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#121 K. LeBlanc

K. LeBlanc

    Firefighter

  • Engine
  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted Yesterday, 01:46 AM

*As the doctor comes in, I put my phone down and I look up at him, still with my T-shirt wrapped up like a tank top on the one side and my tactical shirt across my lap.  When he asks about what happened, I figure that I'm going to make a joke out of it.*

 

'Well you see there was this fire...  And they're hot...'

 

*He's not laughing.  Serious dude.  Okay.  Two can play it that way.*

 

'Nah, what really happened was a compression burn or whatever.  I hit my shoulder against a door frame and it took the air gaps out of my gear and the heat burned me.  Or something like that, I dunno.  The turnout gear class doesn't teach shit here.'


Firefighter Kyle LeBlanc
Truck 7

Ex. Kimberly Volunteer Fire Department Member 730, Ex, SCFD Volunteer


#122 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 52 posts
  • Character Hometown:Reno, NV

Posted Yesterday, 03:28 AM

He seems to be in good spirits, that's good.

 

'Oh wow, I never knew it was just that easy to get burned through all that equipment.' I say legitimately astonished, 'Forgive me though, I'm completely ignorant to how most of the protective equipment works and what the weaknesses are. Eitherway...I'm sorry this happened, I'm sure the last thing you wanted to do today was be here today.' 

 

'Anyway, lets take a look at this thing.' I say as I get up from the stool.

 

*I see a loose cover over the right upper arm.*

 

That must be it.

 

'Is it your right side?' I ask as I move to the right arm. He confirms.

 

*I put on a pair of gloves and carefully start removing the cover over the burn area.*

 

'What's your pain level like?' I ask. 'On a scale from 0 to 10? 10 being unbearable.'

 

The cover comes off, revealing the burn. The whole thing is about 6cm in diameter, probably a little bigger than the palm of a hand. The core of the burn, which is the worst part is pale and almost waxy looking, with dark spots intermingled with it. It measures about 2-3cm. Around the central part of the burn is a larger area of red, raw looking flesh with curled thin peices of singed skin scattered about. It looks like they're starting to form tiny dew-drop like blisters.

 

How is he not in pain? He's probably still running on endorphins or adrenaline. The central part is definitely looking like a mix of deep dermal and full thickness, while the outer edges are partial thickness (2nd degree) fading out to superficial (1st degree) burns. He must be still running on either adrenaline or endorphins. While the full thickness burns typically don't hurt, the surrounding second and first degrees typically do. He's a tough guy, but I'm sure being exposed to open air right now isn't good feeling.

 

'Well....you got yourself pretty good here.' I say.

 

'Is this the first time you've ever gotten injured on the fire ground?' I ask trying to distract him a bit.

 

*I press on the inner portion of the burn. The central area does not blanch, it stays the same color. The outer area does blanch a little. He flinches.*

 

'Sorry about that.' I say as I continue.

 

Central portion is more than likely full thickness, outer edges are not. Lucky for him this is mostly 2nd and 1st degree

 

'You were wearing you full protective equipment? Your BA?' I ask.

 

'So you got burned, and were able to get out of the structure on your own?' I ask trying to make sure I understand the whole situation.

 

'You didn't get hit with debris, ot get knocked out or anything?'

 

*I begin checking his pulse in the burned arm and the uninjured for comparison.*

 

Good strong pulse. No vascular compromise. That's good.

 

*I grab a cotton swap out of on of the drawers in the room*

 

'Okay, close your eyes for me.' I say. 'Now I'm going to lightly touch you at different spots on your arm. Just tell me where i'm touching when you feel it.'

 

*With his eyes closed I begin touching the middle aspect (unburned) of the burned arm, then his outer and inner forearm and the palm and dorsum of his hand. I conclude with an unburned portion of the outer upper arm just below the burn injury. He is able to correctly and immediately identify each spot I lightly rub with the cotton tipped applicator swab.*

 

Good, neuro is intact.

 

*I place two of my fingers into the palms of both of his hands.*

 

'Okay now squeeze my fingers' I say

 

*I flex his lower arm to 90 degrees and have him pull towards him and push away. Both appear to be at least a little painful, probably because of the tension the contracting muscles are putting on the burnt skin.*

 

Good motor strength. I'm not worried about a compartment syndrome. Things are not looking too bad.

 

'Are you breathing okay? No coughing? You didn't inhale any smoke or get any fire or extreme heat in your face did you?' I ask as I reach for my stethoscope. 

