Early this week, Dr. Bessey and I finally decided on a topic
for my summer research project. When a person experiences a serious burn, their
organs and tissues can undergo a hypovolemic shock, when a total volume of
blood falls below normal level. This phenomenon deprives tissues of oxygen
while also allowing build up of waste products. While many organs are affected,
one of the most dangerous consequences is respiratory distress or failure. The
patients experiencing lung failure require mechanical ventilators. According to
a respiratory therapist, all adult patients with respiratory distress syndrome
use airway pressure release ventilation (APRV), while infants and children use
various different types (e.g. oscillators, etc). My project will involve
looking through current as well as past patient records to determine the effect
of the different modes of ventilation in patient recovery. I have thus far
spoken to two respiratory therapists, who also showed me the different types of
ventilators used in the ICUs and the mechanism through which they work. I am
waiting to be cleared for the use of Eclipsis, which contains all the patient
data I will need for my work. I expect to be able to access them by sometime
next week.
I
watched a few surgeries this week, many of which were routine skin grafts. It
seems most of the skin grafting surgeries are very similar. I think I will try
to see contact other surgeons to see if I can watch some other types of
surgeries as well. One of the other surgeries was on a patient’s foot. He had
diabetes and edema on his feet. He also had ulcers on the bottom of his feet,
which had bad infections. I also noticed other open wounds on his legs, which
Dr. Bessey explained was due to poor circulation caused by diabetes. He was
also having trouble breathing and his kidneys were doing very poorly. Before
treating the ulcers, Dr. Bessey first got deep tissue and bone biopsies. This
procedure was interesting because I realized that in the midst of the
cutting-edge technology, some surgical procedures were still very rudimentary.
In order to get bone samples, Dr. Bessey cut into the ulcer and used a device
that looked very similar to pliers to break off a piece of bone. This surgery
also involved the first allografting that I have seen. Because the patient was
in such critical condition, Dr. Bessey decided against autografting. The donor
skin pieces were kept in a liquid nitrogen tank before being taken out to
create pores on them. The rest of the procedure was exactly the same as the
other autografts I’ve seen.
At
the clinic this week, I saw many of the patients that had just been released
from the burn ICU last week. They were coming back for follow-ups to check the
grafts were being taken well. Among them was a patient that seemed to have
gotten dependent on the painkillers. She demanded to be given oxycodone and
when Dr. Bessey suggested using milder painkillers, she became very angry. It was interesting to see clinicians
dealing with such situations outside of treating patients. Another patient came
in with some serious gout and what he claimed was ‘a rock growing on his toe’.
Indeed, he had a crystal as big as a nickel growing out of his third toe. After
sterilizing the foot, Dr. Bessey removed the crystal and sent it off to a lab
for analysis. Dr. Bessey didn’t know at the time if the crystal was due to the
high concentration of uric acid in the blood associated with gout, or it was
something else.
Similar
to last week, I attended rounds with Dr. Bessey, Dr. Yurt, and Dr. Gallagher. I
also attended a research presentation and a multi-disciplinary meeting.
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