First aid treatment of burns

[Fletcher Knives]

THIS IS A TERIFFIC POST!

I'm very interested in the rest of this info that you mentioned. Email on it's way.

 

[j williams]

:thumbup: Got it!

I will do my best, give me a bit to try and spew it out in an understandable fashion.

 

[guitardemon]

J williams,
I have some pictures for wound management in the wilderness that I can get for you if you. If your interested send me a PM and we can talk about it.

 

[a.l.hare]

+1 on wound management! Cuts, gashes, and infection are issues I feel are most likely to occur (at least to my clumsy a$$)in the woods or in a survival situation (lost, stranded, times when you least need to be dealing with injuries). I would love to get some info on different scenarios and how to best address the situation. How to deal with temperature related injuries isn't a bad idea either. Great post!

 

[Wandering_About]

Since we're heading into the winter season, information on dealing with hypothermia would probably be very practical information to know. KGD's ideas were excellent, +1

 

[j williams]

I will work on a wound/fx management one, and get something up on here soon.

Exposure will follow that one. I agree that its a huge concern.

I think with knowlage of those 3 things, you would have a pretty good skillset for wilderness management.

 

[HikingMano]

I will work on a wound/fx management one, and get something up on here soon.

Exposure will follow that one. I agree that its a huge concern.

I think with knowlage of those 3 things, you would have a pretty good skillset for wilderness management.

Great info J Williams, would love to see more like these!! :thumbup::thumbup::thumbup: Would love to learn current info on wound management in non-sterile environments and thermoregulation.

 

[siguy]

very good info, thanks for sharing :thumbup:

 

[Joel Stave]

Oops. Never mind.

 

[antonio_luiz]

Your recent course may have a different take on things but I can't agree with you entirely. All our ER and First Aid trainers emphasise that first thing to do is stop the burning and reduce further heat damage = run under cool (not icy or cold) water for at least 20min. After severe burns = major fluid loss, the victim is likely to go into shock anyway. I think the important point here is the water has to be cool and not cold and only the affected parts should be treated

 

[WolfTracker]

Burns were never really my strong area, as we rarely saw anything worse that a 1st degree scalding. This is an interesting thread. Thanks for starting it.

Concur with the edema, and that is where I was going with my rationale. If it is allowed to propagate, I think, and to your point, that is where one could become septic, long-term. Short term it's fluids, watch for arrhythmia, treat pain, guard against infection, and transport forthwith. That's how I remember it from 15 years ago, anyway. I'm sure that much has changed.

Not to myknowlage it wont. Purpose of elevation is to help offset edema buildup. Thats an interesting question though, I am gonna look into that. I can see as maybe a long term consideration, but for first line, I think restoring osmotic balance is a bigger concern, which is priority in the first 24 hrs following a burn, as I am sure you know. Its easy to forget burn stuff isnt it? We just dont get as many burn pts to keep us sharp on skills and protical.

Not to mention the parkland formula can be a huge PITA w/o pumps. But as for our role in the TX of burns, I feel 500cc over the course of an hour is a great number, as we arent concerned with urine ouput, and central pressures yet. We are just trying to slow fluid loss, start restoring osmotic balance, and provide barrier to infection, and pain relief. Which reminds me. Never give IM pain meds to a pt. Give them IV. If you have the means to have an IV, or access to pain meds able to give IV.

 

[j williams]

Your recent course may have a different take on things but I can't agree with you entirely. All our ER and First Aid trainers emphasise that first thing to do is stop the burning and reduce further heat damage = run under cool (not icy or cold) water for at least 20min. After severe burns = major fluid loss, the victim is likely to go into shock anyway. I think the important point here is the water has to be cool and not cold and only the affected parts should be treated

Thats fine, its called practicing medicine for a reason.:thumbup:

I cant agree with ya though. Just because a person is likely to go into shock anyways doesnt mean I would risk doin it to em. For minor burns, that is right. Run under tepid water, but I just cant see it with full thickness burns. However, there is a million ways to do everything in the medical field, I dont know em all. Id make way more $ if I did! I just do what Ive been taught, which hasnt failed me yet. Ive had alot of bad burn pts too that I dealt with first hand, and never had a Doc chew my ass for not running it under cool water first.

