• OT/PT (ordered on admission),

• Nutrition (ordered on admission)

• Social work (ordered on admission)

• APS (if needed)

• Psych (if needed)

• PRN PO Oxycodone

• PRN IV Dilaudid

• APS consult for better pain control (ketamine/PCA)

Adjunct pain regimen may include:

• Tylenol, Advil, Gabapentin (standing or PRN)

• Telemetry and continuous pulse oximetry if needed (Q1 interventions for 8 hours only).

• Prealbumin & CRP 12-24 hours (Monday & Thursdays)

• Not necessary to draw pre-op labs unless there has been a problem with the HCT or bleeding

Do Not Use Water or Saline to loosen dressing during removal

• Post op dressing stays in place for 7 days

• Rylon (mesh) to stay in place

• Reapply kerlix and ace wrap – tell patient to leave in place for an additional 7 days

• Post op dressing stays in place for 5 days

• Begin graft care after take down

• Charge nurse to coordinate ETA of Dr. Bell

If ETA 8AM:

• Pre medicate patient's at 7:30AM with PO pain medication (if wanted by patient)

• Have dressings down by 8AM

• Surgical dressings to be taken down by burn team

• Nursing can take down non-surgical dressings

• Nursing can take out staples if instructed

• Nursing in charge of redressing

• Post op dressing stays in place for 5 days

• Begin graft care after take down (see below)

• Mepilex Ag: Leave in place 10-14 days reinforce dressing if needed.

  Contact provider if dressing falls off or unable to reinforce.

• Xeroform: Provider needs to remove ace wrap 24 hours post op and non-adherent dressing (considered a surgical dressing). It should be stapled in place over the donor site, do not remove staples until post op day 5. Lifted/ dried xeroform can be trimmed but never removed in full.

• Allow xeroform to air dry. Instruct patients to have legs open to air at all times, can use fan to help air dry.

  
  

• Use figure 8 technique and elevate burned extremities to decrease swelling

Shoulders/proximal UE: Usually WBAT

Hands/wrists/elbows: Usually splinted and NWB

Thighs/knees: Usually WBAT

Feet/ankles: NWB if spinted

With VACs: Usually WBAT but may NWB if crosses a joint

• Post op dressing stays in place for 7 days.

• Water can be used to loosen dressing. The removal should be atraumatic

• Telfa clear should also be removed

• Wash and rinse wound very gently with baby shampoo before reapplying dressing

• Dress with Polysporin, xeroform, kerlix and acewrap if on a limb

• Change dressing every day after initial dressing change

• Once facial burns are re-keratinized, Eucerin may be applied instead of Vaseline

Ear care: BID, baby soap and warm water, moisturize with Sulfamylon cream, wrap with gauzes or Vaseline gauzes

• Ensure ear is dressed at all times, reapply cream as needed

Hands: Wash with Chlorhexidine and rinse with warm water, apply a generous amount of Polysporin followed by edema gloves, reapply Polysporin throughout the shift to keep hands moist

Body: Wash with Chlorhexidine and rinse with warm water, apply Polysporin, xeroform, kerlix, gauze, ACE wrap/surgilast

Remove all dead/ excess skin to promote faster wound healing and prevent scarring

Derek Bell

Megan Barbato

Shauna Cole

• Involves detachment of >30 percent of the body surface area (BSA)

• Mucous membranes are also involved in 90 percent of patients

• Skin detachment is <10 percent of the body surface

• Mucous membranes are affected in over 90 percent patients, usually at two or more distinct sites (ocular, oral, and genital)

• Rare skin condition that causes large, fluid-filled blisters

• They develop on the areas of the skin that often flex, such as lower abdomen, upper thighs or armpits

• Most common in older adults

• Occurs when your immune system attacks a thin layer of tissue below your outer layer of skin, this abnormal immune response is unknown

• Can have a broad range of symptoms: fever, rash, facial swelling, enlarged lymph nodes, kidney or liver injury

• Most will have an abnormal level of blood cells called eosinophils

• Thought to be caused by an allopurinol metabolite called oxypurinol

• Burn should be consulted for extravasation injuries

• Finger Lakes Regional Burn Association (FLRBA)

https://www.flrba.com/

• Phoenix SOAR

Supplements: Juven, Liquacel, Ensure, Vitamins

• Educate patients on need for increase protein intake

• Potential DHT placement/tube feed order if prealbumin is trending down or <13

• Scrub off biofilm from burns to promote wound healing

• Burn patients don't need to prove their toughness- burns and treatments are incredibly painful and distressing

• Always assume that burn patients will experience substantial pain and prepare accordingly

• Psychological makeup

• Ethno-cultural background

• Personal meaning of the injury

For burn patients, this is a significant concern because:

• Repetitive Painful Stimuli: Frequent procedures like dressing changes and physical therapy can worsen sensitization.

• Prolonged Hospitalization: Longer stays increase the risk.

• Psychological Factors: Stress and emotional impact can intensify pain perception.

^{Additional Techniques Include:}

• Psychological Intervention

• Virtual Reality

• Music Therapy

• Psychiatry Consults

• Acute Pain Service Consults

• jfrenzel@solventum.com

• 585-978-6417