Acute Burn Injury, Inhalation Trauma, and Resuscitative Pathophysiology — WACS Viva & Clinical Scenarios (Plastics & Dental)

Exam-style acute burn injury, inhalation trauma, and resuscitative pathophysiology viva scenarios with examiner probes and model answers for ANAESTHESIA…

Scenarios covered

• SCENARIO 1: A 28-year-old male is brought to the emergency department 3 hours after being trapped in an enclosed room fire. He has 45% Total Body Surface Area (TBSA) mixed partial and full-thickness burns involving the face, anterior neck, chest, and upper extremities. He has singed nasal hairs, hoarseness of voice, carbonaceous sputum, SpO2 94% on room air, pulse rate 128 bpm, blood pressure 95/60 mmHg. How do you assess, resuscitate, and secure the airway in this patient?
• SCENARIO 2: A 34-year-old female weighing 60 kg with 55% TBSA flame burns sustained 18 hours ago is scheduled for urgent tangential excision and split-thickness skin grafting tomorrow morning (post-burn day 2). The surgical team estimates excising 20% TBSA. She has received 14 liters of Ringer's lactate over the past 18 hours. Her current urine output is 15 mL/h, heart rate 135 bpm, blood pressure 90/50 mmHg, and serum sodium is 131 mmol/L. Outline your pre-anaesthetic evaluation, fluid optimization, and intraoperative anaesthetic plan.
• SCENARIO 3: A 4-year-old child weighing 15 kg sustained 30% TBSA scald burns 4 days ago and is now posted for wound debridement. The junior resident plans to induce general anaesthesia with propofol and suxamethonium to facilitate rapid endotracheal intubation. Evaluate this plan, explain the underlying cellular pathophysiology, and provide an alternative safe anaesthetic technique.
• SCENARIO 4: A 40-year-old industrial technician survives a high-voltage electrical burn (11,000 volts) with entrance wounds on both hands and exit wounds on both feet. He presents with dark reddish-brown urine, a heart rate of 110 bpm with frequent premature ventricular contractions, and severe metabolic acidosis. Detail your comprehensive anaesthetic and perioperative resuscitation strategy for emergent fasciotomies.