That said, I dont think its fair to say that my advise on burns is wrong, because I didnt say to run it under cold water first. That is not something that is detremental to life and limb. I also didnt mean this to be THE AUTHORITY on burn care. Just wanted to pass on a basic undestanding of burn treatment and care, and factors to consider.

 

[Bushman5]

So J Williams, i guess the old standby of slathering on Vaseline onto burns is no longer used?

kidding kidding kidding!

 

[j williams]

Ok, I talked with my wife(an RN), and another medic, and we came up with the thought process behind first line treatment by running cool water over the wounds.

To extenguish flames, and put out sizzling tissue its adviseable to do that before anything else. So I guess it is sound advice. We normally dont think along those lines b/c we are not there to see the person usually on fire. They are extinguished before we ever arrive to them, but it is an important aspect. Man I love gettin the gears turning!!!!!!:thumbup:

Now thisis adviseable with thermal burns, but as far as we could think, and from what Ive read, it is not adviseable for radiation, chemical or electrical burns.

 

[hannibal lecter spyderco]

I just got back from a staff meeting, where I just taught an inservice on pre-hospital management of burn patients. I was thinking I would pass on some of my lecture on to you guys.

I believe that in a survival situation, it is not to far out to believe that a burn is likely to happen. Whether you are in the desert and it comes from the sun, or are in a natural disaster and it comes from chemical or fire, or maybe even a plane crash or car crash. So you can see that it is something to consider from a survival perspective. It might be you that gets burned, or somebody in your party, or just a stranger in need.

First thing we need to look at is determining the severety(degree), and extent of burn(area). A critical burn is one to the face, hands, feet or genitalia. Or any burn that covers a good majority of the surface.

FIRST DEGREE
The least serious burns are those in which only the outer layer of skin is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin hasn't been burned through.

SECOND DEGREE
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is called a second-degree burn. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

THIRD DEGREE
The most serious burns are painless, involve all layers of the skin and cause permanent tissue damage. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

OK. I am not gonna dive into the rule of nines, or serial halving, cause its tricky, and complicated. I will tell you that a palm is roughly 1% of th surface area. So you can use that to get a rough estimation of affected area.:thumbup: If your interested in the rule of nines, or serial halving, Email me, and I will do my best. I really dont think it has much to do wih survival type medicine, if you can recognize the severity and rough size of burn.

Now on to a list of DONTS when it comes to treatment of burns.

DONT

DONT APPLY BUTTER OR OINTMENTS, IT IMPEDES HEALING.

DONT BREAK BLISTERS.

DONT APPLY ICE, IT CAN CAUSE FROSTBITE.

DONT REMOVE BURNT CLOTHING.

DONT IMERSE IN COLD WATER, IT COULD BRING ON SHOCK.

Ok, you might be thinking, well Jake, WTF should I do then?????

Well. I think its important to look at some concerns you need to be thinking about when attacking treatment of a burned pt. The most important thing when understanding burns is avoiding hypothermia, and infection. The rate your body loses fluids makes hypothermia a real threat to your pts survival. The exposed skin makes infection a runner up in danger, and something to take in mind with long term care. We need to keep exposure to a minimum.

Serious Treatment is.....

You need to boil some water if you dont have access to sterile water. Let it cool to luke-warm, soak dressings in it, and wrap or cover affeccted area. This is where it gets kinda high-speed with a trick I lerned. Wrap saran wrap over the soaked dressing. It will provide a barrier to infection, and it will help regulate temp by decreasing the fluid loss. Cool huh?

Next elevate extremity above heart.:thumbup:


-----------------------------------

Now for minor burns,including first-degree burns and second-degree burns limited to an area no larger than 3 inches (7.5 centimeters) in diameter, take the following action:

Run cool water over site for 5 minutes. Cooling the burn reduces swelling by conducting heat away from the skin. Don't put ice on the burn.

