be a space heater catching on fire. He was sleeping and when he woke up the curtains were burning and smoke was covering the room. He made it to his parents' bedroom before passing out on their floor. His father got him out of the house and to the medics when they arrived. On arrival to the ER he became somewhat alert, but very confused and disoriented. He had 2nd and 3rd degree burns all over his body and was is obvious respiratory distress. The use of accessory muscles and nasal flaring was apparent with each breath. His breathing was rapid and shallow and he was coughing up dark gray sputum. Fletcher is an otherwise very healthy, active boy who plays sports throughout the year. Physical Exam Fletcher appears to be normal in size at approximately 85 lbs and 55.7 inches tall. He has obvious burns to his exposed face, arms, legs and thorax. He is being supplied oxygen with a non-rebreather at 15 lpm in high fowlers position and is still in obvious distress, as seen with use of his sternocleidomastoid and scalene muscles during inspiration and nasal flaring. His HR is elevated at 130 bpm as is his rapid, shallow RR at 35/min. Scattered expiratory wheezes are heard bilaterally and his chest movement shows occasional paradoxical movement. Nasal hairs are singed and oral and laryngeal edema is noted. His temperature is slightly low at 35.9 degree celsius. Pt's cough is productive of dark gray sputum. Glasgow coma scale score of 11- eyes open to speech, confused verbal response, and localize pain. SOAP S: Pt. with 2nd degree burns all over face, arms and thorax and third degree burns to his legs. SOB, and complaining that his chest hurts, and can not breathe. O: Patient is male, normal in statue for age appriopriate, heart rate at 130 bpm, respiratory rate 35 /min rapid and shallow, breath sounds scattered expiratory wheezes bilaterally, use of accessory muscles, nasal flaring with nasal hairs singed. Presence of soot around mouth and nose. Temperature oral=35.9 C ABG's pH 7.37, PaCO2 32, PaO2 60 mmHg, Hbco 25%, HCO3 14 while breathing 100% O2 from non-rebreathing mask. Blood cyanide levels .5 mg/liter. A: Hypoxemic with a Pa02 60 mmHg on 100% 02 non rebreather, coughing due to foreign substances in the lungs,wheezing due to bronchospasms bilaterally. Patient has carbon monoxide poisoning, with possible exposure to hydrogen cyanide. Temperature is a bit low from burn wounds. Patient is showing Respiratory alkalosis. P: Continue with oxygen therapy with indicaions of HbCo levels less than 30 % for hypoxia, until their Hbco is less than 10%, aerosolized bronchodilators for the bronchospasms every 2-4 hours or as needed. Maintain patent airway and possible escharotomy to relieve the compressive effect, because of lost elasticity due from burns. Secretion removal of soot and mucus that may be unable to cough up and out, possible intubation may help remove secretions and adequately ventilate and oxygenate also with edema that may occur . ABG's frequently every hour or so for appropriate adjustments and indication of Hbco levels declining. Prevention of infections some empirical antibotics should possibly be administered. Patient should have adequate pain control due to the severity of burns. I would also recommend HBO (hyperbaric oxygen therapy) for quickly removing carbon monoxide. Continuing monitoring body temperature, CBC, serum electrolytes, ABG's, carboxyhemoglobin, methemoglobins for possible intubation if ctritical results were to occur. Questions: 1) While bagging a burned victim in the emergency department after a fire it will be (easy, hard) to do. 2) The primary cause of death in early postburn is due to? ( ARDS, CNS & cardiovascular dysfunction, infection, pulmonary emboli) 3) The best way to get the oxygen saturation of a burned victim is to apply a pulse ox to the patient? ( true or false) 4) Carbon monoxide allows for___(more, less) hemoglobin to be available for oxygen transportation.
