Hoarse garage-fire burn with adequate urine output, elderly scald, and chemical splash — inhalation grades, depth lethality, and irrigation choice

Examiner prompts

• He is hoarse with soot. What does history alone predict, and what is your airway workup with the tube-size and lavage numbers?^[13][11]
• His bronchoscopy returns severe. What does that carry — the two odds ratios, the ARDS climb, the three-level deaths and vent hours?^[13][15][16]
• Urine output is 35 ml/hr. Why does that not reassure — the five-endpoint bundle, the superior marker, and the 53-patient failure?^[9][10]
• The 82-year-old has 13% that looks deep. What does the deep-share number do to her prognosis?^[32]
• The cement splash keeps burning. Irrigate, pack, or debride first — with what numbers?^[27]

Model answers

• History alone does not predict mortality — scope within 24h; the panel rates ≥ 8.0 mm tubes, lung-protective ventilation, initial and serial lavage for severe injury, heparin/salbutamol for moderate-severe and N-acetylcysteine for moderate injury as appropriate, with prophylactic antibiotics and steroids inappropriate.^[13][11]
• Severe bronchoscopy carries adjusted OR 45.357 with ventilation OR 9.787; carboxyhemoglobin rises with AIS grade while ARDS climbs 0/22/57/80% at 24h with grades 2–3 predicting ARDS and >21 vent days; three-level deaths run 2.3/7.4/30.7% with ventilation 26/84/94 h and severe-only independent mortality at OR 20.4.^[13][15][16]
• Because MAP, HR, UO and lactate are established together with lactate superior and no single endpoint sufficient — and in 53 patients ≥15% TBSA the 30 to 50 ml/hr plus MAP above 70 yardsticks held while lactate and base deficit stayed abnormally high.^[9][10]
• Her 13% mirrors the elderly pattern exactly: smaller TBSA (13% vs 22.5%) with deep share 41% vs 23.3% and mortality 48% vs 24% (OR 2.9, adjusted 12.02) — resuscitate and refer as a high-mortality burn despite the small number.^[32]
• Irrigate continuously first: immediate debridement failed to beat irrigation or wet packs, irrigation beat wet packs, and continuous water irrigation remains preferred — debride later, not first.^[27]
• Doctrine close: re-measure size, integrate five endpoints with least fluid, scope the airway, and send hand/face/neck/leg burns to the burn centre.^[9][13]