This may be more of a vent than asking for help, so bare with me while I try and calm down to type this...
I work in a small 6 bed rural ICU--about 40 min away from a wonderful burn unit--people come from all over the midwest to this burn unit.
I work Sat/Sun night, I come in Saturday to be told that one of my patients a young man who is diabetic and has neruopathy of the feet burnt his feet in the shower Weds night. He came to our hosp Thursday after lunch. Blood sugars out of control. placed on insulin gtt.
So what do I walk in too??? Black toes, red seeping open skin-yellow eschar(sp) that is falling off, blisters that are continuing to appear as the shift goes on---3 days after the original burn, new blisters are still forming?? True. I cant get his fever under 101 even with Vanco/Cleocin(sp) and of course Tyelnol q 4.
Tx for the burn some zinc cream and gauze. Oh and whirlpool tx daily, that FYI had not been done because the latch on the whirlpool is broke, the whirlpool is up on the extended care unit for the elderly, I dont care how clean you get it, I dont want his feet where someones bed sores were.
He is not from our state, he came to visit his sister on Tuesday and burnt his feet on Weds. He doesnt know about this burn center---but our Drs do!!!
So I call the hospitlist who he was assisgned to because he doesnt have a local family doc. Hospitilist refused to admit to me he did not see his feet that day, even though I directly asked him 4x. Did you see his feet? "we need to order a CT of his chest due to the fever" me---he has a fever cause his feet are burnt, did you see his feet today? DR: " you need to run 1 gram vanco every day" me: you wrote an order for him to amubulate halls daily, did you see the feet, he cant walk. Dr: we dont want him to get a DVT. OMG OMG OMG.
Then I call the surgeon who did the initial debreading. "Hi Dr I am calling about so and so..I just came him and was surprised to see his wounds, did you see his feet today?" At least this guy admits he didnt look, he said "the day nurse said they looked better" ..."the day nurse was an agency nurse, it was her 1st day"...."oh it was the night nurse that told me"...."that was Shelly, Friday was her 1st day back from vacation, she didnt have him the day before" ....."oh ya, it was Mike. Mike told me they looked much better"....."Mike wasnt his nurse, but maybe he assisted with the dressing change, but did you know the toes were black?"...OMG OMG OMG
Then reading the DRs notes I see one of them had the nerve to write good capillary refill. So I made sure I wrote in the nursing notes, unable to assess cap refil D/T lack of toe nails!!!!
So here is the deal, we have this guy, now with a 6 day old burn. On both feet, he is not from here, he is diabetic. He has uncontrolled fever and elevated heart rate. And for what ever flippen reason we have these two docs who think they can treat him??? OMG can you see the fire coming out of my eyes???
So here is what I did, 1st off I told that patient how lucky he was to be in this area as we have a great burn unit located in XYZ city just 40 miles up the road. OK so now he knows to ask...then I went to in house social services and told them the whole story, and they are going to talk to Drs and admin about getting this guy transfered, and I told my ICU Mgr.
So what do you all think...is it too late for this guy? I dont know the burn lingo, I had one lecture on it in school. The tips of 3 toes were black. under the toes on teh bottom of the feet was yellow, thick and red open. The tops were red open and seeping all ngiht long. New blisters appeared during my 12 hour shift, then the following night Sunday, those blisters opened and are pink. But the thick yellow/ open red and black is what is amazing to me. I bet 50% of both feet top and bottom are open.
So I am fired up mad, because I am not a burn nurse, this guy needs a burn nurse, and a burn unit, and a whirlpool that works.