Smoke Inhalation
Haley Copus-Use Red Text
Erica Dunnigan-Use Blue Text
Kelly Mowery-Use Green Text
Smoke Inhalation
Group 2
Admitting History
Fletcher Finnigan is a 10 yr old male who was brought to the ER by ambulance. He was rescued from a house fire in the middle of the night, after what is believed to be a space heater catching on fire. He was sleeping and when he woke up the curtains were burning and smoke was covering the room. He made it to his parents' bedroom before passing out on their floor. His father got him out of the house and to the medics when they arrived. On arrival to the ER he became somewhat alert, but very confused and disoriented. He had 2nd and 3rd degree burns all over his body and was is obvious respiratory distress. The use of accessory muscles and nasal flaring was apparent with each breath. His breathing was rapid and shallow and he was coughing up dark gray sputum. Fletcher is an otherwise very healthy, active boy who plays sports throughout the year.
Physical Exam
Fletcher appears to be normal in size at approximately 85 lbs and 55.7 inches tall. He has obvious burns to his exposed face, arms, legs and thorax. He is being supplied oxygen with a non-rebreather at 15 lpm in high fowlers position and is still in obvious distress, as seen with use of his sternocleidomastoid and scalene muscles during inspiration and nasal flaring. His HR is elevated at 130 bpm as is his rapid, shallow RR at 35/min. Scattered expiratory wheezes are heard bilaterally and his chest movement shows occasional paradoxical movement. Nasal hairs are singed and oral and laryngeal edema is noted. His temperature is slightly low at 35.9 degree celsius. Pt's cough is productive of dark gray sputum. Glasgow coma scale score of 11- eyes open to speech, confused verbal response, and localize pain.
SOAP
S: Pt. with 2nd degree burns all over face, arms and thorax and third degree burns to his legs. SOB, and complaining that his chest hurts, and can not breathe.
O: Patient is male, normal in statue for age appriopriate, heart rate at 130 bpm, respiratory rate 35 /min rapid and shallow, breath sounds scattered expiratory wheezes bilaterally, use of accessory muscles, nasal flaring with nasal hairs singed. Presence of soot around mouth and nose. Temperature oral=35.9 C ABG's pH 7.37, PaCO2 32, PaO2 60 mmHg, Hbco 25%, HCO3 14 while breathing 100% O2 from non-rebreathing mask. Blood cyanide levels .5 mg/liter.
A: Hypoxemic with a Pa02 60 mmHg on 100% 02 non rebreather, coughing due to foreign substances in the lungs,wheezing due to bronchospasms bilaterally. Patient has carbon monoxide poisoning, with possible exposure to hydrogen cyanide. Temperature is a bit low from burn wounds. Patient is showing Respiratory alkalosis.
P: Continue with oxygen therapy with indicaions of HbCo levels less than 30 % for hypoxia, until their Hbco is less than 10%, aerosolized bronchodilators for the bronchospasms every 2-4 hours or as needed. Maintain patent airway and possible escharotomy to relieve the compressive effect, because of lost elasticity due from burns. Secretion removal of soot and mucus that may be unable to cough up and out, possible intubation may help remove secretions and adequately ventilate and oxygenate also with edema that may occur . ABG's frequently every hour or so for appropriate adjustments and indication of Hbco levels declining. Prevention of infections some empirical antibotics should possibly be administered. Patient should have adequate pain control due to the severity of burns. I would also recommend HBO (hyperbaric oxygen therapy) for quickly removing carbon monoxide. Continuing monitoring body temperature, CBC, serum electrolytes, ABG's, carboxyhemoglobin, methemoglobins for possible intubation if ctritical results were to occur.
Questions:
1) While bagging a burned victim in the emergency department after a fire it will be (easy, hard) to do.
2) The primary cause of death in early postburn is due to ? ( ARDS, CNS & cardiovascular dysfunction, infection, pulmonary emboli)
3) The best way to get the oxygen saturation of a burned victim is to apply a pulse ox to the patient? ( true or false)
4) Carbon monoxide allows for ___(more, less) hemoglobin to be available for oxygen transportation.