Stint gives intern first-hand look at Harborview burn care

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Stint gives intern first-hand look at Harborview burn care

Nature of patients' injuries can be unclear, she learns
Emily Rasinski

The patient story is usually incomplete. This is the challenge that Sarah Kolnik, a general surgery intern, faced during her four-week rotation on the burn intensive care unit at Harborview Medical Center. 

For example, one man came in with burns from a house fire – and then staff discovered he had also suffered a stroke. 

Burn rotation-confer
Emily Rasinski
Kolnik, a general surgery intern, spent four weeks on her rotation in the burn unit.
picture of Sarah Kolnik speaking with a colleague in Harborview's burn unit

“Which one came first? He can’t tell us what happened,” Kolnik said.

The man was burned on 30 percent of his body. Staff have had no luck locating his family, friends or landlord, and refer to the unidentified patient as Troy Doe.  

Another patient was flown in from Alaska with burns on her head. But her explanation was inconsistent with the injury.

“She said her head caught on fire from lighting a cigarette, but the burns don’t match,” another doctor said.

“The story can tell us why it happened and help guide us where to go.  But unfortunately it’s the story that is often unclear,” Kolnik said.

The University of Washington Regional Burn Center opened in 1974 and has treated nearly 20,000 patients from Washington, Alaska, Montana and Idaho. It has a 97 percent survival rate.

Summer months are typically busiest for the unit, but this winter has seen an unusual spike. During Kolnik’s rotation, the unit treated about a dozen patients.  She carried three pagers and two phones at all times. 

Burn rotation-nurse
Emily Rasinski
Kolnik confers with Jennifer Clayton, a registered nurse in Harborview's burn and pediatric units.
Kolnik confers with Jennifer Clayton, a registered nurse in Harborview's burn and pediatric units.

Burn patients often have long hospital stays due to the injuries’ complex nature, and Kolnik saw patients throughout the whole process – from resuscitation to surgeries to the weaning off of all interventions including ventilation and pain medication.

One patient’s recovery mirrored Kolnik’s rotation.  A man, 35, was burned over 50 percent of his body in a car fire. He spent two weeks on a breathing machine and was heavily sedated.

“I was there when he was really, really sick and then was able to see him progress and get taken off the ventilator and start walking and talking,” Kolnik said.

He transferred to an acute-care floor on the last day of her rotation.

The unit was Kolnik’s initial exposure to critical care and treating acutely ill patients. Ultimately she hopes to pursue a fellowship in trauma surgery and critical care.

“This rotation has made me very aware of how much training I need to be able to provide the best care possible,” she said. “It seems daunting this early in my training, but I know that’s why this is a five-year training program. There is so much to learn.”