Case of Electrical Burn

Case of Electrical Burn

Gaddi.Tagomata.Talan.Toledo.Tolibas.Wi

General Data

WB 25MMarriedConstruction workerfrom Manila

Chief Complaint

Electrical burn

History of Present Illness

DOI: December 22, 2013TOI: 11:30 NNPOI: Singalong, ManilaMOI: electrical injury

History of Present Illness

30 mins post-injuryraising a metal rod from

third floor to fourth floor

↓

rod hit a nearby electrical wire

↓

electrocuted and fell

(+) LOC (-) vomiting

↓

PGH ER

Primary Survey

• Airway • Breathing• Circulation• Deficit• Exposure

Superficial PT Deep PT

Anterior trunk 8% 2%

Genitalia 1%

R upper arm 2% 0.5%

R lower arm 0.5% 1%

R thigh 2.5% 2.5%

L thigh 3.5% 1%

R leg 6%

L foot 0.5%

24% 7%

Total 31%

Initial Assessment

• Electrical burn 31% TBSAWith cutaneous burnWith fall component

Secondary Survey

• Past Medical History(-) DM, HPN, BA, allergy, bleeding disorder

• Family Medical History (-) DM, HPN, BA, allergy, bleeding disorder

• Personal and Social Historysmoker, 0-2 sticks/dayoccasional alcoholic drinkerdenies illicit drug use

• Review of Systems(-) headache, nausea, vomiting(-) cough and colds(-) chest pain, palpitations(-) difficulty of breathing(-) abdominal pain(-) changes in bowel movement(-) urinary changes

General Condition Awake, alert, E4V5M6

Vital Signs BP 90/60 HR 114 RR 24 O2S 99% T o 37.0

HEENT Anicteric sclerae, pink conjunctivae, (+) avulsion, L supraorbital area

Chest and Lungs Equal chest expansion, clear breath sounds

Heart Adynamic precordium, tachycardic, regular rhythm, distinct heart sounds, (-) murmurs

Abdomen Flat, NABS, soft, non-tender, (-) masses

Extremities Pink nail beds, full equal pulses, (-) cyanosis

Physical Examination

Course at the ER

NPO for nowIVF:

R: PLR 1L @ 240cc/hr x 8 hrsL: PLR 1L @ 240cc/hr x 8 hrs

Then 120 cc/hr on R and L X 16 hrs

Diagnostics:CBC, BT, PT/PTT, BUN, crea, Na, K, Cl,UA with myoglobin,12 L ECG,CXR PA, pelvis AP, Towne’s, Water’s, SMVplain cranial CT with BW

TherapeuticsATS 3000 uTeAna 0.5 ccOmeprazole 40mg IV ODTramadol 50 mg IV q 8

Course in the ICU

• 1st PBD– Start NGT feeding– Dressing: SSD– For application of MEBO + Duoderm

• 2nd PBD– MV + Zinc 1 tab OD OD– Vitamin C 1 tab OD OD

• 3rd PBD– DAT with SAP, increase OFI

• 4th

– Give 50 mg NaHCO3 SIVP– IVF D5NR 1L @ 115 cc/hr + SD Plr 1 L + 50 mg

NaHCO3 @ 125 cc/hr