Burn Surgery

Hi there folks,
I have been doing a rotation on Burn Surgery for the past few weeks. It’s an uncanny mixture of Trauma Surgery and Plastic Surgery. I have become totally comfortable taking care of patients with 90+% burns, something that I was dreading when I started this rotation.
My Burn Unit is located at Metro Hospital, the busiest Level I Trauma Center in Ohio. It is one of the most specialized units that I have ever worked under any circumstances. The nurses are awesome and helpful at every turn. They know the dressings and treatments with such great depth that they have been my best resources.
Burn patients are among the most stressed that anyone will ever encouter in medicine. Nothing reves up metabolism like a full thickness burn. I am constantly amazed at the metabolic capability of the human body even in the elderly.
The resuscitation phase is the beginning of dealing with the multitude of complications that can happen when you lose your skin. You can’t imagine how important the skin is for thermoregulation, water retention and most importantly protection. After the initial resuscitation, we move into debridment and grafting.
In a patient with just 30% TBSA full thickness burns, the grafting took more than six hours to complete with five people working at the same time. We used autograf and allograft to cover the burned areas after we had excised the eschar two days before and covered the area with Biobrane (a synthetic covering). We work in ORs that are heated to more than 85 degrees. I come out soaking wet and dehydrated after the five-hour plus cases.
My plastic surgery techniques have improved dramatically. I have been very fortunate to work with two of the best burn surgeons ever. One is Burns and Trauma while the other is Burns and General. Both have been wonderful teachers and have increased my skills exponentially. I have also learned good techniques in critical care managment too.
Our outpatient clinic is open 24/7 and patients may come for dressing changes or medications. There is always a burn nurse and resident available for taking care of these patient’s specialized needs. The Emergency Department refers all burns immediately and will not attemp to treat any of them.
I also have a date to fly on the Metro chopper in the upcoming weeks. I am looking forward to being an flight trauma surgeon. I was chief on Trauma/Critical care last month and to the Burn Unit this month. Surgery is just about the most fun that anyone can have and I am thriving here.

I am always amazed and intrigued by your experiences. When I worked at Albert Einstein (many, many years ago), I used to watch the trauma and plastic surgeons when they worked on burn patients.
I can visualize you doing a really great job and I know your patients will love you.
Can’t wait to hear your experiences on the chopper!

Thanks for sharing your experiences. It sounds like you are having an incredible time–thanks for helping keep the movitavtion in those of us who are still in the early stages of the process.

Hey Folks,
I got a chance to fly in the Metro chopper. What a blast and what fun to view Cleveland from the air. The best thing was that I knew what to do when we landed.
It was great to take care of the patient from accident scene to ER Trauma bay to OR and then to ICU. Surgery is just the greatest!
Only five more days left on Burn ICU

That is so cool Natalie! Thank you for sharing your experiences Before returning to school I was a volunteer in the burn unit at Harborview Medical Center in Seattle. It was an incredible experience! In addition to burns, the unit also handled major wound care so I got to see some very interesting cases (necrotizing fasciitis etc.)

I love your posts. You breath such life into an email!
I have a question re the role of docs in the helicopter. Do they normally put an M.D. into those? Or is the staff specially trained R.N./EMT mix?

Hi there,
Metro routinely puts physicians in the chopper if they wish to fly. I can tell you that most do not like the chopper. Flying is also very time-consuming and most physicians just don’t have time to take 90 minutes or so to ferry patients when the job can be done much cheaper by EMTs and RNs. It is mostly a cost issue.
A few of the docs enjoy flying as a change of pace and schedule it into their week. It was great fun but I still do my best work under bright lights with cold steel.