Welcome to the Burn ICU forum

katrina hays · Aug 16, 2001

Hello Detroit,

I worked in Kalamazoo, MI for 9 years in Bronsons Burn Center. We eventually merged with the Trauma/Neuro Unit which was great for me as I love traumas and burns. It takes a special person to work burns. You either LOVE it or you HATE it. I have found burns to be the most rewarding work I have ever done. I feel there is no bigger trauma to the body than a big burn. Also another perk is that burns know no age group therefore I love them all which is rare in other specialties.

I have many burn stories I'll share one here:

Christmas Eve 3yrs ago I got a call at home with the unit begging me to come in as they had multiple victims from a house fire. I relented much to my childrens dismay. I got to the unit and we had a family who lost a 5y/o in the fire (grandson) and son. A 17y/o with a 70% 3rd degree burn and an 18y/0 with a 98% 3rd degree burn. Not to mention their home and everything they have is now ashes. The mother of the 17 and 18 y/o also had a daughter not burned but the 5y/o was her baby who died.

I walked in and our burn doc asked if I would take care of the 18y/o as he was not going to live and he knew I was good with families and had many years burn experience. Of course I couldn't say no.

Upon entering the room my patient was literally coming off the bed with each vent breath as his chest was so tight and he was on a mso4 gtt at 3mg/hr. I talked with his mother and father and sister. They wanted their son to die peacefully. No problem here. I called our doc and got a order for a vec gtt and an order to increase the mso4 prn to comfort level. This kid as all burns was a & o nodding appropriately. The mom was beside herself with grief and shock. She kept asking "why does he come off the bed" and "is he hurting?". No one had yet told her it was ok to kiss her baby and hold his hand which I promptly did, she lost it and the father had to leave the room. I stayed with her and just let her lose it. In the end he was on 20mg/hr mso4 and 10mg/hr of vec. I know he did not hurt and I told his mother this. She said that what I did for her could not be repaid, little did she know she already had.

He finally went int EMD about 0630 and was pronounced at 0715. Before I left that morning his father picked me up off the ground and bear hugged me. The mom looked at me and said two words that still make me cry "Merry Christmas". I cried with them and all the way home and then some more.

I still get a Christmas Card from them every year, they to have become part of my family.

I learned more about strength that day than in all my years before, this mother, woman, grandmother who had just lost so much still said to me "Merry Christmas"..........

CC NRSE · Aug 16, 2001

Katrina,

What a touching story. To me, that is why I became a nurse. To know I could make a difference.:) Now when that family remembers their son, they will also remember what a loving, caring compassinate person you are. Death is often very hard to deal especially when it is so unexspected. Thank you for sharing your story. Once again, you have made it very clear to me why I am proud to be a nurse!!:)

april

BurnNurse · Aug 18, 2001

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.

Nursz-R-Awsm · Aug 19, 2001

Wow, Katrina, thank you for sharing. I do not work with burns and I do not know if it would be something that I could handle. I am, however, facinated by burn pts and the challenges they present. You are obviously where you belong... to be able to give loving care and to touch someone by being there for them in a way no one else can. You are a credit to our profession.

:)

night owl · Nov 20, 2001

Saint Katrina,

YOU are truely an angel sent from heaven! May God bless you a hundred fold...

A friend of my 16 y/o son was burned last week using somekind of an accelerant in a woodstove in a garage and has 3rd degree burns over 40% of his body. He's in an induced coma and will be brought out of it on thursday. I wonder if he'll remember any of it? Maybe in time...He's had skin grafts done to his arms and legs from his ABD and from what we hear, they seem to be healing. He's got a long road ahead of him, but it's because of angels like yourself that he still belongs to us. I can only say thank you and give you a {{{Hug}}} through space...

Fondly,

Michele

BurnNurse · Nov 21, 2001

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!

night owl · Nov 22, 2001

Thank you for the reply. I am a LPN in LTC and have 0 experience with burn victims. May I ask you a few questions? Please let me know if I'm being a pain...

Do burn victims have PTSD afterwards?

Do they have difficulty weaning from the MSO4?

What is "bucking" the vent? Resisting it?

This fella is an epileptic and is on medication. Will this trauma increase his chances of seizure activity?

I haven't been able to see him yet do to "immediate family only" which is understandable. How do you begin to emotionally support a burn victim and their family...there is so much to deal with...

Thank you for YOUR support.

Michele

BurnNurse · Nov 23, 2001

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...