Spencer Park Wk4

Surgeries

I was in the OR for a few very long surgeries this week.

Motorcycle accident patient

-                When he fell, he crashed into his friend and his fuel tank caught on fire.

-                He experienced bad burns on both his legs and his buttocks.

-                The surgery involved extensive allografting on both of his legs and his buttocks. The surface area to be covered was so big (he was a big guy), that they went through 7-8 skins from the skin bank. This surgery lasted 5-6 hours.

-                I found out that Weill has one of the biggest skin banks in the US.

Necrotizing fasciitis

-                A heavy woman with necrotizing fasciitis, which is also known as ‘flesh-eating bacteria’.

-                She came in two weeks ago with a bad rash on her abdomen, which quickly progressed

-                This type of infection moves along the plane of fascia and can spread very fast

-                Last week they tried to remove as much of the infected tissue as possible. Since the infection is at the depth of fascia, she had very big holes on her abdomen and her right thigh (down to the level of her muscles).

-                Unfortunately, she also had a gaping hole on her lower back from an ulcer that created from her being immobile on her bed.

-                The infection was so bad that when the dressing was removed, the stench was unbearable.

-                The purpose of the OR session was simple debriment, which quickly became removal of more infected tissues. By the time it was over, she had muscle deep chunks missing from her abdomen all the way down to her right knee. The pieces they were cutting out were literally the size of big steaks.

-                They sent many tissues sections to the labs for further analysis, including an infected lymph node.

-                Later this week, when she was brought back up to the ICU, she experienced a septic shock. She is in a very bad shape.

Project

-                Received an extensive list of all the patients that required APRV in the past 7 years in the Burn ICU from Dr. Bessey

-                I am in the process of finding all the respiratory-related information on all those patients using Eclipsys

-                Dr. Bessey and I read an article published on JAMA, which summarized a meeting of many respiratory specialists in Berlin. They came up with ‘the Berlin definition’ for acute respiratory distress syndrome (ARDS). Dr. Bessey and I will be using this definition to sort out the patients with respiratory failure.

-                We narrowed down the list of variables that we need to study. So far: PO₂, PCO₂, FiO₂, T_Lo, T_Hi, P_Lo, P_Hi, ARDS definition, # of days on APRV, length of stay in ICU.