In this presentation, we can learn about the classification and the treatment guidelines for Burns.

1. Case study on second degree burns in gluteal
region
J. Anisha Ebens
Pharm D intern

2. A male patient of age 13, was admitted in the hospital on
11.02.2019
C/O: Burn in gluteal region
H/O: Accidental pouring of hot water over the gluteal region –
2 days back
No H/O fever, headache, vomiting.
O/E: Lt Gluteal and lumbar region.
Past Medical History:
N/K/C/O- DM/SHT/IHD/Epilepsy/BA
Surgical H/O:
Phemosis – 5 yrs old

3. Past Medication History:
Nil
Personal History: Takes veg diet.
Social Habits: Nil
Vitals: Normal.
General Examination:
Temp.: Afebrile BP: 110/80
PR : 80 beats/min RR: 20 breaths/min
Systems examination:
CVS: S₁S₂ + RS: NVBS +
CNS: NFND P/A: soft

4. Lab investigation:
Parameters Report values Normal values
HB 8.8 12 – 16 g/dl
TLC 6.5k 3800 – 11000 Cells/mm³
ESR 16/48 0 – 29 mm/hr
DC N-54, L-43, E-3 N: 45-75, L: 16-46, E: 0-8
BT/CT 2’10”/4’15” 2-7/8-15 mins
BUN 20 8 – 25mg/dl
Cr 0.6 0.5 – 1.1 mg/dl
T. Chol 191 <200

5. Other investigation:
ECG, CXR
Impression: ECG – N, CXR - N
Diagnosis: 2° Burns in gluteal region

6. What are the classifications of burns?
Burns are classified as first-, second-, or third-degree, depending on how deep
and severe they penetrate the skin's surface.

7. • First-degree (superficial) burns
First-degree burns affect only the epidermis, or outer layer of skin. The burn
site is red, painful, dry, and with no blisters. Mild sunburn is an example.
Long-term tissue damage is rare and usually consists of an increase or decrease
in the skin color.
• Second-degree (partial thickness) burns
Second-degree burns involve the epidermis and part of the dermis layer of
skin. The burn site appears red, blistered, and may be swollen and painful.
• Third-degree (full thickness) burns
Third-degree burns destroy the epidermis and dermis and may go into the
subcutaneous tissue. The burn site may appear white or charred
• Fourth degree burns. Fourth degree burns also damage the underlying bones,
muscles, and tendons. There is no sensation in the area since the nerve
endings are destroyed.

8. Critical Analysis:
• The patient was diagnosed with physical findings and
also with Burn clinical practice guidelines.
• The treatment can be with analgesic, IVF. If the burn
is superficial Silver Sulfadiazine can be used.

11. Drug Chart:
15/2 – Collagen dressing was done.
S.No Drug name Dose ROA Freq. No. of days
1 Inj. Ertapenam 1g IV OD 11-17
2 Inj. Metronidazole 400mg IV BD 11-17
3 Inj. Ranitidine 50 mg IV 1-0-1 11-15
4 T. Acetaminophen 500mg P/O TDS 11-17
5 Oint. Silver, Sulfadiazine <1%, 10% EA BD 11-15
6 T. Serratiopeptidase 5mg P/O TDS 11-15
7 IVF RL,DNS 2 pint IV OD 11,15
8 Inj. Diclofenac 2cc IV SOS 15,16
9 T. Alprax 0.25mg P/O HS 16,17
10 T. BCT 1 tab P/O OD 16,17

12. Discarge advice:
Patient discharged on 17.2.19 with the following drugs
T. Para SOS
T. BCT OD
Onit. Silverex
T. Alprax 0.25mg HS - 5days
The patient was asked to review after 2 weeks.

13. Pharmacist intervention:
• No drug interactions found.
• Hb levels were low and it was not treated.

14. SOAP Notes:
Subjective: A 13yr old male patient was admitted for burns in Gluteal
region, following an accidental pouring of hot water before two days.
He had a past case of Phemosis operated when he was 5 yrs old.
Objective: His vitals were normal. His lab report showed increase in
ESR levels and decreased Hb levels. On other examination, ECG and
CXR was normal.
Assesment: He was diagnosed with 2° burns from physical
examination.
Plan: He was given with antibiotics for prophylaxis, pain
management was done. Collagen dressing was done.

15. Patient councelling:
Regarding Disease: It is a 1° and 2° burn, which is on the surface of the skin and can be
cured within 2 to 3 weeks.
Regarding Medication: Medication should be taken properly. If pain persist report to the
doctor. Educate about side effects like nausea, vomiting, GI disturbance, hallucinations,
metallic taste, dark coloured urine.
Regarding lifestyle: Burn injury dramatically increases your nutrition needs. The larger
the burn size, the more nutrients you need to heal. A diet high in calories and protein:
• supports the immune system to decrease risk of infection;
• helps wounds heal faster;
• maintains muscle mass; and
• minimizes weight loss to support rehabilitation.
Vitamins and minerals are also important for healing and preventing infection.
• Vitamin C, zinc, and copper help burns heal.
• Vitamin E, vitamin C, and selenium are antioxidants. They help to reduce the body’s
stress response after an injury.
• Vitamin C, vitamin D, and zinc help to prevent and treat infections.