Burnt
Multisystem Processes & Disorders
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S8_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Perfect timing\u0022, you think, as you pull into the parking lot of your hospital.\n\nYour shift at the specialized burns center starts in a few minutes, giving you just enough time to walk over and sign in for duty.\n\nAs your colleague from the previous shift finishes handing over the patients and walks away, you hear the wail of an ambulance in the distance.\n\nAlmost at the same time, one of the nurses informs you that the EMTs are bringing in an elderly gentleman who was caught in a house fire.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S8_F2.jpg"}},{"insert":"\n\n"},{"insert":"The sound of the siren grows progressively louder, and an ambulance draws up outside.\n\nAs the patient is wheeled in, you take charge of your team, and prepare to handle the situation.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S8_F3.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Wilson is an 84 year old retired schoolteacher, who lives alone in a small house.\n\nApparently, he was caught in an explosion from a gas leak.\n\nFortunately, his neighbors heard the explosion, noticed smoke emanating from his kitchen, and called emergency services immediately.\n\nBy the time the emergency response team reached his house and rescued him, he had been trapped in the smoke for slightly less than 10 minutes.\n"}]}
3
{"ops":[{"insert":"You run your experienced eye over his body and note the presence of minor burns on the face and neck, and extensive burns on the anterior aspect of trunk and dorsal aspect of all four limbs.\n"}]}
4
{"ops":[{"insert":"Mr. Wilson is breathing spontaneously, and is not in respiratory distress. His respiration is being aided by bag and mask ventilation with 100% oxygen.\n\nHe is conscious and able to respond verbally to your questions, albeit with some difficulty.\n\nA closer inspection shows that his nares are singed, with soot around them.\n\nA nurse hands over his arterial blood gas assay results at the same time, which are as follows:\n\nSaO2: 90%\npH: 7.42 (7.35 - 7.45) \npCO2: 35 mmHg (35-45) \npO2: 90 mmHg (80-100) \nHCO3: 22 mEq\/L (22-26)\n\nYou realize that you need to decide on whether intubation is required.\n"}]}
5
{"ops":[{"insert":"What do you do now?\n"}]}
1. Rapid sequence induction followed by intubation
2. Avoid intubation for now
3. Perform bronchoscopic examination of the airway, to identify edema
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