DATE OF ADMISSION: MM/DD/YYYY
DATE OF DISCHARGE: MM/DD/YYYY
HISTORY OF PRESENT ILLNESS: The patient is a (XX)-year-old male who sustained extensive and severe burns from ignition of a solvent at work. On the day of admission, the patient was treated at an outside hospital where he was estimated to have approximately 50-70% total body surface area burn. The patient was orotracheally intubated there and also had bilateral lower extremity escharotomy performed. The patient was transferred by ambulance to this facility for further care. Upon arrival, the patient was sedated but arousable.
PAST MEDICAL HISTORY: There is no significant past medical history noted.
ALLERGIES: There is no known drug allergy recorded.
IMMUNIZATIONS: Up-to-date. Tetanus toxoid was given at the outside hospital.
PHYSICAL EXAMINATION: On physical examination, the patient was calculated to have approximately 56% total body surface area burns involving the face, left head, left neck, small areas of trunk, large area of the upper extremity including hands, most of the lower extremity but sparing the feet; however, a small area on the dorsum of the left foot was burnt. Wounds of the extremities are circumferential with green and whitish eschar on the knee. Lower leg had a dark red and dry eschar appearance, and the upper extremities had a pearly white area, which suggested a third-degree burn. The eyes were fluorescein negative. There was no uptake. The patient had normal chest examination. Lungs were clear to auscultation bilaterally. Peripheral pulses were detectable by Doppler only.
HOSPITAL COURSE: The patient was diagnosed with 50% total body surface area second- and third-degree burns, circumferential, extremities. The patient was then admitted to the burn intensive care unit for ventilatory support, IV hydration, pain control, as well as local wound care and debridement. Wounds were dressed with 1% Silvadene cream.
The patient was then transported to the burn intensive care unit. Normal burn intensive care unit protocols were followed as well as the normal consults were obtained. The patient’s condition continued to remain in serious condition with life-threatening injury. The patient underwent daily wound care and debridement as well as ventilatory support.
On hospital day #6, the patient was then taken to the operating room for excision and split-thickness skin grafting of the third-degree burn areas of the bilateral arms and hands with donor sites taken from the anterior torso. The patient tolerated the procedure well and was then transferred back to the burn intensive care unit for postoperative care.
On postoperative day #3, the patient’s wounds were unveiled. The graft sites appeared viable at the time. There was no cellulitis noted on any of the wounds. The patient continued to undergo daily wound care and debridement and remained in a serious condition under intensive care unit protocol.
On hospital day #10, the patient underwent a second procedure involving the left leg. The patient underwent excision and split-thickness skin graft of the left leg with donor sites taken from the back. Again, the patient tolerated the procedure well and was transferred back to the burn intensive care unit for postoperative management.
On postoperative day #3 of the second procedure, the patient’s wounds were unveiled, and the graft sites appeared to be viable. Again, no cellulitis was noted. The patient’s condition remained critical, continued with ventilatory management, as well as burn intensive care unit protocol. The patient also was noted to spike temperature after the second procedure. The patient was then placed on broad-spectrum IV antibiotic with a white blood cell increase to 16,000. Cultures were obtained, and no source of infection was found.
On MM/DD/YYYY, the patient underwent the third procedure. The patient was taken for tracheostomy, excision of third-degree burn on the right leg with applications of split-thickness autograft with donor sites taken from the chest, lower abdomen, as well as left arm. The patient again tolerated the procedure well and was transferred back to the burn intensive care unit for further care and management. The patient’s condition remained critical and was placed on ventilatory support. The patient underwent daily would care and debridement.
On postoperative day #3, the wounds were unveiled. Again, the graft site appeared viable. There was no cellulitis noted. At the time, ID consult was obtained after the third procedure due to the fact that the patient continued to spike fever as well as increasing white count. The patient was then started on IV Zosyn for positive sputum culture for pseudomonas. The patient’s condition remained serious and was started on amikacin for positive blood cultures for pseudomonas. The patient was continuing to be followed by Infectious Disease.
On hospital day #33, the patient was weaned off the ventilator and placed on trach collar. The patient continued to undergo daily wound care and debridement. On MM/DD/YYYY, the patient underwent a fourth procedure, excision and split-thickness skin graft of third-degree burns of the legs with donor site taken from the flank and lower abdomen. Again, the patient tolerated the procedure well and was then transferred back to the burn intensive care for postoperative care. The patient’s condition was stable after the fourth procedure, and the wounds appear viable and condition continued to improve with the routine burn ICU protocol. The patient was then continued with IV antibiotics due to the fact that he had multiple blood cultures, which were positive for pseudomonas. The patient did respond to the IV antibiotic. His condition continued to improve and was subsequently transferred to the burn step-down unit for further care and daily wound care and debridement.
On MM/DD/YYYY, the patient underwent pinning of the left hand, of the second distal digit. The patient tolerated the procedure well and was then transferred back to the burn step-down unit for further care. The patient continued to undergo daily wound care and debridement, and his condition continued to improve. On MM/DD/YYYY, the patient was then discharged to a rehab facility with a followup appointment given at the outpatient burn office.
