Burned (updated)

Step 1: View clinicals

A 15 year old girl is brought in 20 minutes after being rescued from a burning house. She was asleep at night, when a spark from a faulty phone charger started a fire, leaving her trapped in her bedroom. Her medical and surgical histories are unremarkable. Her COHb level is found to be 7% (normal: <3%).

Step 2: Order all relevant investigations

Complete blood count

WBC/DC: 16,200/mm3 N: 75%, L: 11% Hb: 13.5 g/dL Hct (PCV): 41.5% Platelets: 370,000/mm3

Arterial blood gases

On room air: pH: 7.42 (7.35 - 7.45) paCO2: 35 mmHg (35-45) paO2: 90 mmHg (80-100) HCO3: 22 mEq/L (22-26)

Chest x-ray

The chest x-ray appears normal.

Fiberoptic bronchoscopy

Fiberoptic bronchoscopy reveals no laryngeal or tracheal edema.

Step 3: Select appropriate management

Intubate stat
Referral to burns unit
IV fluids stat

Score: ★★☆