Flame burns –TBSA 30%/mixed deep dermal /3rd degree burns

Flame burns –TBSA 30%/mixed deep dermal /3^rd degree burns

P. Snekapriya^1*, N. Bhuvaneshwari²

Department of Clinical dietitian, Kauvery hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Introduction

A third-degree flame burns is a full-thickness thermal injury caused by direct exposure to flames, resulting in destruction of the epidermis and entire dermis, and sometimes extending into deeper tissues. Treatment of this condition is focused on early diagnosis and surgical intervention. In the report, we described a case of 41 years old male who has no previously known co-morbidities. He had alleged history of burns.

Case presentation

A 41-year-old male with 30%TBSA flame burns involving the face, neck, chest, abdomen, and right upper limb was treated for mixed deep dermal and third-degree burns.
Due to severe airway edema and suspected inhalational injury, she required intubation, mechanical ventilation, and tracheostomy.
Medical Gastroenterologist opinion was obtained for deranged LFTs, and the patient was diagnosed with acute hepatitis.
Burn wound excision, allograft application, and multiple dressing procedures were performed.
She was treated with IV fluids, antibiotics, analgesics, blood products, and other supportive measures.

Discussion

Initially patient was on NPO for observation. Next day patient was kept NPO due to the planned surgery and intubation. She was intubated and mechanically ventilated. So, we started RT feeds (Clear liquid). Patient on NPO for Tracheostomy + Wound Re-Look + Dressing. Next day we restarted the RT feed (Artificial supplement).
Patient was NPO for wound relook + Allograft Application. Patients tolerated RT feeding. As the patient’s condition improves. Patients were shifted to the ward. We started oral trial (Normal liquids) patient tolerated well. RT feeding was stopped and given oral high protein semi solid diet along with oral nutrition supplement. The patient was advice to follow a high protein diet.

Dietetic challenges expected in burns

1. Increased energy requirements

Severe burns cause a hypermetabolic and hypercatabolic state.
Meeting increased calorie requirement is challenging.

2. High protein requirement

Extensive tissue damage increases protein breakdown.
Adequate protein is essential for wound healing, maintaining muscle mass and recovery.

3. Repeated NPO periods

The patient had to remain NPO for intubation, tracheostomy, wound re – look dressing and allograft procedures.
This can result in interruptions in nutrition delivery.

4. Enteral feeding challenges

The patient was mechanically ventilated and required RT feeding.
Feeding had to be adjusted around procedures and clinical condition.

5. Acute hepatitis/deranged LFTs

Altered liver function adds complexity to nutritional planning.
Protein fat medications and overall nutritional intake may need monitoring according to the clinical status.

6. Transition from tube feeding to oral diet

Once the patients’ condition improved oral feeding had to be introduced gradually.
Tolerance swallowing ability and adequate intake needed monitoring.

7. Risk of micronutrient deficiencies

Burns can increase requirements for nutrients involved in tissues repair and immunity, such as vitamins A, C, D and minerals such as zinc and selenium.

Result

The patient with 30% TBSA mixed deep dermal and 3^rd-degree burns underwent burn wound excision, allograft application and repeated dressing procedures.
Initially, she required intubation, mechanical ventilation and tracheostomy due to severe airway edema and suspected inhalational injury.
Enteral (RT) feeding was initiated and tolerated well, with appropriate nutritional supplementation.
Feeding was temporarily withheld during surgical/procedural periods and restarted afterward.
As her clinical condition improved, she was shifted from intensive care to the ward.
She successfully tolerated oral liquid feeding following which RT feeding was stopped.
She was progressed to an oral high – protein semi – solid diet with oral nutritional supplementation.
She was advised to continue a high – protein diet to support wound healing, tissue repair and recovery.

Flame burns –TBSA 30%/mixed deep dermal /3rd degree burns

Flame burns –TBSA 30%/mixed deep dermal /3rd degree burns

Nightingale Journals

Flame burns –TBSA 30%/mixed deep dermal /3^rd degree burns