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The depth of the wound was re-evaluated 48 h after injury.After the shock period, the eschar on the deeper wound is coated with iodine, and the shallow wound healed with the administration of a growth factor. On the 5th d after admission, all vital signs of the patient were determined as reasonable. A 2%TBSA blade thick skin slice of the left thigh was prepared for the particulate skin paste. The eschar of the rest of the lower limb wound was excised and a "microparticle allograft skin transplantation" was performed, with an excised eschar area of about 35% (Figure 2). On the 15th, 35th and 49th d after admission, the scalp was prepared for eschar cutting and skin grafting. On the 65th d after admission, all wounds were closed (Figure 3).
>>Anti-infective therapy: Since the patient's admission, cefmenoxime hydrochloride had been intravenously administered for an anti-infective treatment. On the 3rd d after admission, biapenem was administered as a replacement for antibiotic therapy (0.3 g for every 8 h). At 1 d later, the eschar cutting microparticle allograft transplantation of both lower limbs was performed. On the 9th d of antibiotic administration, fluconazole was taken orally, and antibiotics were discontinued when the general situation of the patient had improved. After treatment, bacterial cultures indicated a Staphylococcus aureus and Pseudomonas aeruginosa infection. Based on results from the bacterial cultures and drug sensitivity tests, sensitive antibiotics were selected for further anti-infective treatment to ensure better efficacy.
>>Ophthalmic treatment: The patient received an urgent ophthalmic consultation after admission, and the examination results were as follows: Right VOD index/anterior, 15 marks, and left VOD index/anterior, 15 marks. The PE examination revealed bilateral eyelid burns, conjunctiva and severe corneal haze. In addition, the anterior chamber was normal. The pupil was faintly visible, which was round and about 3.5 mm in diameter. We observed delayed pupillary light reflex. Crystalline lens, vitreous and fundus were also examined. The Binocular touch Tn. diagnosis was sulfuric acid burns of conjunctiva at both canthus. The ophthalmic treatments were as follows: (1) Rinsing bilateral conjunctival sac with a 0.9% sodium chloride injection of 800 mL; (2) Subconjunctival injection with 0.5 mL vitamin C; (3) Treatments of Pranoprofen eye drops, Recombinant human epidermal growth factor eye drops, ofloxacin eye drops(3 to 5 times a day, one drop each time) and Compound Tropicamide eye liquid (1 to 2 times a day, one drop each time) with an interval of at least 30 min between each eye drop treatment; and (4) Corneal nutritional therapy. The patient was regularly followed up by the department of ophthalmology and the medications were adjusted.
>>On the 65th day after admission, the burn wounds of the patient had completely healed, and the patient was transferred to a specialized hospital in Beijing for further eye treatment. No follow-up was conducted after discharge.
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[Source](https://www.wjgnet.com/2307-8960/full/v8/i7/1337.htm):
>>Chief complaints: A 30-year-old male,when he was at work,a tank containing 80% sulfuric acid exploded, resulting in burns on his face, neck, limbs, trunk, buttocks, and perineum.
>>History of present illness: A 30-year-old male presented to the Burns and Plastic Department of Affiliated Hospital of Qinghai University complaining of worsening concentrated sulfuric acid burns. When the patient was at work, a tank containing 80% sulfuric acid exploded, resulting in burns on the face, neck, limbs, trunk, buttocks, and perineum. At 5 min after the injury, the patient was rescued by his colleagues who helped him take off all his clothes and washed him with cold water for about 20 min. Accompanied by obvious thirst, dyspnea, dry pharyngeal pain, stomach discomfort, and no urine. 7 hours after admission, the patient suddenly vomited. The vomitus was black and brown stomach contents, about 300ml.
>>History of past illness: The patient has been in good health.
>>Physical examination upon admission: At 1 h after the injury, the patient was sent to the Burns and Plastic Department of Affiliated Hospital of Qinghai University by the emergency ambulance service. Upon admission, 85% of the patient’s body surface area was burned . The clinical manifestations were mostly deep II° and III° burns, with a formation of brown-black, leather-like eschar on the wound surface and locally embolized dendrite-like vessels.The patient showed pharyngeal pain, hoarseness, dyspnea after the accident and his nasal hair is scorched.(Figure 1)
>>Laboratory examinations: He had a blood pressure of 110/60 mmHg, pulse rate of 135 times/min and respiratory rate of 35 times/min,Hemoglobin 193.0g/L,White blood cell count 21.94×109/L,Urine protein(++),Urine occult blood test(++), Blood urea nitrogen7.3mmol/L,Glucose 10.9mmol/L, Creatinine76umol/L,Uric acid 296umol/L.
>>The diagnosis by our department was as follows: (1) chemical burns 85% TBSA (III° 70%TBSA, deep II° 15%TBSA)caused by concentrated sulfuric acid; (2) Severe burn shock; (3) Moderate inhalation injury; (4) Severe sulfuric acid burns of conjunctiva at both canthus; and (5) Acute renal insufficiency
>>Prevention and control of shock: Subclavian vein access was immediately established after admission, and rehydration therapy was implemented. During the first 24 h after admission, we estimated a total liquid volume of 11790 mL, a 2:1 ratio of electrolyte liquid to colloid, and a basic water content of 3380 mL in the patient. The second 24 h showed a total liquid volume of 8940 mL, a 1.68:1 ratio of electrolyte liquid to colloid, and a basic water content of 4000 mL. In the shock stage, the urine volume was 149 mL/h. The vital signs of the patient were stable, with a pulse rate of 84 times/min, SaO2 of 99%, and respiratory rate of 17 times/min. The amounts of electrolyte liquids and colloidal rehydration were moderate, and the urine volume was satisfactory. Thus, the patient was considered to be stable in the shock stage.
>>Tracheotomy plus oxygen therapy: The patient showed pharyngeal pain, hoarseness, dyspnea and other symptoms after the injury. Upon admission, with a respiratory rate of 35 times/min, the patient was immediately administered with oxygen inhalation with an oxygen flow of 5 L/min via nasal catheter. Tracheotomy was performed within 3 h after admission, and endotracheal intubation was performed to deliver oxygen with a continuous low flow. Other medications included the injection of 3 mL 0.9% normal saline and 15 mg ambroxol hydrochloride, the administration of 2.5 mL salbutamol sulfate every 6 h, mist aspiration, and diluting sputum to ensure airway patency.
>>Wound treatment: After admission, the wound was exposed and 5% sodium bicarbonate was applied to keep the wound wet. The wetted yarn with sodium bicarbonate was wrapped in the first 3 d. The pH test paper was used to determine the pH value of the wounds during the dressing changes. Dressings were changed daily.
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A tank of 80% sulphuric acid exploded, drenching a poor worker. 65 days in the hospital for his burns.
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Why is everyone enjoying this, but not stopping or helping 😅😅
Which country is this?
