Goals of the Rotation
Goals include learning assessment and classification of burn wounds, including estimation of burn size, depth and reduction of related morbidity and mortality; gaining an appreciation stress response to acute burn injury, including hemodynamic, metabolic, nutritional and immunologic sequelae; learning initial management of the acute burn patients, including fluid resuscitation, nutritional support, wound care and ventilatory management; learning wound management of burn patients, including an understanding of wound healing, wound sepsis, topical antimicrobial agents, biological dressings and skin substitutes, and skin grafts developing fundamental surgical skills in treatment of burn patients, including wound debridement, wound dressing and splinting, skin grafting, and scar contracture release; gaining an appreciation for burn rehabilitation, including physical/occupational therapy, psychosocial support and reconstructives needs; improving communication and leadership through interactions and coordinated discussions with patients and their families, attending physicians, medical personnel, medical students and fellow residents; learning principles of management of injuries of a special nature, including inhalation injuries, chemical injuries, electrical injuries and dermatologic conditions necessitating the wound and surgical care that only a burn center can provide.
Goals of Rotation (PGY-3)
The resident will return to the Burn service for progressive experience with the evaluation and treatment of acute burns. The resident is expected to supervise the PGY-1 and PGY-2 residents and serve as back up for them. The resident will help educate the students and the more junior residents in the evaluation and treatment of the acute burn including fluid management. The resident will become more experienced with the operative debridement and resurfacing for acute burn. The resident will become more adept in recognition and treatment of burn complications, particularly infections. The resident will be adept at running a fluid resuscitation and evaluating the patient for smoke inhalation, compartment syndrome, and related trauma.
Successful management of the acute burn patient requires prompt aggressive fluid resuscitation, metabolic/nutritional support, control of bacterial infection, anticipation and prevention of complications, timely closure of the burn wound and early initiation of rehabilitation therapy. Burn shock must be adequately treated. Post-burn malnutrition must be prevented. In the post-burn stress response, all major organ systems are affected. Closure of the wound is essential for correction of the pathophysiologic post-burn derangements. In essence, management of the burn patient is a race against time, as rapidity of wound closure is inversely related to complications and mortality. This race must be tempered with thoughtful considerations of ultimate function, cosmesis and quality of life.