Case study on 2 degree burns

In this presentation, we can learn about the classification and the treatment guidelines for Burns.

1. Case study on second degree burns in gluteal region J. Anisha Ebens Pharm D intern

2. A male patient of age 13, was admitted in the hospital on 11.02.2019 C/O: Burn in gluteal region H/O: Accidental pouring of hot water over the gluteal region – 2 days back No H/O fever, headache, vomiting. O /E: Lt Gluteal and lumbar region. Past Medical History: N/K/C/O- DM/SHT/IHD/Epilepsy/BA Surgical H/O: Phemosis – 5 yrs old

3. Past M edication History: Nil Personal History: Takes veg diet . Social Habits: Nil Vitals : Normal . General Examination: Temp . : Afebrile BP: 110/80 PR : 80 beats/min RR: 20 breaths/min Systems examination: CVS: S ₁S₂ + RS: NVBS + CNS: NFND P/A: soft

4. Lab investigation: Parameters Report values Normal values HB 8.8 12 – 16 g/dl TLC 6.5k 3800 – 11000 Cells/mm³ ESR 16/48 0 – 29 mm/hr DC N -54 , L-43, E-3 N: 45-75, L: 16-46, E: 0-8 BT/CT 2’10”/4’15” 2-7/8-15 mins BUN 20 8 – 25mg/dl Cr 0.6 0.5 – 1.1 mg/dl T. Chol 191 <200

5. Other investigation: ECG, CXR Impression: ECG – N, CXR - N Diagnosis: 2° Burns in gluteal region

6. What are the classifications of burns? Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin's surface.

7. First-degree (superficial) burns   First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color . Second-degree (partial thickness) burns   Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful. Third-degree (full thickness) burns   Third-degree burns destroy the epidermis and dermis and may go into the subcutaneous tissue. The burn site may appear white or charred Fourth degree burns . Fourth degree burns also damage the underlying bones, muscles, and tendons. There is no sensation in the area since the nerve endings are destroyed.

8. Critical Analysis: The patient was diagnosed with physical findings and also with Burn clinical practice guidelines. The treatment can be with analgesic, IVF. If the burn is superficial Silver Sulfadiazine can be used.

9. Drug Chart: 15/2 – Collagen dressing was done. S.No Drug name Dose ROA Freq. No. of days 1 Inj . Ertapenam 1g IV OD 11-17 2 Inj. Metronidazole 400mg IV BD 11-17 3 Inj. Ranitidine 50 mg IV 1-0-1 11-15 4 T. Acetaminophen 500mg P/O TDS 11-17 5 Oint . Silver, Sulfadiazine <1%, 10% EA BD 11-15 6 T. Serratiopeptidase 5mg P/O TDS 11-15 7 IVF RL,DNS 2 pint IV OD 11,15 8 Inj. Diclofenac 2cc IV SOS 15,16 9 T. Alprax 0.25mg P/O HS 16,17 10 T. BCT 1 tab P/O OD 16,17

10. Discarge advice: Patient discharged on 17.2.19 with the following drugs T. Para SOS T. BCT OD Onit . Silverex T. Alprax 0.25mg HS - 5days The patient was asked to review after 2 weeks.

11. Pharmacist intervention: No drug interactions found. Hb levels were low and it was not treated.

12. SOAP Notes: Subjective: A 13yr old male patient was admitted for burns in Gluteal region, following an accidental pouring of hot water before two days. He had a past case of Phemosis operated when he was 5 yrs old. Objective: His vitals were normal. His lab report showed increase in ESR levels and decreased Hb levels. On other examination, ECG and CXR was normal. Assesment : He was diagnosed with 2° burns from physical examination. Plan: H e was g iven with antibiotics for prophylaxis, pain management was done. Collagen dressing was done.

13. Patient councelling : Regarding Disease: It is a 1° and 2° burn, which is on the surface of the skin and can be cured within 2 to 3 weeks. Regarding Medication: M edication should be taken properly. If pain persist report to the doctor. Educate about side effects like nausea, vomiting, GI disturbance, hallucinations, metallic taste, dark coloured urine. Regarding lifestyle: Burn injury dramatically increases your nutrition needs. The larger the burn size, the more nutrients you need to heal. A diet high in calories and protein: supports the immune system to decrease risk of infection; helps wounds heal faster; maintains muscle mass; and minimizes weight loss to support rehabilitation . Vitamins and minerals are also important for healing and preventing infection. Vitamin C, zinc, and copper help burns heal. Vitamin E, vitamin C, and selenium are antioxidants. They help to reduce the body’s stress response after an injury. Vitamin C, vitamin D, and zinc help to prevent and treat infections .