December 21st, 2007

Pediatric burn victim

1985, England

I've got a 4-year-old burn & accident victim I need help with. He has first through third degree fire burns on his face and one hand and lower arm, probably accounting for about 10% of his body; these preceded the accident by 15-30 minutes. He also has several fractured or broken ribs, a broken leg, a fractured skull, a concussion, and mild brain damage that will result in moderate nominal aphasia. Going from simplest to most complex:

1) What hospital in or near Manchester, England, would he be treated at? I'm looking for the one with a specialized burn unit. If there isn't one, where would he be sent?
--Googled terms: Burn Unit Manchester, Burn treatment Manchester

2) Would the lateral thighs be the probable donor site for skin grafts? If not, where would the grafts be taken from? Does the area the graft is taken from hurt?
--Googled terms: preferred donor site skin graft

3) How long will it be before he can be released from the hospital to specialized foster care (he will not develop infections or pneumonia)?
--Googled terms: recovery third degree burn pediatric, recovery burn pediatric

4) How much pain will he be in while recovering? What kind of pain management was typical for children, since it may have been believed at the time their nervous system was less able to feel pain? (Reference)
--Googled terms: pediatric pain management

5) Will the broken bones interfere with the burn treatment? What about the nominal aphasia, which will interfere with the child communicating with the doctors and nurses?
--Googled terms: none

6) Given that the child will be unconscious on arrival, what will he wake up to? Will he need to be intubated if he has no, or very mild, inhalation damage? What I'm looking for is how he'll feel and what he'll see on waking, how much pain he'll be in, and how awake he'll be with whatever drugs he may have been given.
--Googled terms: none

7) What would be a rough time line for his recovery? When do things like skin grafts take place? Pressure bandages? I keep reading both that it takes 10 days for a second degree burn to heal and that healing is a long, drawn out procedure.
--Googled terms: burn recovery timeline

8) What will will his 'routine' become in the hospital? He'll be fed a great deal of protein (how presented for kids?), have his dressings changed three times a day, etc. Basically, what is it like living in a burn recovery unit?
--Googled terms: burn recovery routine, burn trauma routine, burn unit routine

This ended up much longer than I'd intended once I broke it down - for the sake of reducing redundancy, please skim any responses already posted and don't answer questions already taken care of unless you disagree or have more detail, thanks!

For reference:
Immediate care of burn injuries: Stop, Drop, and Roll by Making Light
General burn injury information: Burns: From Treatment to Prevention
Burn treatment: RNs Provide Complicated Care to Burn Patients
Emotional stages of pediatric burn patients: Burn Recovery in Children
Burn recover post-hospital self-care: How to Recover From Treatment of a Third-Degree Burn
Initial management of a major burn I—overview, II—assessment and resuscitation