Dr Mia Jung1, Dr Varun Harish1, Dr Aruna Wijewardena1, Professor Ian Kerridge1, Dr Rowan Gillies1
1Royal North Shore Hospital, St Leonards, Australia
The management of a severe burn injury in Jehovah’s witness patients poses unique challenges. There is a paucity of literature available guiding management of these patients. We present our experience with 2 consecutive severely burn injured Jehovah’s witness, and review the available literature.
Two adult male patients presented to our Unit with industrial flame/flash burns from a waterproofing glue explosion. A 22-year-old male with 58% TBSA burns and a 21-year-old male with 32% TBSA burns were discharged home 57 days and 54 days post-burn, respectively, after complete wound coverage.
A multimodal medical and surgical approach is suggested. Patient engagement in decision-making and clarification of an advance care plan should be instituted early. Medical perioperative strategies are directed at reducing blood loss and optimising haematopoiesis, and include alternative blood collection regimes (e.g. paediatric vials), reversal of coagulopathy, administration of tranexamic acid, prothrombin and fibrinogen concentrates, regular erythropoietin, and augmentation of iron metabolism. Surgical strategies include staged aggressive burn wound excision to a fascial level where feasible, tumescent high concentration adrenaline-based infiltration of burn wound excision and donor sites, application of limb tourniquets, and the use of argon beam coagulator ablation.
Our two patients were successfully treated without significant morbidity, and were discharged significantly sooner when compared to similar injuries previously reported in the literature.
Dr Mia Jung is a plastic surgery registrar based in Sydney, NSW. She was an unaccredited burns and plastic surgery registrar at Royal North Shore Hospital in 2020 which reinforced her interest in the care of the burn injured patients and in reconstructive burn surgery.