BurnNurse

Michele, I do not consider myself an expert, but am willing to tell you what I know. And, no...you are not a "pain"...that's what this site is here for...for all of us to share information and experiences. I thank you for taking the time to share with us. Burns patients OFTEN experience PTSD both in the hospital and/or later. Nightmares are common, and sometimes a fear of being alone. PTSD can also occur or intensify from the daily painful treatments (wound care, debridement, surgery). Also, ICU psychosis, or some variant of that, can occur. Depression and/or anxiety often develop. Psychiatric care and monitoring, during and after hospitalization are very important. I have not seen problems weaning from the MSO4 drip, as it is gradually withdrawn. I have seen, however, patients who ask for PRN morphine around the clock. I even had a patient tell me he really wasn't in pain but "enjoyed the buzz". Lying in that bed day after day, month after month can be very boring. Generally, all patients receive app. 5mg MSO4 prior to dressing changes, whether on a continuous drip or not. (If on a continuous drip, we bolus them the 5 mg.). Yes, bucking the vent means resisting it, and/or trying to breathe over it. ABG's become crappy and the vent is constantly alarming when this happens. Re: the seizure activity. Yes, physical and emotional trauma such as this can increase or even initiate seizure activity where there previously was none. Oftentimes, Dylantin will need to be monitored and titrated. Every patient is unique. Emotional support can be provided in many ways. Cards and letters of encouragement are always appropriate, both to the patient and the family. Longterm patient's walls are often covered with cards and letters, pictures and children's artwork. Pictures taped to the tv are comforting. While the patient is "family only", it would most likely be helpful to contact the family simply expressing concern and more importantly, giving them a chance to vent their fears and feelings to an objective person. Being a good listener, and "therapeutic communication" is so helpful. When the patient is able to receive visitors, ask the family to check with the patient whether he is ready to receive them. Family and friends at the bedside keeps the patient feeling connected and cared for. With our longterm patients, family and friends often just " hang out" in the patient's room, even while they sleep, and they find it very comforting. Again, this is all up to the individual patient and family. Please let us know how it goes. Take care...

Dear Michele, Thank you for your post. It is quite common to "induce coma" at the beginning of burn therapy, especially if the patient is vented and "bucking" the vent. I have found with my patients that they usually have excellent recall of the burn event itself, but can have almost total amnesia of the hospital experience due to constant sedative and narcotic drips. We have two 90%, 3rd degree burn patients on our unit now that came in in April and May of this year. They have both only recently been weaned from their vents, so they can talk to us now. The one fellow told me all about his accident, but told me he didn't remember who I was, even though I had taken care of him several times a week since he came to us. I hear that is common when they are on a constant Ativan, and also morphine drips. We have had 40 % burns too. Sometimes they surprise you how quickly they are out of the hospital (a few weeks). and others seem to linger (many months) due to infection and grafts that don't take. Every patient and every burn is different. It's common to have many surgeries before the process is through. I would encourage you to support the family emotionally. You will be surprised how quickly you no longer focus on the burn, but only on the special person underneath. Good luck!

What a heartwarming story. In the midst of tragedy, human comfort was paramount and life richly lived. One thing I have noticed is that because our very critical patients tend to stay with us so long, they and their loved ones do indeed become "part of the family". I truly care for these people and their well-being, and often think of them when not at work. I agree that your story is a fine example of the reason we became nurses. Each time a family member leaves their loved one's bedside to go home, and says "thank you"...there is nothing better. Their eyes say it all.

Welcome to our new forum. If anyone has any questions about burn nursing or an experience with a burn, (yourself or a patient), please feel free to join in. I'd like to hear from any others out there working in a similar environment. ER too.... Talk to you all soon.