PATIENT HANDOVER 3
Spo2- 98 RA, RR- 20 breaths/min and a pain score of 3. The vital signs are within normal
ranges apart from the temperature of 37.9⁰C, which is high compared to normal ranges of
36.5-37.5⁰C (Ljunggren et al., 2016 pp 21). Mr Lewis can move his head and neck with no
pain or stiffness ruling out any injuries when he collapsed, but he still has the soft collar
insitu.
Mr Lewis reports pain on both feet, the wound is moist and evidence of swelling and
oozing of fluid from the breaking blisters. There are blisters at the ankles and towards the
toes on the dorsum part of the feet and the wound is red but blanches when pressure is
applied. In the calculation of total surface area burnt using the rule of nines, Mr Lewis has
sustained burns to both feet involving the joints. A burn on the anterior feet adds up to 13/4%
as well as the posterior. Hence the total surface area burnt is 3.5% of the entire body surface
area (Harish et al., 2015 pp 91-99). CT scan of the head and neck has been done awaits
reporting to confirm any soft tissue damage.
Recommendations
Mr Lewis has received fluids, IVC boluses of 0.9% normal saline, pain medication,
topical antibiotic cream applied. The patient is for insertion of the urinary catheter to monitor
urine output giving a picture of the kidney function (Prowle, Kirwan, Honoré, Jacobs and
Spapen, 2019 pp 209-214). Before transferring the patient, I would repeat the vital
observations and physical assessment to monitor for any signs of complications. The patient
needs an urgent senior review to prevent compartment syndrome. Aseptic technic is required
in the handling of the wound to promote healing and to avoid infection. The wound is to be
covered by bluey before transfer; hence, RBWH needs to initiate dressing with silver
sulfadiazine to prevent contamination.

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