OBSERVING AN OPERATION

I will research and observe an operation of a patient and meet with my supervisor to share
notes I made and to reflect and ask questions I have regarding what I observed. I will then
reflect upon my experience in my journal.

Research

Laser treatments for burn scars can be used as a method of improving “redness, irregularities,
bumps, tightness, or discomfort”, including itch, for burn survivors. Several types of lasers are
used to meet different objectives (Phoenix Society, 2019).

There are 3 types of laser treatments used at Shriners:

 The Plused Dye Laser is used to minimize redness and increase comfort or irritation due
to inflammation. It’s designed to remove blood vessels and treats ¼ - ½ inch areas at a
time. Following treatment the comfort and appearance of the lasered area will vary
depending on the setting of the laser.

 The Fractional Laser is designed to improve redness and irregularities in the skin
including redness and bumpiness. There are several different forms of Fractional Laser
treatments including nonablative and ablative treatments. Nonablative targets water
within the skin, heating it up in small columns of tissue. Ablative treatments involves
drilling small holes in in the skin, causing pinpoint bleeding.

 A Q-Switched Laser is used to break up pigmented particles in the skin. It used a lot of
light energy and leaves the skin white, however these spots fade fairy quickly.

Lazier Procedure – Francis

Following anesthesia induction, a tube was inserted down Francis’s throat and her
eyelids taped closed. The anesthesiologist stood at the head of the operating table to continue
monitoring the patient and administering medicine. The fellow began the laser soon after
induction, beginning with the ablative fractional laser, which looked like a large cylinder
attached to tubing which led to another machine. A plastic portion of the laser made direct
contact with the skin and the laser itself could be seen leaving the cylinder and making contact
with the skin. This laser was used on all of the scared tissue on the patient’s back, neck and
face. Following this a few hypertrophic areas were also injected with a solution. The Q-Switched
Laser was then used over the same areas as the ablative factional laser. The Q-Switched Laser
did not have any extension that touched the patient’s skin but was held further away from the
skin and left the skin covered in white dots. Following the laser, the treated areas were covered
with a type of ointment and were covered with dressings.
Upon turning Francis on her side to treat her back, a complication arose in which Francis
was no longer at her baseline for oxygen. This required Dr. Roberts (the attending) to come
back into the room to briefly check in with the fellow and required additional medication to be
given which resulted in a prolonged wake up time for Francis in the PACU.

Journal Entry
“Rebecca was able to arrange for me to observe a laser procedure for a school-aged girl
named Francis. I had the opportunity to spend time, play and help prepare Francis for
surgery in the waiting room and in Pre-Op. Rebecca had previously given me information
on Francis (a 9-year-old girl) that helped guide how I approached, played and interacted
with her. Francis was a bit socially delayed and was at the level of play and social
interactions of a younger school aged child (around that of a 7-year-old). She was very
outgoing, talkative and easy to interact with.

Following Francis's anesthesia induction, I was able to stay in the operating room to
observe her procedure. A tube was inserted down Francis’s throat and her eyelids taped
closed. The anesthesiologist stood at the head of the operating table to continue
monitoring the patient and administering medicine. The Fellow began the laser soon after
induction, beginning with the ablative fractional laser, which looked like a large cylinder
attached to tubing which led to another machine. A plastic portion of the laser made
direct contact with the skin and the laser itself could be seen leaving the cylinder and
making contact with the skin. This laser was used on all of the scared tissue on the
patient’s back, neck and face. Following this a few hypertrophic areas were also injected
with a solution. The Q-Switched Laser was then used over the same areas as the ablative
factional laser. The Q-Switched Laser did not have any extension that touched the
patient’s skin but was held further away from the skin and left the skin covered in white
dots. Following the laser, the treated areas were covered with a type of ointment and
then with dressings. Upon turning Francis on her side to treat her back, a complication
arose in which Francis was no longer at her baseline for oxygen. This required Dr. Roberts
(the attending) to come back into the room to briefly check in with the Fellow and
required additional medication to be given which resulted in a prolonged wake up time
for Francis in the PACU.
 This experience was helpful and applies to my work in Child Life in several different ways.
To help prepare and educate parents and older children who are interested and desire of
more information, it is helpful to be aware of exactly how laser procedures are conducted.
It also gave me more insight as to the roles of other members of the medical team and
their responsibilities. Knowing more about what other staff members do helps me to
more clearly see the very unique and necessary roles of each member of the medical
team.”

References

Laser Treatment for Burn Scars: A Practical Guide. (2019). Retrieved from
https://www.phoenix-society.org/blog/entry/laser-treatment-practical-guide