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Janis Harrison RN, BSN, CWOCN, CFCN pheasantnurse@harrisonwoc.com Harrison W.O.C. Services L.L.C. 103 S. Main St. PO Box 226, Thurston, NE. 68062
Clinical Problem
4 adults and 1 pediatric patient presented with painful trauma wounds managed in an emergency department (ED). Patient 1: right foot crush injury affecting the 1st and 2nd toes. Patients 2 and 3: 2nd degree burns affecting the face near the eyes. Patient 4 (2 yr old): 1st and 2nd degree burns affecting the hands and legs. Patient 5: 2nd degree burns affecting the right arm and hand. All patients’ pain rated from 3-10 initially (0-10 scale).
Initial Management at ED Visit
Patient 1: standard Polymeric Membrane Dressings, (PMDs) wrapped around the toes. Patient 5: silver PMDs applied and patients 2, 3 and 4: silver sulfadiazine (SSD) applied.
Current Clinical Approach
After discharge, all were referred to the outpatient wound clinic and seen within 1- 3 days. PMDs replaced SSD to help reduce patients’ wound pain. There were concerns regarding SSD migrating into patients’ 2 and 3 eyes and with patient 4 (2yr old) rubbing her eyes and putting fingers in her mouth. SSD can damage eyes and mucus membranes, and may be harmful if swallowed. Patients had silver PMDs applied. No further manual cleansing was required after initial removal of SSD, as PMDs continuously cleanse. Dressing changes were decreased from 2 to 3x per day with SSD to every 2 to 3 days with PMDs.
Patient Outcomes
All wounds reached closure with PMDs. Pain was reduced to 3 to 0 (0-10 scale) for all patients. Once PMDs were applied, patient 4 (2 yrs old) was no longer in emotional distress, stopped crying and allowed the dressings to be changed. Reduced frequency of PMD dressing changes reduced disruption of the wound bed. PMDs facilitated blister reabsorption, debridement and reduced scarring.
Conclusions
PMDs provided an optimal healing environment. PMDs are the standard protocol of care in the ED.