Help - advice on burns dressing changes needed

[MummyMellie]

Can any of you knowledgeable people explain to me why it is necessary for a child to be in so much pain during burns dressing changes?

A month ago my DS, 3.5yrs, jumped at my mother just as she was moving a full cup of tea out of his way, and sustained extensive burns.

Many of his dressing changes are still being done under General Anaesthetic, but the few that aren't are truly, utterly awful. Even with oromorph and midazolam he is a terrified, screaming wreck - struggling, panicking and fighting like a wild thing to get away from the nurses.

I cannot believe that in this day and age, in what is apparently a leading Burns Unit, that this is the best that they can do. If I saw someone doing this to an animal in the street I would do everything in my power to stop it, and yet I am expected to hold my poor baby down while this goes on.

The nurses when I question them are full of trite, standard responses, while the leading consultant seems to have had a complete bedside manner bypass. I have had to fight so so hard to get the oromorph and midazolam prescribed for him - as if I didn't have enough to contend with at the moment!

Any info or advice would be so appreciated, I just don't know where to turn to.

Bumping for you

Another Bump

Oh the poor wee lamb. I read this earlier but couldn't reply.

Wounds and dressings are such a huge area even without a burn thrown into the mix.

Now I don't know very much about burns so can't comment on the dressings used. (Work with surgical wounds mainly). What I do know is that dressings can be painful for adults as well. Getting pain control on board before hand is key. When I'm doing dressings, I always ask how sore they are before I start. (And get pain killers first)

When is the pain medication being administered? If it's not early enough, it may not have kicked in and could be why he's so sore.

Another thing to query is the type of dressing, is it "stuck" so it takes a while to be removed in first instance? If so are they using anything to loosen the adhesive first? There are things available to make it come off easily but again may not be used with burns.

It's difficult to give you advice without seeing the wounds/dressing.

And as your poor boy is so traumatised by it all, that will be compounding everything.

No advice re the consultant other than asking for a second opinion?

Try and talk with the burns nurses again. They are the specialists. If need be ask to speak with the charge nurse.

Good luck

Hope you boy starts feeling better soon wee that he is

Thank you Springtimemama, I'll try them on Monday and see if they can help. Bigfudge - that's really interesting about the time lag with medications - he is having oromorph and midazolam, but it seems to be a bit hit and miss with timings as to when they give it and when they start doing the dressings. I'll try looking into it further and see if I can find out what the optimum time for doing the dressings after administration is - although we are always at the mercy of busy nurses so it is often down to when they can get to us.
The biggest problem seems to be that the gauze laid over the Adaptic silicone dressing still manages to get thoroughly stuck, as do the bandages over the top of it, meaning that even the slightest movement of the dressings tugs on the wounds. They have tried a slightly different dressing this time, so fingers crossed it will be better.
Thank you both so much for your responses!

It's so difficult to comment on dressings as each hospital uses different ones so I won't give any suggestions there. Sometimes it is trial and error. Which is heartbreaking for you to watch when it obviously causes your boy so much pain.

Meds wise, i give my patients oromorph and generally it can take 15 -30mins to kick in. Sadly everyone is different as to how quickly it wears off and when they need more. Midazolam is not something we use, so really can't help there. (Hopefully someone much more knowledgeable will see this and comment)

Is there a pain team in your hospital? Might be worth asking for them to be involved if so.

I'm sorry, I feel I'm not being helpful. If I could magic myself to you I'd gladly come and do his dressings!

Midazolam is used so the child doesn't remember the procedure, and perhaps provide sedation and reduce anxiety. It has different effects on people, I use it with children frequently. If it is not having this effect on your little boy op, there is no point using it. You need to ask to talk to the pain nurses or an anaesthetist about the best way to manage procedural pain for your child. A GA may not be right but it needs a team approach. Good luck.

Hmmm, 'Pain Team' or 'Pain Nurses' are definitely not something that we have come across yet. Will see if I can track them down.
Mazed, have you ever come across dependency / needing to constantly up the dose with Midazolam? This seems to be a major concern at this hospital, which surprises me as he is only having one dose per week and as yet we haven't had to up the dose - but they keep trying to halve it and it then doesn't work, so they then need to top it up with the other half. He is 16.5kg and the optimum dose (for chilled out and happy to have dressings done, but still lucid and awake) for him seems to be 8mg (hope I've got the units right, it is def 8 something and it doesn't look like mm in the syringe)
Bigfudge, am off to cast some spells so that we find you on the ward for our next dressing change on Tuesday!

Hope the dressing change goes more smoothly today. and for you

Hey Bigfudge, the cake was delicious and the flowers are gorgeous!
All went a little bit better today, mainly because I got up early and did it myself at home!!! We got through it and it took 2hrs 40mins from start to finish (including soaking off the stuck dressings) which is faster than it takes in the hospital.
It was still pretty stressful as he is just SO scared, but it was much easier to calm him in between the bad bits than it is in hospital. I was absolutely exhausted by the time we'd finished.
Another General Anaesthetic on Friday, but then it is the weekend and we are another week closer to the end - whenever that will be!

what is the name if the dressings they're using. we found mepitel better than the sticky burns dressings x

Aw the wee , nearly 3 hours though. Sheesh!

Make sure you speak to nurses before the dressing change on Friday to tell them how the change went. Hopefully they have another plan in mind.

Mepitel is a great product, (then an allevyn non-adhesive dressing with bandages to hold in place)

Your trust might not have these dressings but should have something similar.

Good luck for friday

Thanks guys - we used Mepitel dressings for the first time this week - they gave us the ones that are like giant plasters (will try and attach a pic - the one here is a much smaller version of what we have). They seemed to stick round the edges too much in some areas, and not enough in others - so I ended up bandaging over them anyway to try and keep them in place and so they kept relatively clean.
Tomorrow is another General - fingers crossed we are getting towards the end of these - but, while there is a small risk, it is less traumatic for him - so good in that respect!
Spoke to a burns charity this week who said it was unusual for a child to be in so much pain during dressings, and that most units deal with it really well. Then rang the hospital burns psychologist and she said she had heard we had been having a terrible time - not sure whether to be cross about this - why are the staff talking about it but not helping us, why didn't the psychologist come and see us if she knew - grrrrr!

Maybe ask for psych to come and have a chat with you/your little one. we got giant mepitel sheets (almost A4 size which covered most of her back then used smaller ones for her tummy etc. (she had scalded skin syndrome, so not actual burns but is treated the same way) she was given oramorph before each dressing change to start with. hope your little one improves soon.

we did bandage over the top too but with a very breathable almost gauze-like bandage.

How's your wee boy doing? Hope it's getting less traumatic for you both and the burns are healing nicely