escharotomy

anonymous asked:

Hi! i have a character who has several broken ribs, many deep cuts in his back, a severe burn on his chest, and just all over bruises, along with a degree of exhaustion. i know these things on their own probably wouldn't warrant a hospital stay of longer than a night, but would it be longer for all of them together? would he still be released within a couple days if he was still in extreme pain from all this? also would he have to lie on his stomach if the wounds to his back were severe enough?

Hey there nonny! We haven’t talked overmuch about polytrauma on this blog, mostly because it’s a very complicated and there’s a lot of “it depends,” but let’s dive in to your scenario and see what’s the what. 

It’s true that, with one exception, no one injury you describe would necessitate admission to the hospital for very long. But one thing you mentioned caught my eye: the words “severe burn.” Depending on the specifics, the burn might be worthy of a fairly lengthy admission, depending on how “severe” that burn is and how large it is. 

Second-degree burns, which involve severe pain, blistering, and lots of lovely wound seepage, is a significant injury. The skin is really important in that it prevents bacteria from entering the body and attacking it, and it sounds like he’s going to need some significant care. 

Third-degree burns, where the skin is burned so deeply that the nerve endings are destroyed and the skin becomes charred and pale, are life-threatening. One of the worries with chest burns is that the skin can become very taught, making it extremely difficult to breathe and possibly requiring surgery (escharotomy) to essentially cut into the burns and allow the chest to expand. This is only made worse by his broken ribs. 

Also, depending on the burn, he might need one or multiple skin grafts, and he’s very likely to need debridement of the burn on a regular basis. This part alone will likely have him be admitted to the hospital for about week, especially in the context of his other injuries.

Then there are your character’s kidneys. If your character is having all of this muscular damage from his apparent beatings and burns, it’s possible that your character will have some level of rhabdomyolosis, which  [we’ve talked about before]. Essentially, muscle breaks down and the byproducts clog the kidneys, which can cause kidney failure. 

If this gets bad enough, your character might wind up on hemodialysis temporarily, which is likely to be continuous (known as CRRT, or continuous renal replacement therapy). This is basically to take the workload off the kidneys while they recover from failure, if they recover from failure. 

Note: the rhabdo / kidney failure issue is optional. You could simply have him be admitted over concern for his kidneys; dark or tea-colored urine, low urine output, and bloodwork (elevated creatinine and BUN would do the trick). 

As for whether he’ll be on his stomach or his back, hospitals do not like having people on their stomachs. It will mostly depend on whether his burn is on the front or the back, as that will be the one most sensitive to pressure. He’ll likely wind up lying on his side most of the time. 

You talk about pain. One of the problems with polytrauma like this is that broken ribs and narcotics don’t mix well, but I have a feeling that your character will be given at least a few days worth of ketorolac (Toradol), plus an opiate like fentanyl, morphine, or hydromorphone (Dilaudid). 

So yeah. Long story less long, your character could spend up to a week or two in the hospital, and may have a lot more outpatient appointments, depending on that burn and the status of their kidneys. 

Hope this helps! 

xoxo, Aunt Scripty

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