It was in the Medicine and Pathology module, which has been taught over at the Medical School rather than on our Biosciences campus. We've had the most wonderful lecturer I've ever encountered, who delivers lectures that are so interesting that I want them to go on longer, even though the Medical School is further from home and I get home pretty late anyway. He will ask the class a question, and although you give an answer that's completely wrong in every respect, he can tell you the right answer and still make you feel good about yourself.
So the task for this module involved 12 case studies, which were randomly allocated to groups of 2 or 3 students. We all went away, researched our topics, and came back to give a presentation to enlighten the rest of the group on our particular subject. Each presentation was supposed to be about 10 minutes plus time for questions, which isn't really very much time, but when you have 12 of them to get through... well, it drags on, especially if they're a little bit boring. Some of them were indeed a little bit tedious, and many of them concerned subjects that aren't very thrilling - an overweight woman with type 2 diabetes, someone with gestational diabetes, a man with Metabolic Syndrome, which is officially the most uninteresting condition in the world. I challenge even the most inspirational speaker to make the subject of fluid accumulation interesting. As we reached the last presentation my head was almost on the desk and I was wishing for it all to end.
Our subject was the only emergency situation out of all of them, and I think we were lucky to get it, compared with some of the other topics. Here are some things I didn't necessarily know about a burn injury before this assignment:
- The patient almost always has to have a breathing tube inserted - if not because of heat or smoke inhalation then because of fluid pressure later on. If the gas exchange surface of the lung is badly damaged, you're really in trouble.
- For the first 48 hours or so the capillaries become leaky, fluid and protein flood out of the blood into the tissue (which is where the fluid pressure comes from that might restrict the airway) You have to set up intravenous infusion to replace the fluid pretty quickly, and put in a urinary catheter so you can monitor fluid out as well as fluid in.
- The skin damage is categorized according to the depth of the burn and the percentage of total body surface area (TBSA) that's been damaged. Anything more than 10% TBSA of superficial burn is starting to get serious.
- Skin that has been burned loses its elasticity. If the burned skin goes all the way round a limb, then it can act like a tourniquet and restrict the blood supply to the extremities. The answer is simply to slice longitudinally through the dead tissue to relieve the pressure - this is called escharotomy. Apparently it's not done under anaesthetic because the nerves have been destroyed in the dead tissue that's being cut through.
- If the burned skin surrounds the chest, then it can hinder chest inflation and affect breathing. Same treatment: escharotomy, in a "W" shape over the chest. Nasty.
- Full depth burns provide a perfect environment for bacterial growth, which is why most patients with serious burns used to die from infections. Nowadays, the recommended treatment is to cut out all the dead stuff and close the wound within a week, using skin grafts.
- There are various types of skin grafts, the best obviously being the patient's own skin harvested from a part of the body that hasn't been burned. If there isn't enough of this, they put it through a cutter that allows it to form a mesh, like expanded aluminium or the lattice on a pie crust, so it covers more area.
- Nutritional support is really important, because the body mobilises all the protein it can get its hands on to repair the damage and replace the proteins that have been lost from the blood through the leaky capillaries. It uses stored energy and protein from muscle to do this, which can lead to fatal wasting if you don't get energy and protein into the patient somehow.
- There is quite a risk of hypothermia, given the damage to the insulating layer of skin, the cooling effect of fluid evaporation, and the patient's metabolic rate being all over the place. You cover them up, and then pipe warm air under the sheet. Hospital burns units are HOT.
- Pain relief. Stands to reason.
So now I have just one more bit of coursework to do, and two more scheduled lectures - one today, and one next Thursday. I have four exams, starting on 19 May and ending on 27 May, and if I get on really well then we may be able to go to one or two days of the music festival that takes place over the weekend before the last exam. We bought the tickets two years ago but it's been cancelled twice - I wouldn't have chosen to buy tickets for this year's event, given the timing.