clgmezzo

i did a rotation in our regional burn unit which is situated in a regional pediatric hospital and takes both adults and children of all ages and burn types. it was the facility at which the skin culturing was developed. afterward i was enthralled, and when the chance came to accept a job there after i had been nursing a while i jumped at it. it is the mosdt rewarding nursing i have ever done, and will always be my favorite nursing for the rest of my life i think. it seems that either people are built for it and love it and are all about it, or cant do it, and as for me, i love it.

Well, all burns get cleaned when they come in, regardless of whats on them under normal curcumstances, even tubed pts. So whether its a big burn that gets tubbed, or a little burn that just gets cleaned it all comes off for examination because, no offense, report is wrong as to the extent and depth of the burn 75% of the time, and for infection control, debridement, etc.... Talk to your regional center as to their guidlines, they should have outreach staff and educators who would probably even be able to come talk to some of your staff.

The cold water is the same priciple as the ice, twofold: the cold temperature of the ice or water can lower body temp very quickly, its surprising, even cold water will do it secondly, the tissue is already damaged, and since part of the skin is already gone the cold temp of water, and especially ice will damdge the tiddue farther, sometimes worsening the burn. our outlying facilites and squads are instructed no cold water, no ice. Wet sterile towels til they arrive at a burn center is best, cool water, but never cold is acceptable.

We use a flowsheet on our burn patients when they enter our 1:1 critical stage and need close monitoring, its a lowsheet that our unit made that spe4cifically tracks everything important to our patients and is set up in a way that works well for us, its much nicer than using one of the ones from other floors

We LOVE students in our burn center, paramedic, nursing, medical, ANY, but i especially love the nursing students, you will get to see SO much, and ill tell you now-you will get SO much information, because of the education aspect of the specialty burn nurses tend to spout information nearly every minute of the day i think, lol. it should be a great experience for you, good luck! and a bit of advice, Eat Breakfast Before You Go it will help a lot.

My apologies for offense, i was writing from a standpoint where i assumed that most persons in this forum were burn nurses. Rural hospitals are outlying, just as metropolitan ones are, I never mentioned rurals to begin with. One outlying facility, which is a large teaching hospital in this area made a horrible mistake, burn knowledge is scarce regardless of the setting. Its the patient that pays for it when i peel dry kerlix of a fresh burn. Thats why we DO spend so much of our time, our own personal time in education. I just wish that folks would not simply assume that i was pointing anything to rurals, outlying in my area= non burn center facilities. Hope to see some burn nurses around at some point in the future.

For heaven sakes! one might think that i bashed rural hospitals into the ground. Outlying facilities are ANY other non burn center facilities, not just ones out in the country like near where i live. A few posts ago there was a note, from gwenith i believe that was like hey, you might have hit a sore spot. When did, "what odd things have been sent your way" turn into my center doesnt educated enough, i have a poor opinion of rural hospitals, and we dont work as a team? Burn nurses are an odd group with odd senses of humor. Perhaps its time to find a forum which actually has some real burn nurses in it. Burn nursing is a specialty, and many places and people dont know alot about it or what to do. Education is important for Docs, and for staff members at hospitals. We are serious about the work we do, about the education we provide, and about the top notch care we give. There is a time however to look back, relax and have some fun, but not, apparently in this forum

gwenith, lol, i understand completely, before i got to my present center i worked in a Tiny little rural hospital in ohio

We offer extensive outreach to all the hospitals in our 17 county area along with inservices for ER staff residents and anyone willing to listen. We also send out materials, and offer an "open door" policy in regards to consultation from pts in their own homes, ER's offices, and immediate care services. I wasnt trying to beat down the other hospitals as much as i was thinking of things that make me shake my head.

