![]() Once I was discharged from this hospital, I was transferred to UC Irvine Medical Center, for another week for medicated bandage changes, which my parents did, and then I spent two more weeks at Healthbridge for inpatient, intensive Physical, Occupational, and Speech therapy. Before I even left this first hospital, I had a total of nine, eight-hour surgeries, and at least 30 bandage changes. At this point, I was having skin grafting surgeries every other day, and bandage changes each day in between. There are no words to describe the agony. Eventually I had to start walking again, and I screamed and cried in pain. ![]() Just sitting up was exhausting and painful, but I still had to scoot, painstakingly and painfully to the edge of the bed, and somehow stand up. I can’t describe the pain of having to move not only sore, severely atrophied muscles, but also the skin, that was so tight. Even so, it was important not to let my muscles continue to atrophy, so each day, the Physical Therapist and her assistant came in to make me stand, and eventually walk again. I was unable to eat or drink for several more weeks, and was fed through an NG tube in my nose, and an IV line. When my lungs were finally strong enough to breathe on my own, they allowed me to wake up, but I was heavily medicated on hallucinogenic drugs like ketamine, to help manage the pain. In between surgeries, I was wrapped from head to feet in bandages. They also began full depth skin grafts while I was in a coma, which is a process where they took donor skin from my back, thighs, calves, stomach, and scalp, placed it on a stretching machine, and applied it to the burned areas to cover the burned skin. During the second infection, my fever reached dangerous levels, and I was placed on a special ice bed. They had to use my ventilator to disrupt my breathing, and pound my chest and lungs from the inside, and I ended up on a Rotabed, a crazy, tilted, rotating bed, for a week. The pneumonia was aggressive, and resistant to treatment because I was inactive. I was kept in a coma for about eight weeks, during which time I caught pneumonia, and another infectious disease. I sustained full depth, second and third degree burns to approximately 60% of my body, including my face, chest, shoulder, stomach, hands, arms, and shins. My injuries were so extensive, that I was put into a medically induced coma, and intubated. I was rushed by ambulance to the nearest hospital, and then life-flighted to the nearest burn intensive care unit in Fresno, California. I panicked, and started running, but thankfully someone had the presence of mind to wrap me in a blanket and tackle me to the ground. It caused the fire to explode, and I immediately caught on fire. When I was twelve years old, I was camping with my dad, and accidentally poured gasoline instead of lighter fluid on a campfire. I turned fifteen years old on Saturday, November 26, 2016. Cyanide poisoning can also occur from smoke inhalation and can be treated with hydroxocobalamin (see Inhalation Injury chapter).My name is Joshua Keeney. If carbon monoxide poisoning is confirmed, continue treatment with high-flow oxygen and consider hyperbaric oxygen in select cases (see Hyperbaric, Carbon Monoxide Toxicity chapter). In patients with moderate to severe flame burns and with suspicion for inhalation injury, carboxyhemoglobin levels should be checked, and patients should be placed on high flow oxygen until carbon monoxide poisoning is ruled out. ![]() Remember that the fluid resuscitation formula for burns is only an estimate and the patient may need more or less fluid based on vital signs, urine output, other injuries or other medical conditions (see Burns, Resuscitation, and Management for discussion of the management of severely burned patients). For example, if a 70 kg patient has a 30% TBSA partial thickness burn they will need 8400 mL Lactated Ringer solution in the first 24 hours with 4200 mL of that total in the first 8 hours. Half of the calculated amount is administered during the first eight hours beginning when the patient was initially burned. The total amount of fluid to be given during the initial 24 hours = 4 ml of LR × patient’s weight (kg) × % TBSA. One commonly used fluid resuscitation formula is the Parkland formula. Splints can also provide support and comfort for certain burned areas.įor burns classified as severe (> 20% TBSA), fluid resuscitation should be initiated to maintain urine output > 0.5 mL/kg/hour. Comfort – Over-the-counter pain medications or prescription pain medications when needed. ![]()
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