 

*I have him take some deep breaths as I listen to his lungs*

 

All clear.

 

*I listen to heart sounds.*

 

Regular rate and rhythm. 


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#123 K. LeBlanc

K. LeBlanc

    Firefighter

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  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted Yesterday, 07:04 AM

*When he apologizes that I'm there, I nod.*

 

'Yeah, thanks.  First good fire that I get to go inside on in a few years actually and I end up getting burned.  I guess I lost some of my badassery playing mathematician at the engine.'

 

*When he asks if it's my right side, I nod.  I guess the sleeve rolled all the way to my shoulder isn't enough, but he's going his job.  I get it.  When he asks what the pain level is, I take a second before I answer.  Part of it is to figure out what the number is also also part of it is for me to figure out if I want to say it.  I'm not one for pain meds, but It's not the most pleasant.*

 

'I dunno.  It's at least a 5.  Probably like a 6 I guess.'

 

*I try and look over as he's doing his examination.*

 

'Yeah this is the first time I've had to go to the hospital, that's for sure.  Like I said, I haven't been in that many fires before.'

 

*Right as I finish, I look back straight again when he starts poking me like a lab rat, but it's his job so I get it.  When he hits near one of the blisters, I eyes go wide as I let out a short grimace.  He apologizes and I shake it off.  When he asks about my "BA" and all of my gear, I laugh.*

 

'The only person I've ever heard the term BA from was a retired Navy guy.  But yeah, I had all of my gear and my airpack on.  Otherwise, I'd probably be unconscious.'

 

*I try to chuckle just to lighten the mood.  He then asks about getting out of the building.*

 

'Yeah I mean all I did was run into a door frame.  I got out fine.  All it was was crawling to the ladder and coming out of the sill.'

 

*Next is the head injury question.  Figured.*

 

'Nah, just the damn door.  Structurally it seemed like it was good while I was in there at least.  I am curious as to what the hell was burning in there.  That thing was took off while I was in there.'

 

*As I start getting swabbed this time, I start calling out where he's hitting me.  Of course it's basically 'upper arm, forearm, and hand' but message received I guess.  I then do basically the same thing that I've had to do with the department physicals.*

 

'Nope breathing's fine thanks to the good people at Scott.'

 

*I reference the air pack distributer as he checks my lungs and then my heart.  I sit back and wait for what he's got next for me.  Hopefully he can do whatever he needs to do and let me go.  Main thing I know about burns is cool water and time to heal.*


Firefighter Kyle LeBlanc
Truck 7

Ex. Kimberly Volunteer Fire Department Member 730, Ex, SCFD Volunteer


#124 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 52 posts
  • Character Hometown:Reno, NV

Posted Yesterday, 11:42 PM

*I smile at some of his answers, but try and keep things moving*

 

*I ask about his past medical history, allergies, and ask about any prior hospitalizations or surgeries.*

 

Nothing, except for a history of sinusitis.

 

*With my physical exam complete, I begin explaining my findings*

 

'Alright, so the burn on your arm does indeed have a central part that is full thickness, or third degree, but the majority of it..'

 

*I start to gesture around the burn*

 

'...is all partial and superficially burnt, meaning they will heal just fine on their own. This full thickness part, unfortunately, will not heal on its own unless a skin graft is performed...otherwise it just scars over.

 

Unfortunately your particular burn is too large for me to make the call as to whether we just let it scar over or if a skin graft is warranted. So what I want to do is call one of our burn specialist surgeons down to take a look, and he or she can give you a definitive answer as to what the best course of action is going to be in your particular case. I will say that from my personal experience with similar cases, the surgeon will probably recommend a skin graft, especially given it's location.'

 

*I pause for a moment before continuing*

 

'As far as everything else is concerned, you're in good shape. It's pretty localized and your strength and sensations are all good, but I do want to give you a tetanus booster. It's pretty much standard practice that every burn patient gets a tetanus booster, unless they've had one within the last year....Have you?'

 

After I get my response I continue on my long winded rant:

 

'Okay. Before I go, I just want to take a second to kind of give you the low down on what's probably going to happen. As you probably have noticed, we're a bit busy in here tonight, so. I honestly don't know how long it's going to take for the surgeon to come and see you. If they're not busy they can be here pretty quick, but my guess is that's not likely. So instead of having you stew in here just wondering without a clue as to what's going to happen...I'd like to offer you what I think will probably happen based on similar cases I've seen.'

