Thermal Injury: Case Study

Introduction

The description of the blisters in the presented case suggests that the patient has third-degree burns. According to Madaghiele, Demitri, Sannino, and Ambrosio (2014), third-degree burns are classified with white and dry blisters that are waxy or leathery. The patient’s assessment matches this classification, which means that the man’s tissue is extremely damaged. The fact that he has blisters on his upper body, including the head and neck, as well as his arms and legs, raises concerns for multiple complications. The patient may experience a variety of adverse outcomes, although he may not feel pain due to nerve damage.

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Systemic Complications

Apart from the risk of contracting an infection through the blisters, the patient may suffer from some systemic complications. Third-degree burns are dangerous, exposing the tissue and making unassisted wound closure impossible (Madaghiele et al., 2014). It is possible that the damage has affected the patient’s respiratory system as he was trapped in a burning car. He inhaled fumes during his entrapment which most likely damaged his pulmonary system. One of the main reasons for respiratory system dysfunction is carbon monoxide poisoning which releases mucus and neutrophils that lead to lumen obstruction (Silva et al., 2016).

In turn, the occlusion of the channels causes such symptoms as difficulty in breathing. Other problems may occur if the patient’s lungs or other parts of the system were burned – the damaged tissue may become infected, with the immune system initiating an inflammatory response. As a result, the patient encounters increased capillary permeability, swelling, mucus production, and leakage of fluid into the lung.

Pain and Risk Factors

The patient may potentially experience hemodynamic instability which is derived from the decreased blood volume. The reduction of the venous return, blood loss, and damage to the cardiac nerves all lead to the change in the cardiac output (Soussi, Dépret, Benyamina, & Legrand, 2018).

Another possible reason is the increased systemic vascular resistance which is also dependent on vasoconstriction. During the accident and treatment, the patient lost a significant amount of blood. Moreover, his capillary system is damaged substantially. Thus, vasoconstriction is an expected outcome that further leads to the mentioned above problems. Here, the risk of sepsis also exists because of the exposure of the body to infections.

Finally, a hypermetabolic response may develop as a result of increased blood pressure which is one of the outcomes of the damaged hemolytic system (Bittner, Shank, Woodson, & Martyn, 2015). Some other causes may include the secretion of glucocorticoids and catecholamines as an immunological response of the body. As an outcome, the patient experiences a higher rate of destruction of protein and lipid. Moreover, insulin resistance may also increase, followed by muscle wasting and other problems.

It should be noted that the patient may not experience pain from these burns. This is not, however, a sign of a positive outcome. As a contrast, the lack of pain signifies that the patient’s nerves were damaged significantly, and his body is unable to react to the damage adequately. Thus, he may not be able to report his pain, which further complicates treatment (Bittner et al., 2015). The patient’s immobility affects his recovery and puts him at risk of developing further problems with metabolism and muscle wasting. Furthermore, the use of narcotics may expose his immune system to infections and suppress the latter’s response to viruses and bacteria.

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Conclusion

The patient’s assessment reveals that he has third-degree burns described as having white and dry blisters. They may cause no pain to the patient as he possibly has damaged nerves. However, the burns generate a variety of complications, including hypermetabolism, sepsis, hemodynamic and respiratory problems. The roots of such issues lie in the fact that smoke and temperature damage tissue, initiating the inflammatory response. The body reacts and induces edema, vasoconstriction, and mucus production.

References

Bittner, E. A., Shank, E., Woodson, L., & Martyn, J. J. (2015). Acute and perioperative care of the burn-injured patient. Anesthesiology: The Journal of the American Society of Anesthesiologists, 122(2), 448-464.

Madaghiele, M., Demitri, C., Sannino, A., & Ambrosio, L. (2014). Polymeric hydrogels for burn wound care: Advanced skin wound dressings and regenerative templates. Burns & Trauma, 2(4), 153-161.

Silva, L., Garcia, L., Oliveira, B., Tanita, M., Festti, J., Cardoso, L.,… Grion, C. (2016). Acute respiratory distress syndrome in burn patients: Incidence and risk factor analysis. Annals of Burns and Fire Disasters, 29(3), 178-182.

Soussi, S., Dépret, F., Benyamina, M., & Legrand, M. (2018). Early hemodynamic management of critically ill burn patients. Anesthesiology: The Journal of the American Society of Anesthesiologists, 129(3), 583-589.

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