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.
Under the circumstances, there may have been a need to keep the sedation down and use minimal pain medication due to renal failure secondary to the burn depending on how substantial it was. After fluid resusitation, I would be concerned with just how much output the patient had and what their chemistry looked like. I've never had a burn patient in my CCU, but from what I remember from nursing school and others' stories, they are very tricky to manage. Many of them are in constant pain from scrubbing the eschar off, to moving them so further skin breakdown doesn't occur. This patient sounds like they would be much more complicated than the initial picture anyhow with being on a vent and the fractures too. The patient's pain would certainly be one of the first things I would address, followed by the need for an MRI after the fractures seem to have been already identified by some other means. As for your facilities particular policies regarding the need for new tubing, a bath, and new leads prior to transport to your DI dept., I would think the second bath would be unneccessary as would the new leads. I could see the need for different tubing if they had different pumps in that department though... This would be a fascinating patient to have indeed. I pray they make a full recovery soon.
Under the circumstances, there may have been a need to keep the sedation down and use minimal pain medication due to renal failure secondary to the burn depending on how substantial it was. After fluid resusitation, I would be concerned with just how much output the patient had and what their chemistry looked like. I've never had a burn patient in my CCU, but from what I remember from nursing school and others' stories, they are very tricky to manage. Many of them are in constant pain from scrubbing the eschar off, to moving them so further skin breakdown doesn't occur. This patient sounds like they would be much more complicated than the initial picture anyhow with being on a vent and the fractures too. The patient's pain would certainly be one of the first things I would address, followed by the need for an MRI after the fractures seem to have been already identified by some other means. As for your facilities particular policies regarding the need for new tubing, a bath, and new leads prior to transport to your DI dept., I would think the second bath would be unneccessary as would the new leads. I could see the need for different tubing if they had different pumps in that department though... This would be a fascinating patient to have indeed. I pray they make a full recovery soon.
Why would you restrict sedation/pain meds bc of renal failure? If they're still awake and in pain, they still need it, right?
I work in a trauma ICU and MRIs are fairly frequent. We have to change the leads once we get to MRI to all MRI compatible EKG patches and wires. Also, we don't change tubing, but we have to use extension tubing because the IV pole must remain outside the MRI suite and the IV tubing must be long enough to reach the patient (10 feet or so). This way, the RN who accompanies the patient can titrate drips, bolus, etc all while not interrupting the procedure. We also change temp sensing foleys to regular foleys and fill out a pre-MRI checklist. Maybe that will shed some insight.
If a patient has a good pressure (or hell a low one but is obviously mentating enough to tell me they want a bath) they are getting a hefty bolus. We bolus freely using our continuous drips. The docs know how much we are giving by clearing the pumps and charting it. Renal disease has nothing to do it other than some of the drugs may not be cleared as easily. But it doesn't sound like that pt was going to be extubated anytime soon so who cares. And my guess is the renal failure is from rhabdo second to burns. So with copious fluid/bicarbonate administration, the kidneys should hopefully kick into gear.
Sun0408, ASN, RN
1,761 Posts
Thank you Esme12 for your answer. I am sorry to hear about your loss, hugs to you and your family..