Tuesday, July 6, 2010

Finding relief from the heat

This third week of Immersion Term brought me to another ICU, arguably one of the most traumatic in NYP: the Burn Unit. I spent the week making daily rounds led by (one of) the attending physicians Dr. James J. Gallagher, Dr. Palmer Q. Bessey, and Dr. Roger W. Yurt, along with the current fellow and resident doctors.

I learned that there are several facets to treating burn patients. Physicians must always keep in mind that in addition to treating the burn, they must also treat the patient, as burn injuries are capable of causing a wide array of secondary conditions. A patient's burn is generally characterized by two parameters: severity (how deep the burn is) and location. These two factors taken together are used to determine what kind of treatment to use. Superficial burns that are not very deep, such as first degree burns, will usually heal on their own. Partial-thickness (second or third degree) burns however, may require some amount of surgical skin grafting to ensure proper closure, depending on their size. Skin grafts primarily come from four sources. Autografts are skin grafts sourced from locations of healthy skin on the patient; allografts are sourced from other humans, usually cadavers; xenografts are from other animals, usually pigs; and synthetic grafts, such as Integra, are made from bovine collagen. The type of graft used depends on the specific case, and it is not uncommon to see more than one type used on a particular patient. This usually occurs with patients that do not have sufficient "donor sites" to create autografts from, in which case allografts will be used complementarily. Each type of graft also has specific healing mechanics and wound closure properties (e.g. full thickness grafts tend to not contract as much as partial thickness grafts). I also found it surprising that surgeons use mechanical adhesive methods (such as stitches/staples) but do not use any kind of chemical or biological adhesive to attach grafts to the wound site or enhance healing.

I also learned that there are several secondary effects that result from larger burns (these are usually addressed after initial fluid resuscitation). First is evaporative fluid loss, which can be counteracted by placing the patient on the correct amount of IV fluids. Second is the risk of infection, as most third degree burns develop some kind of an infection within 5-7 days. This means that any patient with a severe burn will usually receive antibiotic treatment. Another aspect is pain management. Most patients are given some amount of pain medication, which can also cause constipation. As a result, these patients must also receive a specialized diet or even other medication to ensure proper gastrointestinal function.

This week in the burn unit has been very interesting to say the least, and I'm looking forward to what the rest of Immersion Term has in store for me!

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