Question

tasked with assessing Dax’s capacity and making a recommendation about what should be done going forward.

Dax is an athletic, 25-year-old Air Force reserve pilot. His dream is to become a commercial airline pilot, and while awaiting further training he has been helping his father who works as a real-estate broker. Just over a week ago, Dax and his father drove to a rural property in order to appraise some land. When Dax and his father were finished assessing the land, they returned to their car only to discover that it wouldn’t start. Dax’s father went around to the front of the car and opened the hood while Dax sat in the driver’s seat, attempting to start the ignition. Unbeknownst to the men, a corroded pipe from an oil refinery lay below the property, leaking propane gas into a nearby creek bed and the surrounding valley. When Dax and his father finally succeeded in getting the car to start, a spark shot out from the carburetor, igniting the propane that had been collecting in the valley. Without warning, a fiery explosion erupted all around the men, trapping them in a fiery inferno. Instinctively, Dax sprinted from the car but was forced to hurl himself through three walls of fire before finally collapsing on the dirt road in what can only be described as “unimaginable pain.” A passerby saw the explosion and quickly drove over to help. Upon discovering Dax laying in the road, the man approached to offer aid. But to his surprise, Dax simply asked him for a gun, crying out “I’m a dead man. Can’t you see I’m a dead man? I’m going to die anyway. I’ve got to put myself out of this misery!” The man compassionately refused Dax’s plea and called for an ambulance. While en route to the hospital, Dax refused all treatments and watched as his father died from his injuries. Once the ambulance arrived at the hospital, the burn-unit medical team immediately began treating Dax, despite his continuing objections and refusals. They assessed Dax as having second and third-degree burns to over 65% of his body, including to his face and hands. Dax’s injuries are so severe that they render him unable to move, making him unable to physically resist and forcing him to be completely dependent on the care of the medical team. When questioned about the decision to treat Dax’s injuries, the attending physician explained that “burn victims almost always refuse care initially, due to the pain and shock of the situation, but later come to accept that the care was in their best interest.” Treating severe burn injuries, like those Dax sustained, can take up to a year in the hospital. If the treatments are continued, there is greater than an 85% chance that Dax will live, but he will never regain his sight and his hands will likely have to be amputated. If his treatments are stopped within the next few days, there is greater than a 90% chance that he will contract an infection and subsequently die. This information has been clearly communicated to Dax, who has now been a patient in the burn unit for eight days. He acknowledges that he will die without treatment, yet each day he continues to assert that he wants the treatments to stop, explaining that being submersed in the Clorox bath feels like torture and that the daily changing of his bandages feels like he’s routinely being “skinned alive.” Although Dax is being given medication to help manage his pain, the maximum allotted dosage is inadequate to deal with the severity of his injuries, and the treatments are necessary for preventing infection and allowing his skin to heal. Dax’s mother, Ada, is the only close family he has left. The doctors met with Ada on the second morning of his hospitalization, and she was adamant that they do everything possible to keep her son alive. She reminded them that she just lost her husband in the accident, and that she’s afraid of losing her only child as well. She also talked about his plans to become a commercial pilot and all the enthusiasm he had shown for the future, as well as the fact that she “wants him to have time to realize his responsibilities to God, and to come to the realization of what he should be doing.” As a devout Christian, she says that it’s important her son doesn’t die before accepting the teachings of her church. Yesterday, during Dax’s seventh day in the burn unit, a nurse asked him about his repeated refusals of treatment. She again explained how important the treatment was for his recovery, and Dax confided to the nurse that “it’s not that I don’t want to live, but I don’t want to live in the pain, and I don’t want to live in the physical condition I’ll have to live in – completely dependent on other people.” Dax recognizes that without use of his sight or his hands, he will have an extremely difficult recovery and an uncertain future if he survives.

Answer 1

It is common to feel anxious or upset after a traumatic injury. Burns can put tremendous stress on the patient and family. But here the Dax feels both of loosing the father's plus own physical condition.

Burn team include psychologist and psychiatrists who can help with feeling and concern psychiatric and psychological services address issues like depression ,anxiety , post traumatic stress, addition and sleep problems. Social services can help families with managing housing , finances and navigating the healthcare system.

Rehabilitation us the process of using education and therpy to help a patient reach his or her maximum potential for recovery after an injury . Rehabilitation may also include physical therapy or occupatioal therapy.

Physical therapy treats physical impairment . It aiito improve a person ability to walk and move , do daily tasks and live independently . Treatment may include exercise , splinting , bandaging, medicine and use of assistive devices ( such as crutches or walkers)., Massage and joint mobilization.

Occupatioal therapy uses everyday activities band materials to help patients in their own recovery . For example, a patient could practice's dressing , bathing and feeding themselves or cooking.

Speech - language pathology helps swallowing, voice , cognitive issues and communication.

Several types of facilities provide rehabilitation services to patients with burn injuries.

A burn center often provides intensive physical and occupational therapy during acute hospitalization. The burn team will also follow the patient long term , prescribing additional therapy if needed.

An inpatient rehabilitation facility is a special designed Medical rehabilitation facility . Patient stay at the facility full time after discharge fron the burn center and must be able to do at least 3 hours of therpy per day.

A skilled nursing facility is a place where patients may go after they leave the burn center. Patient live in these facilities and receive medicalband nursing care to help them recover.

An outpatient rehabilitation center us a medical facility that provides physical and occupational therapy services to orovide who are living at home

The recovery process differs for everoneveryone . Most patients report feeling pain , fatigue and itching during recovery and rehabilitation.

• Pain is common. Third degree burns are painful with deep pressure. Second degree burns are painful with an air movement or changes in temperature. First degree burns are painful on the surface of the skin. Health care providers treat pain in different ways.
• Fatigue is common. The more severe the burn injury , the greater the level of fatigue.
• Itching is a common part of the healing process. Moisturization and antihistamines can help make the burned area less it hy . Patient should never scratch their wounds.

Patient may have atough time dealing with these symptoms. But health care providers can offer at least some relief. Patient should always let health care staff how they feel.

In addition to care from medical staff , patient can also draw support fron family and friends. Visitors and caregivers play an important role during the recovery process. It is important for family members and friends to also take care of themselves. ( For example, housing, food and care of children) . It can be helpful to coordinate visiting times amongst friends and family members.

Family members should also assign one person to be the main point of contact bwith medical staff .