Marco Dante

44 y/o

Principal Diagnosis: 41% TBSA Flame Burn including anterior and posterior trunk, upper and lower extremities and face Principal Procedure/Operation: Emergency Escharotomy, tangential excision of eschar, STSG legs bilateral Medications: Ferrous Sulfate Classification: Hematinics Indications: Iron Deficiency Anemia Action: Its most important role is the production of hemoglobin. About 80% of iron in plasma goes to bone marrow, where it is used for erythropoiesis Ketorolac Classification: NSAIDs (selective) Indications: Moderately severe, acute pain Action: Inhibits prostaglandin synthesis to produce anti-inflammatory, analgesic and antipyretic response Omeprazole Classification: Proton Pump Inhibitors Indication: Prophylaxis for Curlings ulcer Action: Blocks last step in the secretion of gastric acid by combining with hydrogen, potassium, and ATP in parietal cells of stomach Ceftazidine Classification: Third Generation Cephalosphorins Indication: Pseudomonas Action: Inhibits cell wall synthesis by binding to bacterial enzymes located at the cell membrane. After the drug damages the cell wall, the bodys natural defense mechanisms destroy the bacteria.

Tramadol Classification: Opioid Analgesics Indication: Moderately to severe pain Action: reduces pain by binding to opiate receptor sites (mu receptors and N-methyl-D-asparate receptors) in the PNS and CNS. When these drugs stimulate opioid receptors, they mimic the effects of endorphins (naturally occurring opiates that are part of the bodys own pain relief system). Ascorbic Acid Classification: Vitamins and Minerals Indication: Extensive burns Action: builds up collagen (skin tissues) in the body Paracetamol Classification: Non opioid analgesics and anti-pyeretics Indication: Mild pain or fever Action: Produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that synthesize pain receptors stimulation. The drug may relieve fever through central action in the hypothalamic heat regulating center.

Lund and Browders Head-3 Anterior Trunk- 6.5 Posterior trunk- 5 Upper Arms- 4 Forearms-4 Head- 2.5 Legs- 10 Foot- 6

Management: Topical Antibacterial Therapy There is general agreement that some form of antimicrobial therapy applied to the burn wound is the best method of local care in extensive burn injury. Topical antibacterial therapy does not sterilize the burn wound; it simply reduces the number of bacteria so that the overall microbial population can be controlled by the bodys host defense mechanisms. Topical therapy promotes conversion of the open, dirty wound to a closed, clean one. Wound Dbridement As debris accumulates on the wound surface, it can retard keratinocyte migration, thus delaying the epithelialization process. Debridement, another facet of burn wound care, has two goals: To remove tissue contaminated by bacteria and foreign bodies, thereby protecting the patient from invasion of bacteria To remove devitalized tissue or burn eschar in preparation for grafting and wound healing AUTOGRAFTS Autografts remain the preferred material for definitive burn wound closure following excision. Autografts are the ideal means of covering burn wounds because the grafts are the patients own skin and thus are not rejected by the patients immune system. They can be split-thickness, fullthickness, pedicle flaps, or epithelial grafts. Full-thickness and pedicle flaps are commonly used for reconstructive surgery, months or years after the initial injury. Split-thickness autografts can be applied in sheets or in postage stamplike pieces, or they can be expanded by meshing so that they can cover 1.5 to 9 times more than a given donor site area. Skin meshers enable the surgeon to cut tiny slits into a sheet of donor skin, making it possible to cover large areas with smaller amounts of donor skin. These expanded grafts adhere to the recipient site more easily than sheet grafts and prevent the accumulation of blood, serum, air, or purulent material under the graft. However, any kind of graft other than a sheet graft will contribute to scar formation as it heals. Using expanded grafts may be necessary in large wounds but should be viewed as a compromise in terms of cosmesis. If blood, serum, air, fat, or necrotic tissue lies between the recipient site and the graft, there may be partial or total loss of the graft. Infection and mishandling of the graft, as well as trauma during dressing changes, account for most other instances of graft loss. Using split-thickness grafts allows the remaining donor site to retain sweat glands and hair follicles and minimizes donor site healing time. Use of cultured epithelial autograft (CEA) is common at several burn centers. This involves a biopsy of the patients skin in an unburned area. Keratinocytes are then isolated and epithelial cells are cultured in a laboratory. The original epithelial cell sample can multiply to 10,000 times its original size over 30 days. These cells are then attached to the burn wound. Varying degrees of success have been reported, and results are encouraging. However, the disadvantages of the CEA are that the grafts are thin and fragile and can shear easily. Research has shown that the outcomes of use of CEA are not as positive as once thought. The quality of burn scars is better, but patients have longer hospital stays and higher hospital costs and require more surgical procedures than those treated by traditional methods. In addition, patients require more reconstructive procedures in the first 1 to 2 years postinjury. Therefore, CEA use is very limited and reserved for burn patients whose donor sites are limited Escharotomy Faschiotomy