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TRANSCRIPT
BURN IN PREGNANCY –
A CASE REPORT
ARIA ON, AMIRIZE EE, KEJEH BM, GBENEOL T
University of Port Harcourt Teaching Hospital, Nigeria
• Major burn injuries are greatly
traumatizing and more so, in the
pregnant patient with burns.
• The TBSA is a major determinant of
maternal survival; while fetal survival is
largely dependent on the gestational
age and maternal TBSA .
BACKGROUND
• Prompt resuscitation.
• Adequate nutrition.
• Meticulous sepsis prevention/management.
• Co-management with the obstetrician.
• Wound cover are vital for improved
outcome.
BACKGROUND
AIM
To highlight the challenges
encountered in the
management of this burn
injured pregnant patient; as
well as to share our action plan
to prevent such challenges.
CASE PRESENTATION
• Miss A. B, a 29 year old single lady,
secondary school drop out.
• With Flame burn injury of 8 hours
duration.
• Flame source was kerosene stove
explosion.
PRESENTATION (2)
• First aid comprised of water and raw
eggs smeared on the wounds.
•She was pregnant, G2P1, EGA 27
weeks
EXAMINATION
• At presentation , she was in painful
distress, afebrile, pale, dehydrated, no
pedal edema.
•Weight 60kg.
• Airway- clear.
• She had no obvious signs of inhalation
injury.
• Respiratory rate - 24 cpm
• Pulse rate - 108 pm
• Blood pressure - 100/60 mmHg
• Temperature - 37 Co
• Affected areas were the face/neck,
torso/limbs, with mainly deep partial
thickness burn injury of TBSA 40%.
EXAMINATION (2)
INITIAL DIAGNOSIS
Diagnosis was 40% deep partial
thickness flame burn injury due
to kerosene explosion in a 27
weeks gravid patient.
PLAN (RESUSCITATION)
• Fluid resuscitation (parkland formula;
9,600mls over the next 16 hours)
• Urine output monitoring ( 30mls/ hour)
• Analgesia
• IV Omeprazole, Vitamins A, C, E.
• Tetanus prophylaxis
PLAN (2)
• FBC, serum electrolytes, urea and
creatinine, urinalysis, wound swab for MCS,
total protein albumin.
• High protein, high calorie diet.
• Burn wounds were copiously irrigated with
0.9% saline, and dressed with vaseline
soaked gauze.
MULTIDISCIPLINARY CARE
•The Obstetricians were invited to
co-manage the patient.
2DOA
• Fluid input/ Output = 6000mls / 450mls
(Inadequate)
• Investigations – Not done.
• Voluntary financial contributions by the
managing team were made.
• Social Welfare Unit was notified.
• Hemoglobin concentration was 7g/dl;
serum electrolytes were within normal
range, but urea and creatinine were
mildly elevated.
• Ultrasound scan revealed an active live
fetus, at 72hours post injury. EGA 26
weeks.
INVESTIGATIONS (3DOA)
• A wound swab was sent for MCS
• During cross-matching and blood
screening, the patient tested positive to
HIV.
• A CD 4 count was requested for.
INVESTIGATIONS (2)
COMPLICATIONS
• 5th
day on admission - Intra-uterine fetal
demise; she spontaneously expelled the
fetus same day.
• She was transfused with 2 units of blood.
• Two men who had claimed responsibility
for her pregnancy, had stopped visiting.
• 6DOA- MCS yielded moderate growth of
Pseudomonas aeruginosa.
• Intravenous Ceftazidine 1 gram 12 hourly
was prescribed.
• IV Metronidazole 500mg 8hourly was
added.
• She was worked up for wound
debridement
COMPLICATIONS(2)
• On the 7th day on admission, she was
noticed to be febrile (39 Co), tachycardia
of 120bpm, with facial fullness and
pedal edema.
• Urine was concentrated, with a urine
output of about 12mls/hour.
COMPLICATIONS(3)
• A diagnosis of 40% deep partial thickness
flame burn injury, complicated by sepsis and
suspected Acute Kidney Injury in a newly
diagnosed RVD patient was made at this point.
• Renal function tests were requested for .
• The nephrologists were invited to co- manage .
COMPLICATIONS(4)
•On the same day (7DOA), she
discharged herself against medical
advice; citing distance from her
relatives as the reason.
REQUEST FOR DISCHARGE
BURDEN OF CARE
• PREGNANCY
• INDIGENT PATIENT
BURDEN OF CARE (2)
• IGNORANCE
Refilling a lit kerosene stove, first
aid, unaware of retroviral status, self-
discharge
RETROVIRAL STATUS
• Appeal to the hospital management for
emergency burn care in the first 48 hours.
• Solicit for support from NGOs
• More vigorous burn prevention awareness
campaigns
ACTION PLAN
CONCLUSION
This typifies some challenges faced in
burn management in our sub region.
Outcome measures are usually not
feasible.
DESPITE THESE OBSTACLES,
WE WILL ATTAIN GREAT
HEIGHTS
THANK YOU
FOR YOUR
ATTENTION