Week Two: Child Burn Victim

Hello all,

The following is a report called a SOAPnote that I learned how to write at SOLO, the month-long WEMT (wilderness emergency medical technician) course I took earlier this summer. It is meant to inform the hospital with critical information about the patient, the injury and what was done to help. For the purpose of this blog, I think it is also an appropriate way to summarize a case that I have experienced.

 

Subjective:

Patient: Laydi Israel Oyagata Tuquerres

Age: 15 months

Chief Complaint: Burns with excruciating pain and discomfort from upper thighs to lower back.

Signs/Symptoms: Skin was red and blackened in some areas. One large blister formed at the bottom, inner section of the right gluteal region. Pieces of a green plant (from mother’s cooking) was stuck to the skin in a few places.

Events: Patient´s mother described her daughter falling back into the fire where she was cooking on Sunday, June 27. She was brought into the clinic two days later, on Tuesday the 29th.

No known medications or allergies.

 

Objective:

The height and weight of the patient were not taken, nor were its vital signs.

 

Assessment:

First and mostly second degree burns that completely cover the patient´s buttocks, reaching down to the upper thighs and up to the lower back.

 

Plan:

1. Remove dead skin and clean thoroughly, applying antibiotic ointment and a light dry dressing.

2. Prescribe antibiotic treatment to prevent infection.

3. Prescribe pain medication

 

Summary:

The girl that came in two days after she was burned was already at a huge risk for infection. Her family was very poor and their hygiene was not good. The patient was not wearing shoes, and her feet and legs were smudged with dirt. I held her feet as a form of restriction to keep them from bumping her burn or the nurse, Legia, while she peeled the dead skin away from the site and popped the blisters. It is important to remember that second degree burns are one of the most painful injuries possible because all the nerve endings on the site are severely damaged but still functioning. The patient, who was still too young to communicate, could only scream. Her mother, who had her daughter lying across her lap for the procedure, seemed strangely unfazed by her daughter´s excruciating pain. After the patient was bandaged and wrapped up, the mother was instructed to bring her daughter in the next day to re-clean and re-bandage the burn.

 

The mother did not show up the next day. The doctor, the nurse (Maria Ester, my host), and I walked from the clinic to their house where we found that the mother had taken the bandages off her daughter. She was carrying her daughter with no covering over the site. It was open to bacteria and drying out.

 

Although Maria Ester convinced the woman to come back to the clinic to clean and rebandage her daughter, the doctor was not supportive, and after the patient had left the clinic once again, I was witness to a conflict that I think is a good example of two major medical perspectives that clash. Do you, as a medical practitioner, put yourself first, or your patient?

 

The conflict was this: Maria Ester treated the child because she was concerned for its health (the burn had the beginnings of infection already), but it wasn´t her place, as nurse, to administer that treatment. That should have been the doctor´s decision. The doctor did not want to treat the patient because the mother had removed the patient´s bandages, which was against her orders. By treating the child after this, the doctor would then be putting her own name and practice in jeopardy. She would then be taking responsibility for the mother´s unadvised actions that could lead to severe infection, and even death.

 

I learned that as an EMT, in emergency situations, you´re first concern should always be yourself, then the patient, so the doctor was right in refusing to treat the child, and in doing so refusing to take responsibility for the dangerous actions of the mother. But does that change when your patient is a child who can´t communicate or defend herself, and the parent is already under pressure from poverty, and uneducated on the dangers of infection? Do you jeopardize your name and practice and work outside of jurisdiction to help, or do you take care and do your best to advise the mother--something that clearly had not been effective before.

 

I am left with these questions to ask myself. What would I have done as a medical practitioner in the same situation? It remains a difficult decision that I´m sure no one involved in medicine ever wants to be faced with.

 

Several days later, I stopped by the house again, with Maria Ester. Although we didn´t see the child again, her older sister informed us that the patient had been taking her medication and was improving. The mother never brought her daughter back to the clinic.

 

Thanks again for your support,

Ida