 

'As I said before, they're going to probably recommend the skin grafting or some similar procedure. However, the good thing is I can almost guarantee you'll be going home today. The surgeon will clean the burn, get rid of all the dead skin and debris, and bandage it up with antibiotic dressings. They'll let you go home and follow up again in the clinic with them within the next 2 to 3 days to talk specifics if a procedure is warranted.' I say.

 

*I pause, and get up from the stool*

 

'Can I offer you some medication to take the edge off of any pain you have? Or are you doin' alright?' I ask. 

 

He seems to be doing okay, at least based on his demeanor. If he refuses, I hope the surgeon can at least convince him to accept a short-acting pain killer before they debride the wound, because that is a very painful process.


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital

#125 K. LeBlanc

K. LeBlanc

    Firefighter

  • Engine
  • 185 posts
  • Character Hometown:Cumberland Ridge, Kentucky

Posted Today, 02:45 AM

*Shit.  Here comes the skin grafts.  Lovely.  When he asks about tetanus, I shake my head.*

 

'Nope.  I got a booster 2 years ago.'

 

*When about waiting longer in the hospital, I shake my head.  Figures.  I mean I can't blame them, but Every time I've ever been to a hospital or known someone in a hospital, it's been a delay.  Now that I'm getting a surgeon's opinion, I guess it's more serious than I thought.  I mean it never did look good, but still.  When he asks about any medication, I shake my head.*

 

'Nah, I'm good for now.  I definitely want something though when they go to do whatever though.  I've heard that sorry story before.'

 

*He finishes up with me and heads out as I pull out my phone and update my parents.  I think for a second before I flip over to Ariana's text thread.  Once I finish sending her the message, I look down at my legs for another minute.*

 

'Shit on this.'

 

*I carefully get up, careful to avoid hitting anything or messing with any of the IV tubing.  I carefully work my bunker pants off so that all I have on is my station pants.  I set them up like normal, except now with the suspenders between the boots before and I put them on the foot of the bed with my legs going off to either side while I wait for the next person to come in and tell me what I need to know.*


Firefighter Kyle LeBlanc
Truck 7

Ex. Kimberly Volunteer Fire Department Member 730, Ex, SCFD Volunteer


#126 Dr. Grant

Dr. Grant

    EMS Physician

  • EMS


  • 52 posts
  • Character Hometown:Reno, NV

Posted Today, 05:00 AM

After exiting the room I proceed to the nurse's station and hop onto the computer and start typing up my note.

 

*I look at the clerk*

 

'I need a burn consult for room 41, would you mind paging them for me, please?' I ask as I continue typing my note.

 

She gives me a little bit of a look and then picks up the phone.

 

I continue about my work. I finish my note on the last patient and start looking at my others. I go and examine another patient and return about 8 minutes later. As I'm writing up my note for that patient my hospital-issued VOIP phone rings.

 

*I pull it out of my coat pocket and answer it*

 

'ER, Dr. Grant' I say.

 

A sweet, young female voice replies on the other side.

 

'Hey Dr. Grant, this is Dr. Romano, I heard you have a patient that needs a burn consult?' she replies.

 

She sounds....cheery....not like your typical surgeon. Usually when I ask for a consult I get attitude and passive-aggressive undertones. Ok...maybe not all the time...but it seems to happen all the time. Everyone hates the ER doctor...all he does is give everyone else more work.

 

'Hey Dr. Romano, yes, I have a 21 year old male firefighter who was burned on the job. He's got a localized, well circumscribed, thermal burn about 6cm in diameter on the lateral aspect of the right upper extremity. It looks to be mostly partial thickness but it has a central area of full thickness burn about 2cm wide....' I continue and give her the run down on the patient.

 

'[Sigh], okay...I've got a couple consults ahead of him, it seems like everyone decided today was a good day to play with chemicals and hot things. We're swamped up here. I'll be down as soon as I can, but I have to warn you, it might be a while.', she continues, 'How's his pain level?' she asks.

 

'He's a trooper, I'll give him that. Not a single drop of analgesics since he's been here. He seems to be handling it well.' I reply.

 

'Okay, well....I'll be down to see him as soon as I can.' She says.

 

'Thanks for your time.' I reply. We say our goodbyes and I hang up.

 

*I continue my work.*


Dr. Christopher Grant, DO, MPH
Associate Medical Director, Shiloh County FD (MD - 2)
Attending Physician
Emergency Medicine
Shiloh County General Hospital




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