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BURN Case Presentation

BURN Case Presentation. Block R Magallanes, Vincent Pasco, Bayani Jr. Pambid, Karen Pili, Stephanie Raguindin, Peter Francis. Clinical Profile. E.D. 40 / M, separated Tiaong, Quezon R-handed Roman Catholic. History of Present Illness. DOI: April 2, 2010 TOI: 3 PM

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BURN Case Presentation

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  1. BURNCase Presentation Block R Magallanes, Vincent Pasco, Bayani Jr. Pambid, Karen Pili, Stephanie Raguindin, Peter Francis

  2. Clinical Profile • E.D. • 40 / M, separated • Tiaong, Quezon • R-handed • Roman Catholic

  3. History of Present Illness • DOI: April 2, 2010 • TOI: 3 PM • POI: outside their home in Tiaong, Quezon • MOI: electrical burn

  4. History of Present Illness • 5 hours PTC • Patient was on the ground outside their house, fixing their antenna and accidentally touched a live wire. • Patient got electrocuted, immediately felt intense heat all over his body. He was found lying on the ground (-) LOC, (+) numbness all over his body “nangingimi” • Patient was brought to a local hospital where he was hydrated with 2L of pNSS, given ATS/TeAna and 12L ECG was done. He was immediately referred to PGH for prompt management

  5. (-) HA (-) nausea/vomiting (-) BOV (-) fever (-) chest pain (-) dyspnea (-) cough and colds (-) abdominal pain (+) dark-colored urine (-) melena/ hematochezia (-) seizure Review of Systems

  6. Past Medical History • (-) HPN, DM, BA, PTB, allergies • (-) previous hospitalization/ surgery

  7. Family Medical History • (+) HPN – mother • (-) DM, BA, PTB, allergies

  8. Personal and Social History • Elementary graduate • Works as a welder • Separated with first wife to whom he had 7 children • Currently has a live-in partner • Smoker for 24 years, 3 sticks/day • Occasional alcoholic beverage drinker

  9. Physical Examination • Awake, conscious, coherent, NICRD • BP 100/60, HR 90, RR 20, T 37.3 • HEENT: anicteric sclerae, pink conjunctivae, round pupils EBRTL, (-) NVE, (-) CLAD • CVS: Adynamic precordium, distinct heart sounds, NRRR, apex beat @ 5th ICS L MCL, (-) murmur

  10. Chest: Equal chest expansion, clear breath sounds, (-) crackles/ wheezes Abdomen: flat, NABS, (-) tenderness Extremities: PNB, FEP, (-) edema Neuro: E4V5M6, oriented to 3 spheres CN intact, DTRs 2+ on all ext, (-) Babinski, supple neck Motor Sensory Physical Examination

  11. Assessment • Electrical Burn, 49% TBSA

  12. Course • ER: • Primary Survey: • Airway • Breathing • Circulation • Disability • Exposure • Fluid Resuscitation • Secondary Survey: • history • Related trauma?

  13. Laboratory Exams • CBC • Blood typing • Na, K, Cl, BUN, Crea, Alb • PT/PTT • Urinalysis with myoglobin • 12-L ECG • CXR

  14. LAB results

  15. LAB Results • U/A • Light brown, turbid, pH 6.0, sg 1.030, few bacteria, (+) coarse granular cast 2-6/lpf, (+) amorphous urates +3/lpf • 4/3 3:17 AM • Myoglobin positive • 4/3 5: 21 PM • Myoglobin negative • 12L ECG: RSR, NA, NsSTTwc • CXR: NSCF

  16. PLAN • Diet: NPO • IVF: pLR @ 600cc/hr pLR @ 600cc/hr • Tx: Ceftazidime 2.5g IV q8 Amikacin 1.2g IV OD MV w/ Zn 1 tab OD Vit C 500mg/tab OD Tramadol 50mg/cap, 1 cap TID • NGT open to drain • Monitor UO q1, should not be <100cc/hr • Monitor VS Q1

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