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Burn Patient Care and Referral
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Introduction & Table of Contents
As a burn care team consisting of physician-surgeons, nurses, physical and occupational therapists, dieticians, pharmacists, social workers, psychologists, child-life therapists, prosthetists, medical sculptors, ward clerks and a variety of technicians and assistants, we provide care and support to the patients and their families. Our philosophy of care is based on the concept that each patient is an individual with special needs. Each patients' care, from the day of admission, is designed to return him/her to society as a functional, adaptable and integrated citizen. Shriners Burns Hospital-Galveston provides care to children through the philanthropy of Shriners Hospitals for Children. The Blocker Burn Unit (J2D) is a part of John Sealy Hospital at the University of Texas Medical Branch-Galveston and provides care to adult burn victims from the entire state of Texas. Both facilities provide care through a multidisciplinary team approach. The burn unit residents provide an essential part in coordinated patient care. The 2 units, though separate in nursing staff and administration, should function as one from a physician standpoint. This is because of cross coverage issues on call and the need for additional staffing at times on either side to accommodate large caseloads. Hence, both teams should round together each day. Table of Contents
Section 1:
Life on the Burn Services
Section 2:
Acute Burn Management
Psychological and
Psychiatric Services to Children and Families Nursing Service
Resident Orientation
Rehabilitation Services Resident Orientation
How to Use the Dictation System
SECTION ONE: Life on the Burn Services RESIDENTS/STUDENTS EDUCATIONAL OBJECTIVES 1. Learn assessment and classification of burn wounds, including estimation of burn size and depth, and reduction of related morbidity and mortality. 2. Gain an appreciation of stress response to acute burn injury, including hemodynamic, metabolic, nutritional and immunologic sequelae. 3. Learn initial management of the acute burn patients, including fluid resuscitation , nutritional support, wound care and ventilatory management. 4. Learn wound management of burn patients including an understanding of wound healing, wound sepsis, topical antimicrobial agents, biological dressings, skin substitutes and skin grafts. 5. Develop fundamental surgical skills in treatment of burn patients, including wound debridement, wound dressing and splinting, skin grafting and scar contracture release. 6. Gain an appreciation for burn rehabilitation, including physical/occupational therapy, psychosocial support and reconstructive needs. 7. Improve communication and leadership skills through interactions and coordinated discussions with patients and their families, attending physicians, medical personnel, medical students and fellow residents. 8. Learn principles of management of special problems, including inhalation injuries, chemical burns, electrical injuries and toxic epidermal necrolysis. RESIDENT RESPONSIBILITIES 1. Admit all new patients to the burn units, including initial assessment with burn diagram, history and physical, and initial orders. 2. Take primary responsibility in coordinating all efforts toward daily patient care of all acute inpatients. 3. Assist in the evaluation and treatment of outpatients. 4. Be available on call 24 hours daily for assistance with new admissions, emergency referrals and acute patient transport. 5. Participate in all operative cases of burn patients, including major excisions and gratings, and early post-burn reconstruction cases. You are expected to get to the OR before faculty and formulate an operative plan. Cases should only be started with proper faculty supervision (emergencies excepted). 6. Document patient management in an accurate, thorough and timely fashion in the medical record. A written history, physical exam and burn diagram should be completed upon arrival of every patient, with dictated H & P completed and on the chart within 24 hours. Dictation of operative summaries and discharge summaries are required within 24 hours from event. Justification for laboratory and x-ray requests should be documented in the progress notes, as well as acknowledgement of abnormal findings. 7. Assure all admission cultures are collected in a timely manner. This includes blood, urine, sputum and wound cultures. 8. Keep the attending physicians aware of any significant changes in patient conditions and discuss proposed changes in treatment prior to initiation, when appropriate. 9. Assist in the education of the assigned medical students. 10. Make all preparations for surgical cases, including daily scheduling, notification of anesthesiologists, blood bank, and skin/tissue bank. Obtain informed consent and appropriate perioperative planning. 11. Notify the clinical research nurses of all admissions and assist in collection of study data, therapeutic approaches or application of experimental variables as requested. 12. Attend all required surgical housestaff conferences including:
a. Surgical Grand Rounds - Wednesday 7:30a.m. 13. The courtesy to remind Burn Services faculty of scheduled vacation times already approved by the Department of Surgery is appreciated. STUDENT RESPONSIBILITIES 1. Assist in the care of assigned patients as directed by the senior resident or burn fellow. 2. Contact the senior resident of burn fellow for all questions or concerns relating to changes in patient condition or care. 3. Present assigned patients' hospital course on daily rounds, including significant physical exam, labs, tests, cultures, medications, I/O's, etc. A suggested format is included in this document. 4. Alternate with fellow students in assisting the resident with new admissions. 5. Notify the senior resident or burn fellow in cases of illness, accidents or other excused absences as well as the Department of Surgery Student Education Office (772-1285). 6. Demonstrate self-motivated, on-going learning by review of pertinent medical literature as evidenced by acceptable daily patient care and intraoperative performance. 7. Assist on operative procedures as directed by the senior resident or burn fellow. 8. Attend all required surgical student conferences including:
a. Surgical Grand Rounds - Wednesday 7:30a.m.
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Resident
Orientation Manual (Feb. 2000)