Burn to the right arm


• Scene – IV, Dilaudid, fluids, EKG, cleaned wound, Zofran.

• En Route – Vitals, morphine 2mg increments with a total of 8mg.

• Hospital – unknown


• Response to treatment – patients BP went down, but his pain went from a 3/10 to 4/10


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Burn Injury
• Second degree burn

Differential Diagnosis

• Second degree burn

• Third-degree burn

• Thermal burn

• Compartment syndrome

• Circumferential burn

Patient Workup History

• Patient states – he was throwing some paint thinner on a fire to get it going a little better, and it splashed on him and caught his R arm and his R hip area on fire. He did not have pain right away and was not going to go to the hospital. He washed off the burn areas because he had grease and oil on his hands and lower arm. The pain then started to get bad enough for him to have his wife take him to the ER. His pain was severe by the time they got to the ER.

• Wife states – patient is pretty tough, but he was in a lot of pain. His skin started coming off and the blisters got bigger.

Physical Exam

• Physical findings – partial to full thickness burns noted to R arm, small spots of burns noted to R side and R ear

• GCS – 15


• CBG – n/a

Editor’s Notes

Circumferential burns to an extremity require careful monitoring. These injuries can induce loss of circulation to the extremity and may require an escharotomy. This injury clearly has the hallmarks of a second degree burn, and lack of patient pain suggests it may also be a full thickness (3rd degree) burn. Referral to a burn center is key to this patient’s short and long term care.

-Dr. David Spiro


• Gender: Male

• Age: 66 years

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available

• Blood Pressure: 149/95

• Heart Rate: 89

• Respiratory Rate: 12

• Pulse Oximetry: 96% RA

Signs and Symptoms

Severe burn, pain.



• Allergies: None

• Dispatch info: Cicumferential burn to R arm up to mid-bicep.


• Lives with wife on their farm.


• n/a

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