Major Burns with Mechanical Mitral Valve

A 62-year-old woman has just arrived by ambulance to your burns centre emergency department and you have been called to assist as part of the trauma team. She was caught in a house fire where she was trapped indoors for ten minutes before firefighters were able to free her. Forty-five minutes have lapsed since rescue. Past medical history: Smoking 40 pack-year history Mechanical mitral valve replacement Chronic kidney disease Medications: warfarin 5 mg daily Examination findings: Approximate weight 70 kg SpO2 99% (oxygen via Hudson mask at 10 L/min) HR 120 bpm (sinus rhythm) BP 100/70 mmHg RR 21/min, shallow breathing and coughing intermittently Chest auscultation: mild diffuse wheeze. Her burn injuries have been documented by the paramedic in the diagram (hashed areas). The burnt skin is a blotchy red or dark pink colour and has large blisters. Capillary refill is sluggish (> 2 seconds) and there is loss of sensation in some areas. She is confused about the events, visibly distressed and in pain. She has been administered 10 mg of morphine intravenously.