■ 11:00 AM
Once a week, the entire team meets for interdisciplinary rounds with representatives from adult and pediatric critical care, infectious diseases, nursing, pharmacy, neuropsychology, PT/OT, nutrition, social work, and chaplain services. We outline full treatment plans for all of our patients at this meeting. Every member of the team provides vital information on how well a patient is healing and what needs to be done prior to discharge. Once the meeting is over, the burn fellow and I take care of what needs to be ordered (such as consults, labs, medicine changes, etc.) and which patients need to be scheduled and prepared for surgery this week.
■ 12:15 PM
I meet briefly with the research assistant who helps coordinate new and current studies being conducted at the hospital. She informs me that the Institutional Review Board has just approved our next study, which is on the use of stem cells to treat partial-thickness thermal burn wounds. The trial will compare spraying stem cells on burn wounds with applying normal saline to burn wounds. There is always something new, and we are excited to be involved with the development of a product that can improve patient care.
■ 1:00 PM
I grab some lunch and head to the burn clinic. My first patient is a 3-year-old African American female who was getting her hair braided when she accidentally leaned back too far and hot water spilled down her back. Scald injuries are the most common type of burn injury in pediatric patients; luckily, this little girl only suffered a 4% TBSA partial-thickness injury. It's been 2 weeks since her burn. I remove the dressing to find that her burn wounds have fully epithelialized, and they are only slightly hypopigmented at this time. I instruct her mother to keep the patient out of direct sunlight, give them some moisturizing cream to apply to the healed area, and “medicate” the child with a sucker for being such a good patient today.
■ 2:30 PM
After seeing several other patients, my next patient is a 23-year-old Hispanic male who suffered a 23% TBSA thermal burn wound approximately 12 months ago. He underwent excision and skin grafting to cover his wounds. He has been doing well at home and has been going to outpatient occupational therapy for a hypertrophic burn scar contracture across his right elbow that significantly limits his range of motion. On examination, I see a hyperpigmented, raised hypertrophied scar and find that his elbow extension is decreased by about 15 degrees. The patient states that he has difficulty at work when using the arm. I make an appointment for him for next week to be evaluated by my attending physician for possible surgery to revise the scar.
■ 3:45 PM
My last patient today is a 56-year-old Hispanic male who was referred to the burn clinic for follow-up by another emergency department in the area. He was cooking with grease 2 days ago and suffered superficial burns to his bilateral lower extremities. I evaluate his injury and see that the burn is strictly superficial. I assure him that the wound is similar to a minor sunburn and should be better in about 1 week. He can use moisturizers or aloe vera cream to soothe the affected area.
■ 4:45 PM
While finishing my clinic, I receive an urgent page to return to the burn ICU. The nurse informs me that the patient with the 75% TBSA burn has lost the pulses in his right lower extremity despite adequate fluid resuscitation. I alert the fellow and attending, who meet me at the bedside immediately. We attempt, unsuccessfully, to Doppler any pulses in the extremity. The leg is pale in appearance, and the nurse says she had to increase the patient's sedation to keep him comfortable. We decide that the best course of action is an emergent escharotomy of the leg to relieve the pressure that has accumulated secondary to the injury and swelling. The fellow and I use an electrocautery device to release the compartments of the leg along the lateral aspect of the extremity. We can see the leg opening up as the pressure is released with each cut of the device. On reassessment of the distal pulses, we find that they have returned and are adequate.
■ 6:00 PM
This has been another long, eventful day, and I am ready to go home. I make my final rounds and write my postoperative assessments. I am told that sometime during the night the unit will receive a 31-year-old African American female from an outside hospital with suspected Stevens-Johnson syndrome after taking an antibiotic. According to the outside facility, she has approximately 45% TBSA open at this time. I know we will need to be ready for almost anything when she arrives. After finishing my remaining dictations, I head off to dinner with my girlfriend and some friends. JAAPA
Scott Blow works at the Tampa General Hospital Regional Burn Center, Tampa, Florida. He has indicated no relationships to disclose relating to the content of this article.