Burn Victim Case Study – BIO 168 Chief Complaint: 7-year-oldgirl admitted for severe second- and third-degree burns followingher rescue from a burning house. History: Helen Hogan, a 7-year-oldwhite female, was transported by ambulance to the emergency roomafter being rescued from her burning house. She was asleep at nightwhen a spark from the family fireplace started a fire, leaving hertrapped in her bedroom. By the time the fire rescue squad arrived,she had suffered severe burns and excessive smoke inhalation. Inthe emergency room, Helen was unconscious. She had second-degreeburns over 5% of her body and third-degree burns over 15% of herbody -- both covering her thoracic and abdominal regions and herright elbow. Her vital signs were quite unstable: blood pressure =55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40breaths / min. She was quickly deteriorating from circulatoryfailure. Two IVs were inserted and fluids were administered througheach. Her vital signs stabilized and she was transported to thepediatric intensive care unit (ICU). Helen regained consciousnessthe following morning, surprisingly complaining of only minor painover her trunk. Following debridement of her burns and applicationof a broad-spectrum, topical antibiotic, a plastic epidermal graftwas applied over the burned areas. Despite treatment with abroad-spectrum antibiotic, she developed a systemic staphylococcalinfection, necessitating a switch to a different antibiotic. Helenbegan a long, slow recovery. Her position in bed had to be changedevery 2 hours to prevent the formation of decubitus ulcers (i.e.bedsores). She lost 9 pounds over the next 3 weeks, despitenasogastric tube feeding of 5000 calories (\"Kcals\") per day. After9 weeks, sheets of cultured epidermal cells were grafted to herregenerating dermal layer. By the 15th week of her hospitalization,her epidermal graft was complete, and she was back on solid foods,her antibiotics were discontinued, and she was discharged from thehospital with a rehabilitation plan for both physical andoccupational therapy at home, as well as twice-weekly visits by anurse.
Questions: Research the following questions about Helen’s casefully using lecture notes, your textbook, and any other sources tohelp you. Answer in full, complete sentences using properterminology.
1.Briefly describe the three major layers that make up healthyskin and the connective tissue that holds it on. What is found ineach layer and what purpose does each layer serve?
2.Briefly describe the extent of damage seen in first-degree,second-degree, and third-degree burns. How are they different?
3.Why was Helen (the patient) relatively pain-free when she wokeup? Would she have been pain-free if she had suffered first-degreeburns rather than third-degree burns?
4.Explain why Helen’s blood pressure was so low and her heartrate so high upon arrival at the emergency room.
5.Why was it important to immediately administer intravenousfluids to Helen?
6.What is a “broad-spectrum†antibiotic, and why did Helen needone so quickly?
