The Case:

An elderly woman was cooking a meal on a gas stove.  She was wearing a long sleeved blouse which accidentally caught on fire.  Luckily her teenage grandson was up in his bedroom on the second floor of the house.  He heard her shouts, ran downstairs and saw that portions of her right arm, trunk, and right leg were engulfed in flames.   He thought quickly, ran to get a towel, and managed to extinguish the flames. He then immediately called 911.  The paramedics arrived shortly and transported the woman to the hospital.

During the emergency room examination it was noted that 50% of her right arm, 25% of the whole back, and 25% of her right leg were involved.  The burned areas appeared black and charred, with patches of white and yellow. The skin was dry to touch. The patient reported no pain or sensation to these the burned areas.  The patient also displays reddened, painful skin, but no blisters on 50% of her left arm. She exhibited labored breathing and made whistling sounds when breathing, and complained of being cold. The physician immediately put her on intravenous (IV) fluids, oxygen, treated the burned area with topical antibiotics and dressed the wounds. 

1. What percentage of the total body surface has been burned?  Show your calculations.

2. What type of burn has the woman received?  Explain your answer.

3. List all of the layers of skin damaged.

4. Why does the patient report no pain or sensation in some burned areas, but not others?

5. Other than the obvious burned areas, what other type of burn/fire related injuries might the physician be concerned with?

6. Why is it vital to the burn patient to be given fluids?  Explain your answer by relating it to one of the functions of skin.  Be specific as you can.

7. Why is the possibility of infection a major concern?  Explain your answer by relating it to the functions of skin.  Be specific as you can.

8. Why is the patient complaining of being cold? Explain your answer by relating it to one of the functions of skin.