Two case studies on the integumentary system
Chief Complaint: 8-year-old girl admitted for severe second- and third-degree burns following her rescue from a burning house.
History: Angela Creighton, an 8-year-old white female, was transported by ambulance to the emergency room after being rescued from her burning house. She was asleep at night when a spark from the family fireplace started a fire, leaving her trapped in her bedroom. By the time the fire rescue squad arrived, she had suffered severe burns and excessive smoke inhalation.
In the emergency room, Angela was unconscious. She had second-degree burns over 5% of her body and third-degree burns over 15% of her body -- both covering her thoracic and abdominal regions and her right elbow. Her vital signs were quite unstable: blood pressure = 55 / 35; heart rate = 210 beats / min.; and respiratory rate = 40 breaths / min. She was quickly deteriorating from circulatory failure. Two IVs were inserted and fluids were administered through each. Her vital signs stabilized and she was transported to the pediatric intensive care unit (ICU).
Angela regained consciousness the following morning, surprisingly complaining of only minor pain over her trunk. Following debridement of her burns and application of a broad-spectrum, topical antibiotic, a plastic epidermal graft was applied over the burned areas. Despite treatment with a broad-spectrum antibiotic, she developed a systemic staphylococcal infection, necessitating a switch to a different antibiotic.
Angela began a long, slow recovery. Her position in bed had to be changed every 2 hours to prevent the formation of decubitus ulcers (i.e. bedsores). She lost 9 pounds over the next 3 weeks, despite nasogastric tube feeding of 5000 calories ("Kcals") per day. After 9 weeks, sheets of cultured epidermal cells were grafted to her regenerating dermal layer. By the 15th week of her hospitalization, her epidermal graft was