Garage-fire burn with soot-stained airway and 35 ml/hr urine output — TBSA method, resuscitation endpoints, and inhalation grading

Model answer

• TBSA method: assess by Lund Browder Chart, Rule of Nines or Rule of Palms — all assume fixed body-part shares and ignore sex, age, weight, height and shape.^[1]
• Accuracy order: EasyTBSA -0.01% (SD 3.59) beats Palms 3.92%, Lund-Browder 4.42% and Nines 5.05% — name the method and its bias aloud.^[2]
• Deviation discipline: expert estimates deviate to 62% of the mean with 161% overestimation vs computer — re-measure at the door because misestimation buys transfer and overload.^[3][2]
• Volumes: ABRUPT first-24h at/above Parkland (albumin 5.2 ± 2.3 vs crystalloid 3.7 ± 1.7); review mean 5.2±1.1mL/kg per %TBSA with wide variability; single-centre 6.3 +/- 2.9 with 76% above the 4.3 Baxter ceiling.^[4][5][7]
• Endpoints: integrate MAP, HR, UO, lactate and base deficit with lactate superior and no single endpoint sufficient; 30 to 50 ml/hr plus MAP above 70 are yardsticks that fail while lactate/BD stay high — resuscitate with the least fluid for perfusion.^[9][10]
• Inhalation: history does not predict mortality — bronchoscope within 24h; severe grades carry adjusted OR 45.357 with ventilation OR 9.787; three-level deaths run 2.3/7.4/30.7% with ventilation 26/84/94 h.^[13][16]
• Additivity: inhalation alone adds up to 20% mortality, pneumonia 40%, both about 60% — maximal midrange.^[14]
• Referral and prognosis: 70% of admissions meet ABA criteria yet 48% of eligible nonburn cases go untransferred — transfer him; rBaux summary AUC 0.93 (weak at age extremes) rising from 0.906 to 0.938 with admission lactate.^[17][18][19]