Ms Eliza Palfery¹, Ms Megan  McKenchie

¹The Alfred Hospital, Melbourne, Australia

Abstract:

This presentation will explore the treatment journey of a 40-year-old man who was admitted to The Victorian Adult Burns Service at the Alfred Hospital, Melbourne, after attempting to retrieve a drone from high power voltage lines using a cherry picker.  The patient was exposed to high-voltage electricity and sustained 25% TBSA flash flame burns to his face, neck, chest and bilateral upper limbs.

This patient presented with a complex medical past history which required clinicians to alter their approach to care significantly.  This included large cell lymphoma, left subdural empyema, left frontal craniotomy, traumatic brain injury, and an iatrogenic dependence on benzodiazepines and opioids on high dose opioid agonist therapy, Suboxone.  In particular, this patient had significant difficulties with frustration tolerance and distress associated with crippling anxiety around medical procedures.  He would use aggression and, at times, threatening behaviour in order to communicate his needs.

During the prolonged admission the team faced a range of challenges across multiple domains of his care; from extubation in ICU, through to alterations to dressing change plans, engagement with allied health and now ongoing management in the community.  A collaborative approach was adopted between multiple specialist teams; the burns multidisciplinary team (including medical, nursing and allied health), acute pain services, consultation and liaison addictions and psychology.  Through adopting such a collaborative and flexible approach to care this man has been able to remain engaged in both community and inpatient based treatment which is likely to continue for some time.

Biography:

1) Eliza Palfery; is the Pain Liaison Nurse Manager who has been working as an acute pain CNC, she has extensive experience in burns.

2) Megan McKenchie is an addiction psychiatry NP who currently coordinates the Alfred Health CL Addictions service. She has extensive experience across both acute, community settings.