Case Study - Burns in Disasters and Conflicts

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Patient Characteristics

Mrs T is a 35-year-old lady who was coo king

over a fire in a temporary camp following an

earthquake that destroyed her house. The fire

was put out with a bucket of cold water and

she presented to your facility four hours later.

There is no history or additional trauma and

you do not suspect C-spine injury, so she does

not require neck collar/sandbags and tape.

A: Airway and C-spine control

Is patient maintaining airway? Yes, Mrs T is maintaining her airway. However, there

are burns to face and neck, so we are concerned that the airway may be at risk due to

swelling and/or inhalation injury. Sit patient up

Medical management – there is a need for oxygen: link with medical team

B: Breathing

Spontaneously breathing with normal breath sounds throughout

RR of 16BPM, breathing is a little shallow. Evidence of burns to her chest and upper back

– burns appear deep, so patient may require escharotomy – link with medical team

Signs of superficial burn round nose and mouth (may be indicative of toxic smoke

inhalation)

C: Circulation

Patient is not haemorrhaging from anywhere

Pulse is 110, BP 100/70: likely to be dehydrated, but not in shock

Hands are cold with poor capillary return in fingers – the burns on the upper arm are

deep and circumferential

Medical team to insert cannulas and start fluid therapy and carry out escharotomy to

both arms and chest

D: Disability

Mrs T is conscious and talking when spoken to (V on the AVPU Scale)

Examination of her pupils are equal and responsive to light, and there appears to be no

neurological concerns

Patient able to sit up independently, so you do not need to log roll her

E: Exposure

Patient needs to be kept warm to prevent hypothermia

F: Fluid resuscitation

Crucial in acute burns management: medical team to lead on this (important to monitor

urine output, pulse, BP and capillary refill and continue to assess her airway and swelling

due to oedema)

Pain management

Ensure pain management is covered, to include pre-change of dressings (COD’s)/therapy

analgesia

Wound care

Discuss the plan for Mrs T’s wound care – therapy ties in well to COD’s and is a chance

to check on wound healing/assess for complications

From assessment, rehabilitation concerns

Oedema

Respiratory

Joints affected (REMEMBER– maintain correct position, splint to prevent contracture and

mobilise to encourage normal function)

Rehabilitation treatment

Nurse Mrs T sitting up due to inhalation injury risk – add breathing exercises and, if

required, chest physiotherapy (as with any other condition). Keeping the patient well-

hydrated is important, so that secretions don’t dry up

NB, post-SSG to the chest area vibrations and percussion should be left for five days

if possible, and if necessary, done over Gamgee (absorbent cotton between gauze)

dressings/pads

Elevate her arms gently and keep them abducted and extended at rest, as safely

appropriate. (see treatment Table). Keep monitoring fingers to check on her circulation

Splint neck and axilla and, if needed, mouth (see Table)

Teach ROM and stretching (avoiding overstretch) exercises (see Table for area specific

information)

Assess and advise on mobilisation

Ensure patient is feeding with her own participation as safely able, and monitor pain

levels

Document everything clearly and COMMUNICATE everything clearly to patient and her

family

Short-term

Encourage activity from day one.

Aim is to prevent contracture and maximise return to function – initial movements can

be limited if patient has had to undergo any skin grafts, but once surgeon allows it,

movement must be encouraged.

Outcome assessment to include measurement of active and passive ROM and also chin-

to-sternal notch measurement and commenting on mouth opening (limited/full), as well

as contours of the face, neck and trunk.

Long-term expected management and outcome

Assess stage of scar maturation and patient’s acceptance of altered body image and function.

Examination Findings

References