They wheeled in the lady at 7.30am that morning, she was talking, she was coherent, she was completely burnt and still alive.
I left a gogo (granny) in mid consultation to assess the situation quite speedily, the site was unparalleled. This poor lady was covered in a blanket but the patches of exposed flesh, showed she had none. The chocolate coloured dermis was dripping off and lay in crumbs on the floor. As we removed the blanket a wave of more dripping skin wafted to the ground. She had white limbs, white chest and breast and a peeling face.
That morning at 6am a canister holding 5 litres of petrol in the house had accidentally ignited, setting the house up in flames. The patient had been caught in these flames along with her three year old daughter. The door was locked from the outside but there was small window through which the mother intuitively through the child out of. The child was incredibly fortunate to survive with minimal superficial burns. Mother though, as I have already alluded to, did not fair well.
The mortality of burns this severe and this deep is high, infact the percentage burn corresponds to the mortality rate and after stabilisation a thorough assessment of the burns revealed a total of 85%.
The scene was not just visual experience, the olfactory nerves were tainted by the smell of burnt flesh in mass volume. It was an incredible and provoking scene.
Knowing the prognosis, we still felt we should proceed with trying to optimise her as much as possible, the burns unit for referrals, said what we knew already and didn't feel any virtue in transferring her across to them. Airways and breathing she was doing for herself for now, but we could help her with fluid losses if we could only get venous access. I called for more help, with myself , the senior doctor, nurses, phlebotomists we poked the poor lady all over to no avail. We didn't have any central lines and simple cannulation of the external neck veins failed. So after a quick read of the ATLS manual the senior doctor successfully did a venous cut-down of the long saphenous vein and we had access!
The daughter stayed the night on the paediatric ward and in the early hours of the next day mother passed away.
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