Burn Injuries

HI EDC!

We are so close to being finished with medical school – I am finally feeling the weight of that thought and getting excited about graduation. 🙂

My final surgical elective was in the Burn Unit at a local hospital. It was a very busy rotation; from pre-rounding at 5am, rounding at 6am, a very full panel of patients, and surgery MWF, there was a lot going on. Overall, I really enjoyed this rotation. I am fairly non-surgical, but having the opportunity to observe application of various skin grafts to 50% total body surface areas (TBSA) burns was pretty cool. I will not miss the 90 deg temps in the OR though. Burn surgery ORs are kept at least 85 deg F for patients with large burns because of the tremendous loss of heat from the absence of skin. It gets gross under surgical gowns quite quickly.

Some highlights of this rotation:

  • Working with a large team of residents: 4 Interns (1 ortho, 2 gen surg, 1 EM), 1 gen surg pgy-3, and 2 fellows. Plus me, tagging along. We were a big group and everyone’s roles changed weekly.
  • Surgery on Monday, Wednesday, Friday: burn cases would take up to 4 hours depending on the extent of the burn injury
  • Clinical rehab psychologist on site. Many burn injuries result in PTSD from the injury or may be the consequence of behavioral issues (drug use, violence/abuse). Rehab psychologists are quite rare in hospital settings, but essential – especially in the burn unit. The majority of the cases were tragic and having a resource for patients coping with serious life changes was instrumental for their treatment and long-term prognosis. Patients that believe that life can get better, after severe tragedy, are ones that will do better with their burn/wound care and have the best outcomes.
  • Patient cases were complex and a many of them were the result of homes catching fire. When your home is destroyed… what do you do after? These are really unfortunate cases and many times patients live in transitional housing or if they’re lucky will live with friends/family until they can obtain stable housing.
  • Patients were very sick, and not necessarily because of their burns. So much of how well someone does is based on their health status prior to hospital admission. If someone has chronic peripheral vascular disease, poorly controlled diabetes or regular diabetes, meth use (this one’s huge), poor nutritional status (alcoholism, Crohn’s disease), or any autoimmune process then the ability for wounds to heal is significantly impaired.

I am really glad to have had the opportunity to participate on this service as I think this is a really unique surgical specialty and one in which more attention should be paid. But I’m biased now. 🙂

Until Match Day,

N

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