Ep 2: A 25-year-old with burns to the face, torso, and upper extremities

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Every case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.

A 25-year-old man weighing 70 kg is brought to the casualty department one hour after sustaining burn injuries to his face, torso, and upper extremities in a house fire. He is awake but appears confused and disoriented. He also complains of a severe headache. On examination, his temperature is 39.7 C, blood pressure 90/74 mmHg, heart rate 120 beats per minute, respiratory rate 26 breaths per minute, and oxygen saturation 89%. He has blistering, painful burns to the face with singed nasal hairs and carbonaceous sputum. The remainder of his skin that is not burned has a cherry-red appearance. The burns on his chest and back 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. He also has sunken eyes, a dry tongue, and a slow capillary refill.