trauama/burn

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Question 1 / 3

683b964d31242d93219d2c27

Emergency

trauama

burn

Case History

A 35-year-old female construction worker, with a history of controlled hypertension, is directed to the emergency department after experiencing an electrical exposure incident at a job site. She reports accidentally touching a high-voltage line, estimated to be over 1,000 V, feeling a transient, sharp jolt through her left hand and arm. Despite the significant exposure, she currently reports feeling well, without specific complaints of pain, numbness, or weakness, and denies any loss of consciousness or cardiac symptoms. Her vital signs upon arrival are stable: BP 130/85 mmHg, HR 78 bpm, RR 16 bpm, Temp 37.0°C, SpO2 99% on room air. Physical examination reveals no visible entry or exit wounds, superficial burns, or signs of acute trauma. Capillary refill is brisk, and motor and sensory functions are intact in all extremities. Initial ECG shows normal sinus rhythm without ischemic changes or arrhythmias. What is the most crucial underlying diagnosis to consider in this seemingly stable patient, and what immediate comprehensive management approach is warranted to detect potential delayed complications?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	9.5 x 10^9/L	4.0-11.0 x 10^9/L
Hemoglobin	13.8 g/dL	12.0-15.5 g/dL
Platelets	280 x 10^9/L	150-450 x 10^9/L
Sodium	140 mEq/L	135-145 mEq/L
Potassium	4.1 mEq/L	3.5-5.0 mEq/L
Creatinine Kinase (CK)	220 U/L	30-200 U/L
Blood Urea Nitrogen (BUN)	18 mg/dL	8-20 mg/dL
Creatinine	0.8 mg/dL	0.6-1.2 mg/dL
Urinalysis (UA)	Negative for protein, blood, leukocytes; trace myoglobin detected	Negative

A ) Suspected deep tissue electrical injury; admit for at least 12-24 hours of continuous cardiac monitoring and serial creatine kinase and renal function assays.

B ) Electrolyte derangement with potential for cardiac arrhythmia; initiate immediate aggressive intravenous fluid resuscitation with potassium chloride replacement.

C ) Low-risk electrical exposure; discharge home with comprehensive instructions for self-monitoring and follow-up with her primary care physician in 24-48 hours.

D ) Immediate need for advanced burn care; transfer to a regional burn center for urgent surgical debridement and reconstructive assessment.

E ) Concern for acute compartment syndrome; obtain urgent orthopedic consultation for possible emergent fasciotomy of the left arm.

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Question 2 / 3

683b964d31242d93219d2c2a

Emergency

trauama

burn

Case History

A 35-year-old male is admitted to the emergency department after sustaining severe flame burns to both upper extremities when a gas canister ignited in his garage. Physical examination reveals extensive third-degree burns involving the entire circumference of both arms and forearms. The affected skin appears dry, white, leathery, and completely insensate. Peripheral pulses are diminished on palpation, and capillary refill is sluggish in the distal extremities. His initial vital signs are stable, but he appears anxious. Given this presentation, what is the most critical immediate management strategy, and which specific parameter requires the most vigilant monitoring to prevent limb-threatening complications?

Lab Parameter	Value	Reference Range
Hemoglobin	15.2 g/dL	13.5-17.5 g/dL
Hematocrit	48%	40-52%
White Blood Cell Count	14.5 x 10^3/uL	4.0-11.0 x 10^3/uL
Serum Potassium	4.1 mEq/L	3.5-5.0 mEq/L
Creatinine	1.0 mg/dL	0.6-1.2 mg/dL
Urinalysis	Negative for myoglobin	Negative

A ) Administer high-flow oxygen and continuously monitor carboxyhemoglobin levels.

B ) Initiate aggressive fluid resuscitation based on body weight and monitor daily urine output.

C ) Perform emergent escharotomy and meticulously assess distal peripheral pulses and capillary refill.

D ) Monitor for myoglobinuria and administer intravenous sodium bicarbonate to prevent acute kidney injury.

E ) Prepare for fasciotomy and measure compartment pressures hourly in all affected extremities.

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Question 3 / 3

683b964d31242d93219d2c40

Emergency

trauama

burn

Case History

A concerned father brings his 6-year-old son to the pediatric emergency department after the child accidentally pulled a hot tea kettle off the counter, spilling some hot water on his left hand. The incident occurred about 15 minutes ago. Upon examination, the child is tearful but alert. His left palm, thumb, and index finger show areas of erythema, and there are two intact, fluid-filled blisters: one measuring approximately 1.5 cm x 0.7 cm at the base of his thumb and another smaller one on the tip of his index finger. Capillary refill is brisk in the affected digits. The surrounding skin appears healthy, and there are no other apparent injuries. The father initially applied a small amount of petroleum jelly to the area. Considering these findings, what is the most likely diagnosis, and what is the optimal immediate management strategy, including essential parental counseling for preventing future incidents and recognizing signs of potential complications?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	11.5 x 10^9/L	4.5-11.0 x 10^9/L
Hemoglobin	12.8 g/dL	11.5-15.5 g/dL
Platelets	350 x 10^9/L	150-450 x 10^9/L

A ) Diagnosis: Superficial partial-thickness burn; Immediate management: Gently clean the area with cool water, apply a topical antimicrobial ointment (e.g., bacitracin), dress with a non-adherent material, provide oral analgesia, and counsel on wound care, signs of infection, and burn prevention.

B ) Diagnosis: Superficial burn; Immediate management: Apply ice packs directly to the affected area, provide acetaminophen for pain, and advise the father to change dressings daily with plain gauze.

C ) Diagnosis: Full-thickness burn; Immediate management: Initiate intravenous fluids, prepare for surgical debridement, administer tetanus prophylaxis if immunization status is unknown, and admit the child for inpatient observation.

D ) Diagnosis: Deep partial-thickness burn; Immediate management: Debride all blisters, apply silver sulfadiazine cream, prescribe oral antibiotics to prevent infection, and schedule follow-up with a burn specialist within 24 hours for potential skin grafting.

E ) Diagnosis: Epidermal burn; Immediate management: Apply aloe vera gel, discharge with instructions for rest and elevation, and advise on monitoring for discoloration as the primary complication.

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