Management of Burn Injuries: Perspectives of ODP, STP, and Anaesthetic

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Care Case Study

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Overview:
Burn is an injury mainly caused by thermal energy. Scald is a burn caused by contact with hot
liquid or steam. Few burns can be managed by simple management; however, few of the
burns require complex treatment comprising of surgeon, STP, ODP and anaesthetic. In UK
hospitals burn admission rate is 0.29 per 1,000. In UK approximately 250,000 people get
admitted to hospitals and approximately 300 burn related deaths occur (Cleland, 2012; Kemp
et al., 2014). In this essay, perspective of different professionals like ODP, STP and
anaesthetic in management of burn is discussed. Psychological and legal aspects in care are
also discussed.
Operating department practitioner (ODP) perspectives:
Due to burn injury, Zaynab might be experiencing fluid replacement. It might have resulted
in cardiovascular instability and respiratory insufficiency in her. For the speedy recovery of
Zaynab, early excision of dead or necrotic tissue is required. It would be helpful in the
reducing chances of wound colonization and systemic sepsis (Ong et l., 2006).
ODP and doctors need to assess amount of blood loos prior to surgery. Based on the
assessment of blood loss, surgeon and surgical theatre practitioner (STP) can plan suitable
vascular accessibility, invasive monitoring and can request for suitable blood products.
Surgeon and STP need to access history of Zaynab and perform physical examination to
evaluate additional requirements during surgery. Physical evaluation would be helpful in
evaluating degree of burn injury, respiratory tract evaluation, existence of inhalation injury
resuscitation, vascular disturbance, existing resuscitation aids and Zaynab’s response to it and
tolerance to enteral feeding (Yeung et al., 2013). Prior to surgery, surgeon and ODP need to
manage vascular disturbance by reducing edema and bloodstream infection. ODP need to
maintain temperature and the humidity of theatre room for paediatric patient specifically to
prevent a hypothermic and fluid loose. It can be helpful in maintaining homeostasis. Edema
can be reduced by pressing on the swollen area hence accumulated fluid can be taken out
(Allorto et al., 2016). Bloodstream infection can be prevented by administrating suitable
antibiotic. Surgeon, STP and ODP need to identify whether intravenous route can be used to
insert catheter in Zaynab. Surgeon, STP and ODP need to identify whether peripheral or
central catheter can be used in Zaynab. Moreover, the urinary catheter is very crucial to
monitor the fluid outcome of the in burn paediatric patient. In addition, ODP should prepare
all surgical instruments for burn patients such as dermatome and special equipment as well as
the special dressing. ODP and STP need to assess this preoperative assessment which cab be

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helpful in reducing complications during surgery procedure. Dexmedetomidine can be used
because it can induce sedation and analgesia, however it would not produce respiratory
depression (Rode and Heimbach, 2013).
Recovery perspective:
There can be occurrence of respiratory insufficiency in Zaynab due to higher metabolic state
and increased production of carbon dioxide (Buckley et al., 2011). Hence, it is necessary to
maintain homeostasis. Respiratory insufficiency can be effectively managed by using
Laryngeal mask airways in Zaynab (McCall et al., 1999). These masks proved successful in
numerous patients with burn. These masks can be useful in improving oxygen saturation in
Zaynab. During intrahospital transportation of Zaynab having mechanical ventilation,
minimum of two anaesthesia personnel need to be present there (Mackie et al., 2009). There
can be agitation in Zaynab during intrahospital transportation. Hence, anaesthesia, analgesia
and muscle relaxant need to be given to Zaynab. There might be delayed or no gastric
emptying in Zaynab due to infection, sepsis, opioid consumption and intestinal edema.
Methylnaltrexone can be used to improve gastric emptying in Zaynab. It is evident that burn
related pain is undertreated in case of burn patients. However, pain need to be managed
effectively in burn patients because it can affect speedy recovery of Zaynab. Untreated pain
lead to depression and anxiety in Zaynab. Pain due to burn might be mostly of neuropathic
pain nature. It is evident that neuropathic pain is opioid resistant. Hence, other pain-relieving
drugs need to be administered for Zaynab prior to surgery (Crellin et al., 2015; Alharbi et al,
2012). There should be prior administration of sedative and anxiolytic agents because these
agents can reduce pain and fever due to burn. Premedication can also be useful in the
relieving physiological and psychological adverse effects in Zaynab. There might be more
fluid loss due to burn which can disturb homeostasis. Hence, Zaynab should be administered
with fluid through nasojejunal tube approximately two hours prior to surgery (Klein et al.,
2007). Wounds due to burn need to be treated with either short or long acting topical
antiseptic agents (Coetzee et al., 2012).
Anaesthetic perspective: Anaesthetic drug should be selected for Zaynab based on her
hemodynamic and pulmonary status. Due to change in the haemodynamic characters in
Zaynab, there can be alteration in the pharmacodynamic and pharmacokinetic characters of
anaesthetic drugs. Due to change in the pulmonary status, volatile anaesthetics cannot be used
in burn patients like Zaynab. Hence, ODP and STP need to select admixture of intravenous