This is the podcast, Surgery I See Rounds. My name's Jeff Guy.

The topic that I like to present today is the idea of early surgical excision in the treatment of critically injured burn patients.

When we look at the current literature and critical care, particularly in regards of sepsis, there's a massive amount of research effort and literature produced on attempts to abrogate the systemic inflammatory response syndrome, what we call

CERS. We've learned that often, particularly in regards to infection, it's not the actual

source of infection, the bacteriomeremia or the urinary tract infection that kills the patient,

but it's the body's response of that kills the patient, but it's the

body's response of that infection. How does the patients, how do they upregulate that inflammatory

response? I use the example. It's not the fall that kills you, but the sudden stop.

The other example I'd like to use is the idea of the campfire. If you have a campfire

and a forest and an ember gets out of the campfire, it's just a forest

on fire.

You can put out the campfire all day, but now you've got to deal with this forest fire.

This is the idea of trying to abrogate or control this systemic inflammatory response

syndrome.

If we end up looking at somebody who has an abscess in their abdomen,

or have got a gangrenous gobladder or appendix, or a perforated colon, and they were presented to us in a state of septic shock,

it would be considered remiss, which is a nice way of putting, if you consider about practice, simply to put the patient on antibiotics.

Because all the antibiotics in the world

aren't going to treat that gangrenous gallbladder

or that gangrenous appendix or the perforated viscous

or drain the abscess.

We know that in order to have effective antimicrobial therapy,

...