How would you handle this..?

Specialties MICU

Published

Burn trauma comes into SICU. Man in a MVA who was partially ejected from vehicle. Vehicle had landed on top of him and burst into flames. Hip Fx, spinal Fx, severe third degree burns on his back. BICU nurses come down and dress the wound. This man is intubated and in extreme pain.

Later in the shift the physician comes to her room and says he needs to be prepped for an MRI (this was minutes after we gave him a full bed bath)... That means another bath, wipe off ALL the silvadene from her back, change his gown and sheets again, also change her leads and tubing for the procedure.

He was moaning in pain and smacking the bed because it hurt to be turned and wipe those burns. About 30 minutes later we had finished everything and had him ready to roll. MD comes back and says "sorry for the miscommunication but he doesn't need an MRI" and walks out. After all the pain and discomfort we just put him through, I couldn't believe it. So frustrating.:no:

Specializes in Anesthesia.
Burn trauma comes into SICU. Man in a MVA who was partially ejected from vehicle. Vehicle had landed on top of him and burst into flames. Hip Fx, spinal Fx, severe third degree burns on his back. BICU nurses come down and dress the wound. This man is intubated and in extreme pain.

Later in the shift the physician comes to her room and says he needs to be prepped for an MRI (this was minutes after we gave him a full bed bath)... That means another bath, wipe off ALL the silvadene from her back, change his gown and sheets again, also change her leads and tubing for the procedure.

He was moaning in pain and smacking the bed because it hurt to be turned and wipe those burns. About 30 minutes later we had finished everything and had him ready to roll. MD comes back and says "sorry for the miscommunication but he doesn't need an MRI" and walks out. After all the pain and discomfort we just put him through, I couldn't believe it. So frustrating.:no:

That's wrong. However, what were the patient's vitals like? If they were stable and he/she was intubated why not load up on narcs and sedation, especially if he/she was writhing in pain. Knock me out please! Understand the frustration as I know how long all that can take as well as the ignorance of the attending not understanding what just entailed.

Unfortunately, not much you can do other than let the MD know what they just put the patient through. Also did he/she know that a bath was just given? Maybe the MRI might have been able to put off till later.....just my 5 cents... But again that must have been painful on both of you!

Specializes in Trauma Surgical ICU.

Please explain the need for a bath, gown and linen changes before the MRI as well as the tubing change.. I'm not understanding why.. I have only had one burn pt because it wasn't bad; we flew all others to a burn center..

As for what the pt went through, yes that was horrible. If he is intubated/sedated. Give all the pain meds you can/increase the sedation if needed before baths, excessive moving etc.. I hope the PCP has the pt on very generous amounts and frequencies.

Specializes in Trauma Surgical ICU.

Sorry OP, I was under the impression you were a RN and this was your pt. I did not realize you are a nursing student..

I am an aide on this floor. The RN called me in for help (along with about 6 others) he was bolused (x2) his vitals were stable. The gown and sheets had silvedene on them as well which is why they had to be changed (no metal in the MRI). Tubing had to be switched out to specific MRI tubing... not posiitive why.

The pt had requested the original bath as she was still covered in dried blood and dirt

Specializes in ICU.

Yeah, this is just wrong. SO frustrating...reminds me of the time we spent at least an hour sticking a patient multiple multiple times for IVs and blood draws...as soon as we finally get everything collected the doc changes his mind and wants to start a central line...:no:

Ugh obviously your situation was much worse but I can appreciate the frustration. I agree with as liberal amounts of pain meds and sedation as possible. That's the only thing I can think of. These things happen. Explain to the doc everything that went into getting the patient bathed and then set up for MRI- question why they needed one 1/2 hour ago but not now...sorry for you and your patient:(

Specializes in Trauma Surgical ICU.

Anyone have a link to silvadene and MRI contraindications.. OP, that's what I was thinking also but after several searches; I haven't found anything. I even went to the makers home page and none of the contraindications stated no MRI with silvadene on.. Sorry OP, I still ask lots of questions etc on things I have never seen or heard of and this is one of them :)

Oh dear, intubated and requesting a bath.. not sedated enough for me. I hope pain meds were given before the second bath and removal of the silvadene.

oops-I see Sun had the same thoughts I did!

Specializes in Trauma ICU.

I had a similar experience when I was in nursing school (and a tech in the ED) to which I always hear the resounding words of my clinical instructor. You are the nurse and you protect your patient.

Having just done an extreme dressing change I would question the need for the MRI BEFORE I went and did anything. Was there a concern about spinal cord compression? A mental status change? If he's moaning in pain I'm guessing he's not intubated or he's coherent enough to ask you to clean the blood off. Explain to the doc how much this is going to hurt in a patient who's likely still in shock (both from the hypovolemia related to the fractures and the fluid loss from being charbroiled). If his vitals were stable Im guessing they weren't after that dressing change (I would be tachycardic as all get out). Maybe a halfway point could be reached ie. if he needed the MRI for a neuro exam you could show the doc that he is oriented or possibly do a sensorimotor exam far faar away from the burns. Most of the time when you word it correctly the docs try and think of ways to work with you. If all else fails then you medicate medicate medicate.

Friend of mine had an Assistant Vol FF Chief badly burned in a flashover. He had third degree to his arms and a good portion of his torso. To put pain meds into perspective this man was never intubated but cleaned the transport helicopter of its entire narc supply while they flew him to a regional burn center.

Sounds like a mistake was made.

Humans are very prone to human error.

A better question is why this patient had inadequate pain control and sedation.

Hmmm, what does M R I stand for?

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