Sterile bandage, no fluffy cotton. I would treat with wetted down dressings.:thumbup:

Pain controll is something you need to think about too if its available.

Fluid resuscitation is great if you have the means. W/O gettin into the complicated formulas for it, I will say a good number is 500cc over the course of an hour.

As always monitor for pulse, and breathing, and be ready for CPR if need be.

Now, this is only for tx of burns not related to chemical or electrical burns, which there are other things to consider. Wanna learn more????????

And I will say, that I am not a DR, nor do I work in a burn unit. Of course their treatment is more advanced with drug therpy, scrupping the burn etc, but I think this will give all of you a good idea of what to do as first line care of burns.

Sorry if I bored you, and I will be happy to post another post on chemical burns, and electrical burns if you allwant me to add it in.:thumbup:

Not to put a muddy up the waters here, but there a few key points that I think you didn't cover. You have to access what type of burn and how much of the body is burned. If the entire body was burn 3rd degree burn or just your hand, the sole reason that you don't want to immerse someone in extreme cold water for a long period of time is cooling the body down that drastically that fast leads to shock. Its acceptable to put your hand in cold water "non ice this only causes more cell death" You have to return body back to normal body temperature. Whether it be placing some one part of your body in cold water or putting cool compresses on victim entire body. Remember just because you take a chicken out of the oven its still cooking just as the human body would be. The key is to bring back the body temperature. Hypothermia isn't really the major problem with most burn victims, hypovolemic shock, fluid and electrolytes issues become a major problem when patient has large surface area 3rd degree burns. Force fluids if patient does not have any facial or neck burn and gag reflex is present, elevate extremities that are affected to reduce edema that would normally occur.

 

[jh205]

Please do not pass on information (especially medical information that could effect someones life) if you have not checked to make sure it is true.

I have checked you dimwit. Read some of the following:

O.P. Jakobsson and G. Arturson , The effect of prompt local cooling on oedema formation in scalded rat paw. Burns 12 (1985), pp. 8–15.

O.J. Ofeigsson , Water cooling: first aid treatment for scalds and burns. Surgery 57 3 (1965), pp. 391–400.

J.V. Boykin, E. Erikson, M.M. Sholley et al., Cold water treatment of scald injury and inhibition of histamine mediated burn oedema. J. Surg. Reconstruct. 31 (1981), p. 111

.L. De Camara, T. Raine and M.C. Robson , Ultrastractural aspects of cooled thermal injury. J. Trauma 21 11 (1981), pp. 911–919.

R.H Demling, P.B Mazess and W. Wolberg , The effect of immediate and delayed cold immersion on burn oedema formation and resorption. J. Trauma 19 1 (1979), pp. 56–60.

T.J. Raine, J.R. Heggers, M. Robson et al., Cooling the burned wound to maintain microcirculation. J. Trauma 21 5 (1981), pp. 394–397.

.J Ofeigsson, R. Mitchell and R.S. Patrick , Observations of the cold water treatment of cutaneous burns. J. Pathol. 108 (1972), pp. 145–150

J.C. Lawrence , First aid measures for the treatment of burns and scalds. J. Wound Care 5 7 (1996), pp. 319–323.


J.M. Ferrari, G.F. Circular and D. Armstrong , Some effect of cooling on scald burn in the rat. Surg. Forum 13 (1962), p. 486


N . Nguyen, The importance of immediate cooling—a case series of childhood burns in Vietnam , Burns , Volume 28 , Issue 2 , (2002) Page 173

 

[Mentor]

I have checked you dimwit. Read some of the following:

The name-calling is totally unnecessary. There is a constructive discussion taking place about some of the finer points of burn care, with differences of opinion. No need to sling mud.

All the best,

- Mike

 

[j williams]

I agree. Lets not start that.

Medical opinions often disagree. Often. Doesnt mean you are right or wrong. As I always say, as long as you have a thought process.