Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
acute burn pain, but non-pharmacological options can be effective
adjunct modalities. Further research that focuses on burn pain at
each phase of recovery from injury will lead to effective evidencedbased
pain relief modalities.
Burn Case Study #1
John, a 37 year-old married male, sustained a 45% total burn
surface area (T.B.S.A.) injury following a trailer home fire. His
injuries consisted of 25% full-thickness burns surrounded by 20%
partial thickness burns over his face, chest, back, and bilateral
circumferential upper extremities. The fire investigator suspected
that John was drinking alcohol and fell asleep while smoking a
cigarette. The patient’s blood alcohol level (B.A.L.) was high upon
admission, and his family reports a past history of both smoking
and substance abuse (both alcohol and marijuana). The paramedics
at the trauma scene were concerned about the patient’s airway
patency due to his obvious facial burns and suspected smoke
inhalation injury. John was then pharmacologically paralyzed and
sedated for rapid endotracheal intubation followed by mechanical
ventilation. He received a total of 8 m.g. of Morphine by I.V.P.
during transport. After a ninety minute medical air transport, he
was directly admitted to the Burn Intensive Care Unit (I.C.U.) of a
regional Level 1 trauma center. Due to intubation and medication
received, John was unable to verbalize of burn pain upon admission.
John’s full-thickness burns presented as tan-colored and
charred, with the leathery skin changes associated with eschar.
These areas lacked capillary refill and felt stiff to palpation. The
surrounding partial-thickness burns were red to pale in color, with
various levels of capillary refill, and were covered with scattered
blebs and bullae (both ruptured and unruptured). Clothing was
adherent to the burn eschar in some sites. Initial wound care was
performed under I.V.P. administration of Fentanyl (sublimaze) in
50-100 m.c.g. increments, supplemented with I.V.P. administration
of Versed (midazolam hydrochloride) in 1- 0.5 m.g. increments. A
total of 600 m.c.g. of Fentanyl, and 4 m.g. of Versed were
administered during wound care. The patient remained nonresponsive
at this time, but exhibited tachycardia and elevated
blood pressure immediately following position changes or
aggressive wound care. The burn unit nurses interpreted these vital
sign changes as indicators of uncontrolled pain, and administered
additional narcotic analgesia. Towards the end of the procedure, the
patient began to be restless and agitated at times despite analgesia.
Continuous intravenous infusions of narcotic, sedative, and paralytic
agents were then initiated by the nursing staff per physician order.
- 152 -