The Burns Unit of Baca Ortiz de Quito Children's Hospital, Ecuador, receives patients from 75% of the national territory. During 2007, 169 patients with burns of more than 15% of the body surface were admitted to our Unit.
In 56 patients (56.8 %) the cause was direct fire, in 96 (56.8 %) by boiling liquid and in 17 (10.05%) by alternating high voltage electric current (AC).
In the same period there were 2 deaths (1.18 %), corresponding to the group of patients suffering from direct fire.
We describe the clinical case of a 12-year-old male patient, born and resident in the city of Riobamba, Ecuador, who is referred to the Emergency Department of the Baca Ortific Children's Hospital for superficial burns second degree, 5 hours of superficial burns caused by personal burns.
Upon admission to our unit, the patient is conscious, oriented in time and space, with Glasgow 15/15 score, hemodynamically oriented with systolic murmur grade II/VI in mitral and aortic focus, frank hematuria and proteinuria.
Abdominal palpation revealed painful hepatomegaly of 2 cm below the right costal margin.
Electrical fixation with carbonization and tissue necrosis affecting the hand, forearm with bone exposure of the cubitus and radius ( burst) and necrosis of the arm was observed in the upper left limb.
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On the left lower extremity, he presented carbonization and foot necrosis up to the upper third of fixation with deep second degree thigh anterior face.
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In the right lower extremity, a deep second degree cleft on the anterior thigh was observed.
Laboratory tests were performed on admission with the following results:
Blood biometry: leukocytes 23100/mm3, neutrophils 88.5%, lymphocytes 5.8% monocytes 4.8% eosinophils 0.1%, basophils 0.7%, hematocrit 52.3%, hemoglobin.
17.3mg/dl, platelets 434,000/mm3.
Electrocardiogram: microvolts with altered repolarization.
Echocardiogram: situs solitus, levoate, levoapex, normal cardiac anatomy, aortic and mild mitral regurgitation.
False non-obstructive tendon in the middle third of the left ventricle.
Doppler ultrasound of the lower limbs: popliteal artery and veins, posterior tibial artery, plantar arteries and pedis arteries with present flow.
The basic initial treatment was performed with the modified Galon formula by the Baca Ortiz Hospital, which:
Day 1: (5000 x SCQ) + (2000 x SCT) (Lactato Ringer 50% in the first 8 hours and 50% in the remaining 16 hours).
BSA (body surface area)
TCS (total body surface area)
Day 2:(3750 x SCQ)+ (1500 x SCT) (Lactate Ringer in 24 hours)
Day 3:Dextrose in 5% water + electrolytes Na and K, calculating the volume of maintenance fluids as follows: the remaining 10 kg. first per 100 cc, the loss 10 kg. cc.
Electrolyte calculations are: 2-3 mEq/Kg Na-electrosol and 1-2mEq/Kg K-electrosol.
It is important to maintain renal function in normal values of urea and creatinine, a urinary density of 1010 and hourly diuresis around 2cc/kg/hour.
According to the patient's response to pain, several analgesics were given and, due to the complexity of the lesions, prophylactic antibiotic therapy with third generation Cephalosporins and Aminoglycosides was initiated.
In patients with electrical burns, we also administered capillary vascular expanders, such as Pentoxyphylline, platelet protective agents and drugs for use as proton pump inhibitors or H2 blockers.
At 11 days of hospitalization, the patient underwent a bone scintigraphy in which we observed a lack of vascularization of the tibio-peroneal segment of the middle and distal third of the left orthopedic prosthesis to define its viability, which effectively guides the surgical articulation.
In the left upper limb, due to the lack of vascular viability and severity of fracture (carbonization), amputation was required.
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The patient was discharged with psychological support and referred to the Rehabilitation Service.
