Burn Unit

[deucerp]

Anyone have any advice on surviving the burn unit? Any "must-know" tidbits? Thanks for any advice.

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[theOne3]

Anyone have any advice on surviving the burn unit? Any "must-know" tidbits? Thanks for any advice.

1. Don't play with fire.
2. Don't douse your trash with gasoline and light it on fire.
3. Don't leave your baby on the stove with the stove on.
4. Don't wash your kids in a bath of gasoline then bring in a space heater.
5. Never take Dilantin or any sulfa drugs.

 

[Blade28]

Besides the usual ICU information that you need (drips, vents, pressors, etc.)...

*Know the standard and modified "rule of 9s"
*Know the Parkland formula, or whatever your institution uses
*Know the common (higher) doses of narcotics
*Know how to recognize burn cellulitis, and when to use antibiotics
*Know how to differentiate between 1st, 2nd, 3rd degree burns (AKA superficial, partial thickness, full thickness, etc.)
*Gain proficiency in central line placement, arterial line placement
*Know which burns need to go to the OR for tangential excision, debridement and skin grafting, and which just need PT/OT/hydrotherapy/whirlpool
*Know which topical meds are for what (e.g. silver sulfadiazene [Silvadene or "SSD"] vs. gentamicin ointment vs. sulfamylon)
*Know routine post-op care of skin grafts

(We have a great burn unit here!)

 

[deucerp]

Besides the usual ICU information that you need (drips, vents, pressors, etc.)...

*Know the standard and modified "rule of 9s"
*Know the Parkland formula, or whatever your institution uses
*Know the common (higher) doses of narcotics
*Know how to recognize burn cellulitis, and when to use antibiotics
*Know how to differentiate between 1st, 2nd, 3rd degree burns (AKA superficial, partial thickness, full thickness, etc.)
*Gain proficiency in central line placement, arterial line placement
*Know which burns need to go to the OR for tangential excision, debridement and skin grafting, and which just need PT/OT/hydrotherapy/whirlpool
*Know which topical meds are for what (e.g. silver sulfadiazene [Silvadene or "SSD"] vs. gentamicin ointment vs. sulfamylon)
*Know routine post-op care of skin grafts

(We have a great burn unit here!)

Thanks for the advice, good stuff. We've got a pretty good one as well, kinda small, but with a great burn attending that teaches a ton. One more question...you have a good source for the above stuff or just piece it together from different places?

 

[LuckyBambooGirl]

My advice....do not lean against the operating table when you are doing big skin grafts, unless you want the fluids to soak all the way through your gown and scrub pants. And wear old shoes! I learned these things the hard way!

 

[njbmd]

Besides the usual ICU information that you need (drips, vents, pressors, etc.)...

*Know the standard and modified "rule of 9s"
*Know the Parkland formula, or whatever your institution uses
*Know the common (higher) doses of narcotics
*Know how to recognize burn cellulitis, and when to use antibiotics
*Know how to differentiate between 1st, 2nd, 3rd degree burns (AKA superficial, partial thickness, full thickness, etc.)
*Gain proficiency in central line placement, arterial line placement
*Know which burns need to go to the OR for tangential excision, debridement and skin grafting, and which just need PT/OT/hydrotherapy/whirlpool
*Know which topical meds are for what (e.g. silver sulfadiazene [Silvadene or "SSD"] vs. gentamicin ointment vs. sulfamylon)
*Know routine post-op care of skin grafts

(We have a great burn unit here!)

I would agree with this advice and add that you should know the side effects of the topical meds.

You should also know the constituents of the burn coverage materials such as Biobrane, Transite and Alloderm.

Learn how to mesh skin and how to sew down grafts (lots of stitching for everyone on a huge burn).

Know the components of dressings like Scarlet Red, Aquaphor and Xeroderm.

Know the stages of engraftment and how to evaluate and care for donor sites.

Wear shoes that don't have laces in the OR (use aprons and boots if you can find them).

Attend the dressing changes with the nurses as these are a great time to evaluate the progress of the burns.

Rotating through a burn unit is very good experience.

 

[Blade28]

One more question...you have a good source for the above stuff or just piece it together from different places?

A few notes...

(1) We have a great burn unit here. We receive most burn patients from the state of Georgia, as well as some neighboring states' cities too.
(2) We have a great burn unit director.
(3) You learn a lot being one of only two residents in the burn ICU, and often the only one there when you're on call, or when the other resident is in the OR.
(4) I think we were also given a very complete handout when we started.

I should add that njbmd has also included some excellent advice.