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A 30-year-old male has sustained 30% (body surface area) burns to his upper limbs and trunk in a house fire. He is breathing spontaneously, has palpable peripheral pulses but is unconscious (barely responds to stimulation).

The following conditions may explain his unresponsiveness:

True / False

Hypoxia Correct

Alcohol intoxication Correct

Fluid loss from the burn and subsequent hypovolaemia Incorrect answer selected

Carbon monoxide poisoning Correct

An associated head injury Correct

Explanation

Whenever the burn injury is extensive, i.e. >15-20% of the body surface area (BSA) in adult patients, the patient will require intravenous fluid resuscitation. However, a young healthy patient with a 30% BSA burn is unlikely to be hypovolaemic resulting in unconsciousness.

Several fluid resuscitation formulae are known and are used to calculate the volume of fluid required in the first 24 hours following a burn. With the Parkland formula the normal crystalloid requirements for the first 24 hours is around 4 ml per % BSA burned per kg body weight. The rate of fluid resuscitation is subsequently adjusted to maintain a urine output of between 0.5 and 1.0 ml/kg per hour.

The possibility of associated injuries, inhalation burns, drug overdoses or alcohol intoxication, should always be kept in mind. Alcohol and drug intoxication are both potential causes of unconsciousness. Concomitant mechanical trauma is not infrequently seen in burn victims, and so should always be looked for. An associated head injury could easily account for the reduced conscious level.

If the patient has been exposed to fire or smoke in an enclosed space, eg. in a house fire, then the possibility of inhalation injury, including carbon monoxide (not dioxide) and cyanide poisoning should be considered. A high concentration of carboxyhaemoglobin can cause unconsciousness, convulsions and coma. The resulting hypoxia should be treated with high 100% oxygen.

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Average score: 86.95%

Times answered: 285