Patient with 3d degree burns over 100% of body?

Question

Read about the case of 24 year old guy who jumped head first into a boiling hot spring at Yellowstone National Park. He sustained 3d degree burns over 100% of his body including his entire head and died the following morning at a Salt Lake City Hospital

Question

If someone is rushed into the ER with 3d degree over 100% of body after jumping and swimming in 100 degree celsius (210 F) water what can be done for the patient?? This accident happened in 1981, what would be the prognosis with the medical technology we have today??

hear is the case:

http://www.snopes.com/horrors/freakish/hotspring.asp

Answer 1

No difference.

That poor patient would have died.

Answer 2

Still would not survive.  The current addage in major burn centers is:  age + %body burned (3d degree) = mortality

So a 50 year old with 50% 3d degree burns would have 100%chance of dying.  This is not absolute but in my experience it's pretty accurate.  

The problem is mainly due to fluid and electrolyte loss along with infection.  There are also complications of long term admission to burn units such as pneuminia and DVT's

Answer 3

Still would die.  Your skin is your largest organ.  It helps regulate your temperature, keeps out infections, helps maintain you fluid balance and many other tasks.  

100% burns means that virtually all your skin would be gone.  The clinical shock you'd suffer from alone would probably kill you.  The amount of IV fluid you have to give burned patients is amazing.  This guy would leak fluid from every pore.  Not only would he go into shock the electrolytes he also lost would cause all kinds of problems.  

Next there would be massive infection.  The hospital would simply not be able to keep this guy from literally rotting in the bed.  

Those are just a couple of reasons he would die.  So, unless you are Woverine of the X-Men don't try this stunt at home.  The best you could hope for is for them to let you die quickly.

Answer 4

There really is nothing to be done in a case like this.  Sure, you could try intubating the patient, sedating them, controlling their pain, maybe even doing a fluid resuscitation and, if they survived in the emergency department, admitting them to the burn unit.  However, it is highly unlikely that the patient would even survive in the emergency department.  

If someone like this came into our ER, we would probably give them lots of pain medicine while monitoring their vital signs, give them some medicine to sedate them, but not put them to sleep.  Apply oxygen to help make breathing easier, and give them some fluids to try and maintain as much of a balance as possible.  Then, if they survived in the emergency department long enough to get them a room upstairs, we would admit them, keep the wounds clean and uninfected and provide pain control.  We would not try anything heroic.

Answer 5

The outcome would be the same.  With third degree burns your skin can't 'breath', and end up dieing.  With all that dead skin the body would have nothing to keep it together.

Answer 6

Would this patient survive? Highly, HIGHLY unlikely

I just read the link, obviously this guy wasn't too smart, you do not jump into a boiling hot spring for ANY reason, even if that would have a family member. Remember the old saying: someone drowning and you jump in after them, chance are you will both drown.

What to do with a patient like this?

Remember, burns do not just cause skin damage but when the surface area of burned tissue is that great, systemic affects manifest due to release of pro-inflammatory mediators into the systemic circulation. This will further cause vasodilation and increase capillary permeability exacerbating the sever hypovolemia the patient already has. In addition the cytokines such as TNF can also cause depressed myocardial contractility and pro-coagulant effect resulting in disseminated intravascular coagulation (DIC), which can actually the patient to bleed to death internally. Also toxins from necrotic skin tissue can seep into the blood stream and cause acute renal failure and other complication, which although can be treated with further decrease the survival rate. It is because of this reason, together with th massive hypovolemic shock and the very, VERY high rate of sever infection (remember the skin is a very important part of your immune system) that when 3d degree burns cover more then 75% of your body, mortality rapidly approaches 100%

ABC, airway-breathing circulation

The patient should be intubated and two large bore central venous lines and a peripheral IV line secured for rapid and aggressive volume resuscitation.

The patient should be admitted immediately to the burn unit ICU and regular checked for signs of infection, antibiotic use is NOT warranted prophylactically unless there are actual sign of infection, however should be started with the slightest hint of an infection to prevent a lethal septic shock

If the patient should code, proceed with ALS protocols!!!!

Yes the prognosis is extremely poor, but there have been people who have fallen into yellowstone hot springs, had 3d degree burns over 90+ and survived, although this is the exceptions

Someone suggested to give pain medication, why?? 3d degree burns are NOT painful as the entire thickness of the skin with the senosry receptors are destroyed, morphine and other analgetic agents can actually decrease respiration, not a good idea!!

Bottom line:

Treat as aggressively as possible!!!!!!!!!!!!!!!

But...more then likely, unless there is some miracle, the patient in that condition ill succumb sooner or later, unfortunately

Answer 7

The object in the care of a patient like this is pain control. I have seen bad burns require incredible doses of medicine just to think and plan their last moments.

The prognosis is the same.

Old Doc