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Question: Discuss TWO diagnostic results and relate it to the underlying pathophysiology. Mr. Reddy is a 62 yo presenting to ED at 1500hrs. He was preparing the gas cylinder for a Sunday BBQ when it suddenly exploded while he was trying to connect the hose. Family standing by tried to extinguish the fire with their hands and tried to remove his clothing. Burns 30% TBSA – Face, hands, bilateral lower limbs. Complaints of severe pain and burning 10/10. Past Medical History: Hypertension, Type II DM Regular medications – Candesartan 8mg, Glimepiride 4mg, Metformin 500mg and Pravastatin 20mg. Fully vaccinated against COVID. Airway. – Patent, superficial burns to right side of face Breathing. – Spontaneous, RR-22mt, SPO2-92% RA, air-entry equal Circulation- Lower limb odema, cap refill 3 seconds, bilateral dorsalis pedis pulses weak. BP- 88/50 mmHg, HR- 127/mt, sinus tachycardia, Disability – GCS-15 E4V5M6, PEARL- 3mm, Exposure – Temperature 35.9 deg Celsius. Full thickness burns to right lower limb and right arm, partial thickness burns to left lower limb, bilateral hands. Superficial burns to face. Fluids – IVF saline in-situ 80ml/hr. Tolerating sips of water. Oliguric Glucose – 12mmol/L ABG: pH- 7.35, HCO3- 39, BE-4.8, Lactate- 3.2 Urine analysis: Negative for nitrites and leukocytes, urine appears very concentrated Bloods- WCC- 22.4, CRP- 164, GFR 15, CK 226 Diagnosis: Septic shock secondary to burns. A MET call was activated at 1600hrs.
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