A patient has the second and third degree burns of the 15% of the body surface. On the 20th day after the trauma the patient presents with sharp increase of body temperature, general weakness, rapid vesicular respiration; facial features are sharpened, BP is 90/50 mm Hg, heart rate is 112/min. What complication is it?

Answer options

1. Sepsis
2. Pneumonia
3. Anaerobic infection
4. Purulent bronchitis
5. Acute intoxication

Explanation

The inflammatory changes caused by the burn influence the patient’s immune system. Cell-mediated immunity is significantly reduced in large burns, leaving them more susceptible to bacterial and fungal infections. There are many potential sources of infection, especially from the burn wound and from the lung if this is injured, but also from any central venous lines, tracheostomies, or urinary catheters present. Control of infection begins with policies on hand-washing and other cross-contamination prevention measures. Bacteriological surveillance of the wound, catheter tips, and sputum help to build a picture of the patient’s flora. If there are signs of infection, then further cultures need to be taken and antibiotics started. This is often initially on a best guess basis, hence the usefulness of prior surveillance; close liaison with a bacteriologist is essential. In patients with large burns that remain catabolic, the core temperature is usually reset by the hypothalamus above 37 °C. Significant temperatures are those above 38.5°C, but often other signs of infection are more useful to the clinician. These include significant rise or fall in the white cell count, thrombocytosis, increasing signs of catabolism, and decreasing the clinical status of the patient. Infection control in burns patients is immunocompromised They are susceptible to infection from many routes Sterile precautions must be rigorous Swabs should be taken regularly A rise in white blood cell count, thrombocytosis and increased catabolism are warnings of infection Bailey & Love’s short practice of surgery. – 27th edition. – P. 619.