Module 1 Case
This case was written by David A. Sandmire, MD and was editedfor content for use in this class.
Chief Complaint: 8-year-old girl admitted for severe second- andthird-degree burns following her rescue from a burning house.
History: A 13-year-old female was transported by ambulance tothe emergency room after being rescued from her burning house. Shewas asleep at night when a spark from the family fireplace starteda fire, leaving her trapped in her bedroom. By the time the firerescue squad arrived, she had suffered severe burns and excessivesmoke inhalation.
In the emergency room, the patient was unconscious. She hadsecond-degree burns over 5% of her body and third-degree burns over15% of her body -- both covering her thoracic and abdominal regionsand her right elbow. Her vital signs were quite unstable: bloodpressure = 55 / 35; heart rate = 210 beats / min.; and respiratoryrate = 40 breaths / min. She was quickly deteriorating fromcirculatory failure. Two IVs were inserted and fluids wereadministered through each. Her vital signs stabilized and she wastransported to the pediatric intensive care unit (ICU).
The patient regained consciousness the following morning,surprisingly complaining of only minor pain over her trunk.Following debridement of her burns and application of abroad-spectrum, topical antibiotic, a plastic epidermal graft wasapplied over the burned areas. Despite treatment with abroad-spectrum antibiotic, she developed a systemic staphylococcalinfection, necessitating a switch to a different antibiotic.
The patient began a long, slow recovery. Her position in bed hadto be changed every 2 hours to prevent the formation of decubitusulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks,despite nasogastric tube feeding of 5000 calories (\"Kcals\") perday. After 9 weeks, sheets of cultured epidermal cells were graftedto her regenerating dermal layer. By the 15th week of herhospitalization, her epidermal graft was complete, and she was backon solid foods, her antibiotics were discontinued, and she wasdischarged from the hospital with a rehabilitation plan for bothphysical and occupational therapy at home, as well as twice-weeklyvisits by a nurse.
Questions:
1. Propose a possible treatment for the patient in thiscase study. How does this treatment improve conditions for thepatient? Are these improvements seen at the cellular, tissue,organ or systemiclevel?
