/clinical/,/clinical/references/,/clinical/references/burn/,/clinical/references/burn/other/,

/clinical/references/burn/other/

201606159

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UWHC,UWMF,

Patient Care,

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Focus

Weekly Schedule for Burn Team

MONDAY

TUESDAY (DAY FOR INPATIENT CASES)

WEDNESDAY (DAY FOR OUTPATIENT CASES)

THURSDAY

FRIDAY

The attending will see all patients but you are encouraged to see the patients beforehand, write notes and make a plan. It is your job to seek learning opportunities.

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Ten Commandments of the Burn Center

  1. Thou shalt make no surprises for the attending.
  2. Thou shalt listen to the burn nurses; the experienced ones know much more about burns than you do.
  3. If not absolutely sure about what thee are about to do, check with thy attending.
  4. Thou shalt use problem oriented charting and ensure problem list is updated daily.
  5. Thou shalt always order PT, OT, Health Psych consults on all patients, and NEVER uncheck anything on the initial order sets unless you have a well-thought out medical reason that you can defend.
  6. Thou shalt not order other physician consults until speaking with an attending.
  7. Thou shalt complete the discharge summary when the patient leaves the hospital and fill out the final burn diagram. Discharge summary must include problem list that has been updated at the time of discharge.
  8. Thou shalt look through orders and make sure they are accurate and reflect the plan of care EVERY day and adjust anticipated discharge date EVERY day.
  9. Thou shalt use problem-oriented charting.
  10. Thou shalt have fun. This may be the last time you get to care for burns.

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Chronic Wound Treatments

The burn center also sees a significant number of patients with chronic wounds. Chronic wounds are not uncommon and collectively cause significant morbidity within a population. Because the wound care industry is a multimillion dollar industry, there are a myriad of special dressings available; each touted to be the best. Most have sound scientific explanations for why they improve wound healing, although almost none have proven superiority in rigorous clinical trials. Factors we know promote wound healing are: moist wound environment, low bacterial load, minimal necrotic tissue, management of edema, protection from physical trauma, adequate blood flow, “positive” inflammatory state. Treatment is aimed at both removing the cause of the wound and improving the wound environment to promote healing.

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Typical Presentation for Rounds

The following is what is important information in burn patients and should be reviewed and discussed on rounds every day:

EXAMPLE

Austin is 5-year-old boy now 8 days after a 50% TBSA burn involving his legs and torso; and post-op day 3 from excision and split-thickness skin grafting of his legs. His blood pressure has been stable at 110-130/60-70, and his heart rate between 120-140. I’s and O’s were 2300 in and 1200 out, or 1.25ml/kg/hr urine output. Total fluids are at maintenance rate with D5 1/2 NS. Serum sodium is falling, now at 126; BUN is stable at 10; hct. fell 4 points to 23%. He is awake and responding appropriately but still uncomfortable on 5mg/hr morphine and 2mg/hr midazolam. His respiratory rate is 18-24 and he is breathing comfortably on 2L per nasal cannula, sat’ing 96-100%. He is tolerating tube feeding at goal with the tube beyond the pyloris. Metabolic cart is pending. He had a temp. max. of 39°C last night and was cultured yet his CRP value has remained stable at 18. No antibiotics currently. His graft dressings are intact and irrigated with DAB/Sulfa. Unexcised burns are in Silvadene. Rehab is on hold until POD 5.

ASSESSMENT AND PLAN

Go through every item in the problem list and discuss what we are doing for that problem today and what is the plan for the stay. Additionally, make sure you have an anticipated discharge date that is updated regularly as the plan of care moves along.

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Reviewed by Burn Director, May 2016