A Burn Intensive Care Unit Nurse's Perspective

Abstract

Abstract : For burn patients, the day of surgery can come as quickly as hours or as late as days, possibly even weeks, after the initial injury. With reconstructive and scar revision procedures the patient's surgical journey may not end until years after the burn. It is the first few surgical procedures that concern the burn intensive care unit (BICU) nursing staff the most. After a large burn encompassing 30% total body surface area or greater, the first excision and grafting (E&G) procedures are the most critical. Experienced burn surgeons and BICU staff know that there is no substitute for early, aggressive excision of the burn wound in patients with large burns. Deep or Full thickness burns produce an inflammatory response where the eschar (the deep cutaneous necrotic tissue produced by thermal burn or corrosive application) and the viable tissue meet. This area is where bacterial growth in the eschar attracts polymorphonuclear leukocytes (neutrophils) that release large amounts of proteolytic enzymes and inflammatory mediators. As a result, these mediators start separating eschar from the granulating tissue that produces nonsurgical burn scars. These untreated burns result in limited mobility and disfiguring scars. By removing the burned and devitalized tissue, burn surgeons are able to save the patient's life as well as improve appearance and function.