This is aweful! Our unit has these patients frequently, and to me it sounds as if she was completely mistreated from the beginning. Xeroform is a good dressing, but certainly not the cetaphil lotion alone, and probably with no tubbing or baths either. Pts survive with thei % of SJ or more ALL THE TIME. Pig skin, dressings, and appropriate care at a regional burn center accredited by the college of surgeons might have saved your patient. there are guidelines for which pts need to be seen at an accredited burn center, she falls in the category hands down. im so sorry for this family. SJS is treatable, and is no olnger as uncommon as we might like to think, also the drugs that can trigger this disorder may surprise you- PRILOSEC has had more than 4 reported cases, given more time that number will simply increase. I had a healthy young Nursing student with this problem from prilosec only a month ago. 60%, on a vent, pig skin, all kinds of stuff going on. It can happen to about anyone.

The burn center i work at was the first to have cultured skin, but we have stopped using it entirely because of its poor endurance and easy breakdown later in life, I wonder if the same problems are found in this technique

I had one woman who burned her children up purposely in a housefire, very susan smith-ish, new boyfriend, didnt want her kids-tried to pin it on th 6 year old playing with a lighter. The other is just recently a woman and a man were getting a divorce, he was upset and had a "if i cant have you no one can attitude" went on line, bought the strongest acid he could. When she came to pick up her things he chased her, grabbed her, drug her down the basement and held her down while he covered her with the acid, especially her face, horrible full thickness stuff. He got some acid burns in the process, and was brought to our center as well, and she knew he was there and was scared til he left. Hes going on trial soon. That was horrid

We use it for cauterization of wounds. Acticoat is something we use in our center, though it does stain the skin like crazy as well, we change it every 2 days, our surgeons like to see our wounds as often as possible so we dont usually do a 3 day change

burn nurses love to pick!!!! we pick dead skin all day long, lol, kind of like peeling a family member sun burn only on a different scale i guess!! Many type A's but since it takes a wierd sense of humor its not too bad here, we all get along really well. Our dressing team works hard to ensure that each pt gets their dressings just right. I mean its so important that all the wound areas get covered, so we dont slack on the dressings, i like gooping with silva, or bacitracin, i like cutting them to get a good fit, i like putting them on, i like securing the net, its all good to me!!!

i was wondering if any of you have the new temporal ones in your facilities and use them, and what you think of them overall. I tend to use them as long as the pt is not sweaty or covered in dressings but i also touch their skin just to double check its not entirely wrong as well, i am still learning if i should trust it or not. . .

Hi! heres the deal. At our regional burn center we have seen a good number of BAD mistakes made by paramedics our outlying ERs and Docs that didnt know what the heck they were doing with burns. I suspect we arent the only ones to see this, so please share, what have you seen come through your doors in the way of complete screw ups . . ? For my part i have seen an ER doc leave a mayo dressing on a tar burn victim for 2 days instead of just using it to get the tar off. Paramedics once packed a major body surface area burn ompletely in ICE during transport to us, and the pts temp was almost unbelievable low. Not to mention, lol, the way they tend to screw up fluid resucitation, which you know just isnt funny when its a big burn.and a few other things . .

my burn center uses mayo as well, sounds funny but it works great!! however you know how some non experienced practitioners nd hospitals are with burns . . this is FOR REAL. A hospital in our area got a pt with a tar burn which id not require admission to our unit and sched them for our outpt clinic. When the pt came in they had the worst smell coming from this nasty looking dressing. Turns out the doc at the outlying ER had heard we used mayo on tar burns and mad a DRESSING out of it!! the guy left it on or 2 days!!! Our chief attending had us call to tell the nurses in ER over there for future reference its just to get the tar off!!!!

Hi love. I hated clinicals, dreaded them every week, felt ill, and was miserable the entire time i was in the hospital. By the sam tolkein i hated my first job on a med surg floor. The thing is there are SO many areas in nursing, you can do nearly Anything!! I found that i am a great fit in a specialty area, in a regional burn center. It took a wee bit to find a perfect fit but i love it!! Let yourself try some other areas of nusing hon there is so much you can do!! and dont be too discouraged, everyone is miserable in nursiong school and wants to quit, probably the worst time in my life!!

