When clinicians at the University of Washington Burn Center assess the damage to an incoming victim, they're considering more than the terrible wounds they have to quickly treat. They're also concerned about the shock to the patient's system.
The key to preventing complications involves accurately diagramming all the wounds and precisely calculating the total percentage of body surface that's burned. Normally that's done subjectively by eyeballing areas of a diagram shaded in by hand.
But a new computerized diagram uses a mouse as a "pen" to record burns on a computer workstation and automatically calculate the percentage, says David Jaffe, executive director of Harborview Medical Center in Seattle, where the burn center is located.
The joint software development project between Harborview and nearby Boeing Corp. has improved the reliability of these calculations, which are crucial to determining precise fluid requirements to keep a patient stable, Jaffe says.
A person with deep burns over more than 20% of body surface can suffer a life-threatening fluid shift. Averting that shock involves massive infusions of fluid to keep blood pressure up, heart rate down and the cardiovascular system stable during the first 24 hours of the injury.
But the amount of fluid is based on a formula that plugs in the precise percentage of burned body surface. Too little fluid could lead to life-threatening shock from insufficient blood circulation. Fluid overload could cause heart failure.
Now when a burn patient is admitted, a clinician pulls up a blank human figure on the computer screen, draws a picture of the patient's burns by shading according to the depth of the burn, and then enters the patient's age and weight. The resulting calculation also adjusts for differences in adult and child anatomy, Jaffe says.
Diagrams are redrawn every week or when dressings are removed after skin grafts, giving physicians easily accessible updates on the progress of healing. By contrast, "the old paper diagrams were posted near each patient's door and they often got lost, soiled or out of chronological order," Jaffe says.
Included with every visual display is a statistical report that divides the body into about 20 sections and lists the percentage of each section that is healed, grafted or still burned.
Other areas of the hospital also rely on the diagrams for decisions based on the total surface area of unhealed skin. For example, the more severe the burns, the greater the intensity of patient care required. While intensive care would be necessary for a patient with a high percentage of burns, the hospital needs to be able to transfer the patient out of intensive care as healing progresses, Jaffe says.
Since the burn diagrams debuted at Harborview in November 1994, more than 900 have been drawn for more than 300 patients, he says.