Tuesday, October 12, 2010
Okay, so today was really day 2 in the burn unit, but I was tired yesterday, and fell asleep before I had time to post.  But day 1 was certainly more post-worthy that day 2... so we're just going to pretend.

I chose to do a rotation in the burn unit this year, because I did a rotation last year during surgery, and really loved it.  I chose to do one last year because I thought I was going to hate it.  Burns are one of those things that I was always afraid of, that seemed kind of mysterious, and seemed almost "beyond medicine", beyond help.  But during my month last year, I came to enjoy the surgeries, the medicine of taking care of burn patients, and the progress you can make with a burn patient, albeit slow, that gives them back a normal life. 

So yesterday, I headed up to the BICU (burn ICU) at the time I was told to be there, ready to jump right back in where I'd left off almost a year ago.  I was met with a situation I hadn't experienced last year.  Not only was I alone on the unit (there was a 3rd year med student, but neither the PA's nor physicians had arrived yet, but we had a patient who had come in overnight that they needed some direction on.  Normally this wouldn't be a problem, except this was a situation that I could do NOTHING about.

Overnight (around midnight), a patient came in after being pulled from a mobile home fire in which his home was burned to the ground, and he was pulled out by fire fighters after being found right inside the front door.  He made it from the ED up to the burn unit, but he had a "nonsurvivable injury".  Over 93% of his body had full thickness (3rd degree) burns.  He required a surgical airway in the field to ventilate him, his face was completely burned, part of his feet had been burned off.  The only part of his skin that remained intact was a portion of one arm and flank.  There is a score that we calculate that determines, based on age and percent burn, what the likelihood of death is in a burn patient.  His score was 149%, meaning there is a 149% chance of him dying from these injuries.  Given modern burn care, we actually can save people up to 120%.  But he was well beyond even that.  He we kept alive with comfort care while they tried to locate family, but after hours and hours of trying, we were not able to contact them.  Eventually, it was decided that it was inhumane to continue to keep him alive, and support was withdrawn.  He passed away less than an hour later. 

It's something to see, a person with injuries like that who is still alive.  The truth is, he would have lived a bit longer if we'd continued care.  But he was in excruciating pain.  And the body simply can not heal such huge wounds.  Infection, organ failure, fluid loss, huge metabolic needs; any number of things would have eventually taken his life. 

When I was in the BICU last year, we didn't have a major burn come in during the whole month (meaning >60%).  I hope we don't have another one for the rest of the month.  Today, we saw many more manageable cases.  People with smaller burns that we can treat, heal, and give back normal lives.  It's extremely satisfying to take a patient that, without care would most certainly die, and take them to the point that the only way to tell they were burned is to see the scars. 

I'm sure there will be many more stories over the next month, hopefully of success.

In the mean time, I'll leave you with some lessons learned on burns.  Please, heed this advice.  It's based on 2nd hand experience.

Don't, ever ever ever, smoke while wearing oxygen.
Don't burn the fringe off cut off jeans... while they are still on your legs.

Stay safe!


Sarah said...

I learned some of my most, "well DUH" lessons in the burn unit. Being in that unit all summer was such a tragedy, but at the same time I knew the families appreciated me.

Nothing prepares you for seeing that, though.

About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


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