Thank you!!! My brother has had juvenille diabetes for 21 years, since he was 4. Artificial sweetners became a way of life for our entire family because of this. I have had peole shoving these fake chain letters in my fae for a couple of years now, and it irks me every time. One lady on my exhusbands side of the family who didnt now us well ran up to me with a copy of one i had already seen and said point blank "i heard your brother is a diabetic you should read this so you can save him before some of these things happen to him" After the first few came around i went back to a professor i highly regard from nursing school and speak with off and on, he and my old chemistry prof were sitting in his office ( he teaches anatomy and micro) and i showed them one of these letters and started asking questions because some of it didnt make sense to me and i had questions. They both completely flipped all of these things over with sound principles of science, some that i aleady knew, and some things that were a bit beyond me. Now when someone tosses these in my face i smile and keep drinking my diet coke

yeh, Varicella and Measels, man that was scary when i was preggo we would get unvaccinated kids sometimes and if they had an unexplained ash i was always scred to death, plus my hosp didnt have proper neg pressure iso rooms for some of those things, and i was always relieved when those pts left the floor

were you asking me goodie . .? :) yeh, i like big burn ICU patients or dressing and tub team the best

It depends on the doctor. I think its wrong to stereotype docs as eveil nurse basking superioir feeling folks, however there are a few out there, and the always make life. . . interesting. I work in a specialty critical care area and on my unit a lot of the residents that we get have never seen a burn pt before, and sometimes the orders they give are completely inapproriate. We tend to take charge, especially with some newerr ones who dont realize they dont know it all, and when they give us gruff just remind them that i could always call their attending at home, which is where we get lucky, all but one of our attendings backs us up every time. They are a part of the team and we all trust and count on each other, an attending at my hospital will listen to a nusrses assessment of a situaion over a residents many times, which they tend to NOT like!!! You have to stand up for yourself and be respectful at the same time, but always put the pt first and not back down when it comes to pt safety and condition

i worked with many MRSA pts while pregnant with both my children, VRE however was a strict no no with my doc, so i avoided it, the thing is, come on folks, even with percautions most of us who work in MRSA areas everyday are colonized to begin with . . .

An average day in a burn unit depends on your function for the day, burn patients have surgery frequently, so if you are directly caring for a large burn most of your day can be tied up in preparing for your pt to go to OR, getting ready before they get back, and getting everything back together once they get back. The basic care of a minor burn inpatient is almost like a surgical floor pt, there are irrigations, and other daily care things, meds, meals, that kind of thing. We have a "tub team" each day, this is a group of folks that do only dressings until they are done for the day. It can take 5 people plus an RT for a big big burn, or as little as a tech for a minor minor one. Normally there is a concious sedation nurse, (RN) and either other nurses or other nurses and a burn tech or 2 doing the dressings. The nurse performing concious sedation should be focused on that, her job is the Patients safety and comfort during a rather painful procedure. All the nurses in the unit are qualified to do either job for the day depending on what they would like to do, if they need a break from one part they having been doing for a few days, or what the unit needs are. I like burn nursing because of the variety. We get pts who have a burn injury as a primary problem regardless of other medical conditions, head trauma, anything. So you could have a critcal ICU type pt. We have regular recooperating folks, people who are recovering from some reconstructive surgery, outpatients, and we traige our own pts, so there is a bit of an ER flavor as well. Also soince we take all agees i can work with a 2 wk old or a 90 yr old. the variety is amazing!!

Thats right where i work as well, no advanced degree required, a lot of this, as aws mentioned is on the job experience and such, especially with the dressings. At my facility we dont even let OR dress our post ops, they call for us at the completeion of a surgery and our team goes up and does the dressings in the OR, it helps make sure that the dressings are correct and dont need to be redone when they get back to the unit.