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
injury. He does not verbalize any flashbacks, nightmares, or
anticipatory fear of his wound care.
Burn Case Study #3
Peter, a 48-year old unmarried male was admitted to the
Emergency Room. Peter sustained a 22% T.B.S.A. full-thickness
non-circumferential burn to the lower anterior aspects of both legs
as a result of flame contact from a welding accident. The fullthickness
burns were not surrounded by partial-thickness burn
injury. Burn eschar appeared tan in color, charred, non-blanching to
pressure, and with a leathery skin texture to touch. Most of the
traumatized area was insensate to touch and painless at the time of
admission. However, the patient reported acute pain at the burn
margins, which he rated as 7/10 in intensity and “burning and
intolerable” in nature. The patient received Morphine 4 m.g. I.V.P.
during Emergency Medical System (E.M.S.) transport to the E.R.
Wound care was implemented using a shower gurney for
hydrotherapy, followed by the application of Silvadene (silver
sulfadiazine)-covered gauze dressings. The initial wound care
session was successfully completed under intravenous conscious
sedation using Fentanyl (sublimaze) 350 m.c.g. and Versed
(midazolam hydrochloride) 2 m.g. given in small I.V.P. increments.
Two hours after wound care, Peter reported background burn pain
as 3-4/10 in intensity and “now tolerable.” Both oral and parenteral
narcotic analgesia were available on a P.R.N. basis. The patient was
admitted to the burn stepdown unit, and scheduled for surgical
debridement and skin grafting within forty-eight hours. Preoperative
education included anticipated surgical pain from both the
skin donor site and the debrided/grafted burn site areas, and the
use of a patient-controlled analgesia (P.C.A.) for post-operative pain
management.
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