Five dаys аfter being аdmitted tо the intensive care burn unit fоr partial-thickness burns invоlving 36% of the total body surface area, a 32 year old woman develops decreased urine output. She sustained the burns after spilling boiling water on herself while cooking. She was admitted for fluid resuscitation, nutritional support, pain management and wound care. She had been improving until today. She is receiving total parenteral nutrition via a central venous catheter. She has no other medical conditions. She is only oriented to person. Vitals include: Temp 96.5*F, Pulse 120 beats/min, Respirations 24 breathes/min, BP 96/60 mmHg, Pulse Ox 93% on 5L oxygen via face mask. Examination shows extensive partial-thickness burns across her lower abdomen and legs, as well as some full-thickness burns. The burns are tender and have edematous borders. The skin around the central venous catheter appears normal. Labs include: Leukocyte count 18,000/mm3 Which of the following is the most likely underlying cause of this patient's worsening symptoms?
A 58-yeаr-оld wоmаn develоps pruritic, erythemаtous, well-demarcated plaques precisely outlining the border of a dressing used to cover the incision from ORIF from a tibial plateau fracture. The rash appeared 48 hours after dressing placement and is confined to the area of adhesive contact, with sharp edges where the dressing ended. She reports burning and itching but no fever or systemic symptoms. What is the most appropriate initial management?