Lessons from the Burn Unit

Spending a second week in the Burn Unit provided me more insight on burn patient care, particularly the social aspects of treatment. I followed attending rounds with both Dr. Roger W. Yurt and Dr. James J. Gallagher.

Burn injuries are quite unique in that they can be traumatic and result in patient disfigurement even after the most high tech treatments available. This can have impacts on patient care ranging from simple patient irritability to difficulties in obtaining patient consent for complicated surgeries. Needless to say, patient psychological status (as determined by qualified individuals of course) was high on the list for consideration during rounds.

In addition to some new patient arrivals, there were also some departures. It is not uncommon however, for a patient who was injured during a fire, to not have a home to go back to once they have healed. This can make patient discharge a tricky task, requiring physicians in the burn unit to work closely with social workers to ensure that patients can enter a safe environment once they leave the hospital. For example, a patient could be treated for minor burn or smoke inhalation injuries after their house burnt down, and then not have a place to go after leaving the hospital.

Also noted during rounds was how each patient received their burn injury. Causes ranged from spilled hot water or oil, to electrical shock, and even exploding aerosol cans. Some patient's injuries even resulted from them being assaulted, which I found shocking at the least. It is hard to imagine what would motivate an individual to do such a thing. If there is one thing I can take away from my time in the Burn Unit these past two weeks, its don't get burned!

On a brighter note, next week I will commence work on my first project related data on patients from the Neonatal ICU. I sense some advanced statistical analysis in my future...

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!