Case Study #1: J.B.Case Study #1: J.B.

• 6 y.o. female pulled from burning house, apneic upon arrival to rural clinic; intubated by GAT

• Flight estimated 60% TBSA, Burn ED placed at 75% TBSA

• Escharotomies to bilat thighs, fascio to calves, Dobhoff with enteral feedings (11.18.09)

• Amputation of all left digits, albumin continued (11.18.09)

• 6 y.o. female pulled from burning house, apneic upon arrival to rural clinic; intubated by GAT

• Flight estimated 60% TBSA, Burn ED placed at 75% TBSA

• Escharotomies to bilat thighs, fascio to calves, Dobhoff with enteral feedings (11.18.09)

• Amputation of all left digits, albumin continued (11.18.09)

• MRSA cultured from ET tube (11.17.09), trached (11.20.09)

• Acute septicemia (11.23.09)• Burns evolved to 95% TBSA

at time of death (11.30.09)• Final diagnosis at time of

death: rhabdomyolysis, hypokalemia, MRSA septicemia, fungemia, hyperchloremic metabolic acidosis, hypoxic encephalopathy

• MRSA cultured from ET tube (11.17.09), trached (11.20.09)

• Acute septicemia (11.23.09)• Burns evolved to 95% TBSA

at time of death (11.30.09)• Final diagnosis at time of

death: rhabdomyolysis, hypokalemia, MRSA septicemia, fungemia, hyperchloremic metabolic acidosis, hypoxic encephalopathy

Case Study #2: D.W.Case Study #2: D.W.

• 2 y.o. female pulled from house fire by mother and taken via EMS to rural clinic

• Intubated by flight crew p/ carbonaceous sputum noted

• Flight estimated 80% TBSA, Burn ED placed at 60%

• Pt admitted to Burn ICU, underwent immediate excision and xenografting on back, arms, legs and trunk (12.8.09)

• 2 y.o. female pulled from house fire by mother and taken via EMS to rural clinic

• Intubated by flight crew p/ carbonaceous sputum noted

• Flight estimated 80% TBSA, Burn ED placed at 60%

• Pt admitted to Burn ICU, underwent immediate excision and xenografting on back, arms, legs and trunk (12.8.09)

(Case Study #2: D.W., cont.)

(Case Study #2: D.W., cont.)

• Multiple xenografts, aquaseal dressings and transcyte (wk 3)

• Fem art line developed clot secondary to compartment syndrome, requiring amputation of all right toes (week 2-4)

• Developed hypertrophic scarring and MRSA infection to back, responsive to abx (week 6)

• Transferred to med-surg, continuing therapy (week 9)

• Multiple xenografts, aquaseal dressings and transcyte (wk 3)

• Fem art line developed clot secondary to compartment syndrome, requiring amputation of all right toes (week 2-4)

• Developed hypertrophic scarring and MRSA infection to back, responsive to abx (week 6)

• Transferred to med-surg, continuing therapy (week 9)

(Case Study #2: D.W., cont.)

(Case Study #2: D.W., cont.)