2 Patients with 3d degree burn over 97% survive!!?
Answer:
We're never as smart as we think, and nature is more robust than we imagine. The famous Captain Murphy of the USAF promulgated his law about the rocket program. It's geometric progressions more true in medicine.
Just when the fluid and electrolyte problems seem to be in hand, the patient goes into ARDS or you need to have a Swan-Ganz to keep up, and it causes SBE. Your antibiotics work, but you wind up with Pseudomonas, it requires an aminoglycoside, and the kidneys are shot. There's a PE, or your prophylaxis for the PE causes a massive GI hemorrhage. The old "age+%BSA burn=mortality rate" rule still holds as an empiric guide, and if we do better, it's not through medical advances but devine intervention, though of course we always try our best.
good answer: give ivf for hypovolemic shock, epi for vasodilation, and hyperbaric O2, but this O2 therapy only inhibit the growth of anaerobic organisms like the Clostridia specie, which are responsible for tetanus, pseudomembranous colitis and butolism. the organism which is mostly present in burns are usually aerobes, meaning they thrive well in areas with oxygen. in burns, the pseudomona specie is most responsible for wound infection. these aerobes will then be responsible for sepsis.
a big problem in burned patients is electrolyte imbalance, which though can be corrected with fluids but can lessen survival of victims
but, if a patient will have 98% of his total body surface area (tsba) burned, he still have good chances of survival if he will be under strict medical care. and, percentage in burned patient only measures the tsba. if internal organs are not severely damages, chances for suvival are optimistic.
ps: your linked page does not mention burns
Put epinephrine on the skin would cause vasoconstriction, but that's the opposite of what you want. You'd be shutting off blood supply to anything still living.
Hyperbaric 02 has not proven to be effective at all with patients with burns. In fact, it could be harmful due to delay in other treatments.
Antibiotic use is not warranted unless documented infection.
As for just "SIMPLY" treating the hypovolemia, it's easier said than done.
97% and alive??
The patient was misclassified (miscalculation of the burnt area)
He is dead already..
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