Cody

Abstract

Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.

Keywords: burns; psychosocial; rehabilitation; resuscitation.

Figure 1

Cody on admission at 0200 on February 2, 2011.

Figure 2

Phases of treatment.

Figure 3

Bronchoscopy showing mild erythema with soot in the airways.

Figure 4

Cumulative fluids administered in first 24 hours.

Figure 5

Urine output. OR indicates operating room.

Figure 6

Facial oedema 12 hours after admission.

Figure 7a

Cody's normal chest xray on admission. 7b. Pulmonary edema day 2.

Figure 8

Fall in PaO₂/FiO₂ ratio.

Figure 9

Chest and abdominal wall escharotomies.

Figure 10

Fascial excision of chest post burn day 3.

Figure 11

Lower extremities covered with allograft.

Figure 12

(a) Ectropion of lower eyelids. (b) Release of lower lid ectropions and full thickness skin-grafts. (c) Ectropions corrected, restoring protection of the cornea, a year after a surgery.

Figure 13

Infectious disease recurrence during a 500-day intensive care stay. The UTI indicates urinary tract infection; C. diff, Clostridium difficile infection.

Figure 14

Harvesting skin from the scrotum.

Figure 15

CEA place over 4:1 meshed autograft.

Figure 16

Legs suspended for 6 weeks using Steinman pins to decrease shear on CEA.

Figure 17a-17c

Progression of healing of anterior trunk.

Figure 18

Cody during therapy.

Figure 19

Percutaneous endoscopic gastrostomy tube in situ.

Figure 20

Video fluoroscopic examination showing no tracheal aspiration.

Figure 21

Delayed healing in lower back.

Figure 22

Back finally healed.

Figure 23

Cody rendered vertical for the first time since he was injured with the help of the tilt table.

Figure 24

Walking with the help of a platform walker.

Figure 25

Walking out of the hospital.

Figure 26

Persistent tracheal fistula B. Layered local flaps C. Wound closure.

Figure 27

Cody at his high school prom.

Figure 28

Cody's surgical and psychosocial progress to date.