I had my 1st burn pt and I am fired up mad!!!

[racing-mom4, BSN, RN]

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.

[XB9S, BSN, MSN, EdD, RN, APN]

I think his main problem is going to be infection and wound healing, the black toes would make me think that this would be a long standing diabetic foot problem as well as burns, with scalds the wounds may get infected but I am not sure they would cause black toes.

THis in itself is going to cause you problems, without adequate circulation wound healing is going to be very poor and with the added problem of diabetic feet he is very much at risk.

I wonder what state his feet were in before the burn, if he already had exsiting diabetic foot problems and wounds. It sounds like he needs the input of a burns surgeon and if he was in my care I would get the vascular and wound specialist nurses involved.

Sounds ver frustrating for you

[racing-mom4, BSN, RN]

Something I couldnt figure out was OK he burnt his feet in the shower right?? So why did he not burn his shoulders or back? I can understand that he couldnt feel the water was that hot on his feet, but it was the same water that was hitting his back and head right? Why werent they burned?

Yes I dont know what his feet looked like prior to the burn, maybe there were already in poor condition with fragile skin, that would mean they would burn easier than his back would.

HOPEFULLY he will be transfered tomorrow...I was very upset with everyone that was involved or lack of involved in his care up until Sat night. It starts with the ER doc, why did he even admit him?? anyway...that is one thing I do love about nursing, the variety and the patient advocacy.

[donsterRN, ASN, BSN]

I just think I need to say that the patient is extremely lucky that he has you advocating for him. Blessings to both of you. I'd be spitting fire all over God's creation if I was in your shoes.

[XB9S, BSN, MSN, EdD, RN, APN]

Something I couldnt figure out was OK he burnt his feet in the shower right?? So why did he not burn his shoulders or back? I can understand that he couldnt feel the water was that hot on his feet, but it was the same water that was hitting his back and head right? Why werent they burned?

Yes I dont know what his feet looked like prior to the burn, maybe there were already in poor condition with fragile skin, that would mean they would burn easier than his back would.

HOPEFULLY he will be transfered tomorrow...I was very upset with everyone that was involved or lack of involved in his care up until Sat night. It starts with the ER doc, why did he even admit him?? anyway...that is one thing I do love about nursing, the variety and the patient advocacy.

You know I was thinking about just his feet being burnt as well, it is inconistant with a shower injury as you quite rightly say. Is it the patients that has given you details of injury, I would put money on the fact his feet were in a really poor conditions pre-burn. If he had stood in a hot bath and then jumped out then maybe, but again usually there would be a burn demarkation line and often if it is because there is neuropathy meaning reduction in sensation they will often have sat before realising the heat of the water causing injuries to buttocks.

He is luck to have you advocating for him, it sounds like he will get the care he needs on his transfer tomorrow

[XB9S, BSN, MSN, EdD, RN, APN]

did he go to the burns centre racingmom?

[racing-mom4, BSN, RN]

Thanks for your concern---I dont know if they transfered him, I work tomorrow night so I will find out then...I hope so, I am sure they did.

I think I caused a big enough stink about the whole situation by involving mgmt and social services that they had to do something.

[santhony44, MSN, RN, NP]

It sounds like a horrible situation. I'd like to be a fly on the wall when a burn surgeon gets a look at his feet.

[racing-mom4, BSN, RN]

I hate to say it, but they kept him...they moved him down to extended care and supposedly have the latch fixed on the whirlpool tub. I was so mad, I asked soc services this morning what was up with him staying and they said they tried their best but the Drs get the final call and then she told me "they say his burns are improving"...OK if it makes you sleep better thinking that ok.

I went down to extended care last night to look at his chart, because I did a peir report on the Dr who would not answer my direct question of "did you see his feet" 4x. And I spoke to the nurse that was taking care of him, she had yet to see his feet, cause she came in at 11 and the dressing change was at 9pm. He was sleeping so I didnt bother him.

I am mad, but what can I do at this point? I talked to Mgmt, soc services and filled out the official complaint document. Until his feet get worse, I guess we have him. True shame. I dont think his family is all that bright and they probably think we can take care of him vs one of the leading burn units in this part of the country!!! eeeggadds....

Thanks for your concern and advice.

[racing-mom4, BSN, RN]

oh and just to add more of a crazy spin on this---when I said to his nurse last night..."can you believe we still have him?" and her crazy response was "ya I cant believe he is not in jail?" "Jail--what are you talking about?" she replies "Oh I heard he robbed a bank in Fla and a meth lab exploded and that is how he burnt his feet"....I said "well I had him over the weekend and that is not the story I was told,(then I rolled my eyes and said) and anyways when my husbands meth lab exploded it got him in the face" She looked at me like I was crazy---and at that moment that was just how I felt.....

Please know I am being sarcastic about my husbands "meth lab"!!!!

[XB9S, BSN, MSN, EdD, RN, APN]

Oh dear, it sounds like your fighting a losing battle there. Good job filling in a complaint form it sounds like that's just about all you can do now.

Meth lab explosions, what was he doing making the stuff with his feet????????

(sarcasm BTW :))

[jacklady]

Sorry but you made me laugh a little about your response to the explosion? Did the nurse really believed that only his toes where burn if it happens to be a "meth explosion"?

I guess that patient is hiding something about how he really got that burn...for it's very intriguing!!!

Anyways, all hospitals wants to show up their abilities that sometimes they wont swallow their prides and keep on saying that they are doing their very best even if the last best that they can give is to swallow their pride and offer a much better way of healing from other specialized hospitals...and mostly nurses are carrying the burden because we see and care for the patient everyday...

I guess you will just have to pray for a miracle... Just give your best and maybe he will be healed by your prayers and sincere care...

With God nothing is impossible...