Burns to the Face, Trunk, and Extremities

Abstract

A 25-year-old man arrives to the emergency department an hour after sustaining burn injuries in a house fire. He weighs 70 kilograms. He is awake but appears confused and disoriented. He complains of a severe headache and sounds stridorous. At initial exam, his temperature is 38.3 °C, blood pressure is 90/74 mmHg, heart rate is 120/min, respiratory rate is 26/min, and oxygen saturation is 89%. He has blistering, painful burns to the entire face with singed nasal hairs and carbonaceous sputum. He has burns on his entire chest, abdomen, and back which are painless, circumferential, white, dry, and leathery. The bilateral upper extremities are also burned with painful, swollen, mottled areas with blisters that appear to have open weeping surfaces. The remainder of his skin that is not burned has a cherry-red appearance. He also has sunken eyes, a dry tongue, and slow capillary refill.