Case Study: Bhikhiben Bhil

This case exemplifies some of the work of the Radha Mohan Mehrotra Global Hospital Trauma Centre at Abu Road. The photos of the case study are available, but too gruesome to post on the Web...

Bhikhiben, a 35 year old woman living in a village near the Radha Mohan Mehrotra Global Hospital Trauma Centre, was brought by her family members to the casualty department on September 14. She had suffered extensive burns of her upper right side - face, eye, ear, neck and upper back - as well as a head injury.

Case history: The young lady had suffered a head injury four years ago, as a result of which she had developed a seizure disorder of the brain. She developed convulsions off and on, for which she was prescribed an anticonvulsant medication. The patient was either not given her medication or she had not taken her medication as she disliked it. What is clear is that she had not taken her medication for an unknown period of time.

Accident: As a result of not taking medication, Bhikhiben developed convulsions on September 14. That morning, she was cooking in her kitchen on a flame stove. Now, it is fairly well known that patients with seizure disorders are usually advised not to cook. They are also advised not to use a flame stove in their homes. We do not know whether these instructions were given to the patient or not. It is very likely that Bhikhiben does not have electricity at home and so, she could not use an electric stove even if she wanted to. Bhikhiben was not being supervised by anyone when she developed convulsions while cooking on a flame stove in her kitchen. She was found unconscious and burnt, lying on her kitchen floor. No one was able to conclusively say whether she had inhaled any fumes or not.

Findings: On arrival, Bhikhiben was found to have a large hematoma on the right side of her head in addition to the burns, which were classified as third degree and fourth degree in some areas and superficial second degree burns in other areas. She was conscious but restless and uncooperative. A CT scan of the brain was attempted but the films were not clear enough as the patient was constantly moving. Still, from whatever could be ascertained from the films, doctors concluded that there was no serious injury to the brain.

Treatment: The patient was resuscitated with oxygen, intravenous fluids and an antibiotic. The burnt eye was treated with eye ointment, the rest of the burnt area was treated with silver sulfadiazine skin ointment. The patient complained of pain in the throat from laryngeal burns that must have occured when she inhaled fumes.

Continuing treatment: Since then, she has been kept under isolation and every precaution is being taken to give her care in aseptic conditions. She is also being given pain medications, vitamins and iron supplements. She has neither developed infection of the wounds nor toxaemia from the burns. She does not have any fever. She now has a good appetite and eats well. Her neck and affected shoulder are being given physical therapy. She initially had a lot of swelling in eyes and face during her four day stay in the hospital. This went down considerably. Bhikhiben is being treated by a general surgeon and an ophthalmologist. Next, she will be evaluated by an ENT surgeon for the burns to her ear and larynx. Her next evaluation will be done by a plastic surgeon.

Future treatment: Her external ear is completely burnt and it will eventually get absorbed and disappear. The ear canal has burns of the skin and its cartilage. The dead tissues would ordinarily form scar tissue which could occlude the ear canal completely. The treatment of the third degree burns involving the eyelids and face is primary excision and thin skin grafting would preferably by done a plastic surgeon. The ear canal will need to be reconstructed by a thin skin graft to restore the hearing by an ENT surgeon. This will be completed within one month. The external ear will require reconstruction at a later date with a thick skin flap by a plastic surgeon. This will take about six weeks treatment.