SU4.1-4 | Burns — Assignment

CLINICAL SCENARIO

A 60 kg, 30-year-old woman is brought to your emergency department two hours after sustaining flame burns in a kitchen fire. She is conscious and tearful. On examination she has deep partial- and full-thickness burns involving the whole of her anterior trunk, the whole of one entire upper limb, and the anterior aspect of one entire lower limb. There is soot around the nostrils and a hoarse voice. Her account of how the fire started is hesitant and inconsistent, and she has recently married. You are the surgical resident receiving her.

Immediate assessment and the airway

Describe your ABCDE approach to this patient. Identify the specific features in this case that suggest possible inhalation injury and explain why airway protection takes priority over the burn wound.

Guidance: Name the warning signs of inhalation injury present here (soot around nostrils, hoarse voice) and state what early airway action they mandate.

Burn extent and fluid resuscitation (show your working)

Calculate the %TBSA using the Rule of Nines, then compute the 24-hour Parkland fluid requirement. State clearly how the first half is timed and over what period it must now be given, given that two hours have already elapsed since the burn. Specify the monitoring end point.

Guidance: Use 4 mL/kg/%TBSA Ringer's lactate; first half in the first 8 hours from the time of the burn; titrate to urine output 0.5–1 mL/kg/h. Account for the 2-hour delay.

Medico-legal duties

Explain why this presentation is a medico-legal case and list the doctor's specific duties. Describe how you would document the history and what a dying declaration is and when it applies.

Guidance: Cover: treat first, intimate the police, obtain consent, contemporaneous and non-accusatory documentation in the patient's own words, body-map, and the conditions for a valid dying declaration (conscious, compos mentis).

Counselling and rehabilitation

Outline how you would counsel the patient and family about the expected outcome and rehabilitation, addressing both the physical and psychological arms with empathy.

Guidance: Address physical rehabilitation (contracture prevention, physiotherapy, scar/pressure therapy) and psychological rehabilitation (coping, body image, reintegration); demonstrate an empathic, honest, stepwise approach.