Saturday, July 1, 2017

Don't get burnt

By: Sebastian Berry

I do not claim credit to any of the images used unless specifically indicated. All rights and credits remain with the original owners.

DISCLAIMER: Instructions and information here is not a substitute for professional medical care and treatment. If you are having a medical emergency call 911 or your local emergency number for assistance.

Ladies and Gentlemen, as we celebrate the birth and independence of our great nation with campouts, cookouts, and decorative explosions, someone reading this will make an ER visit because they burned themselves.


Burns are all avoidable injuries. Whether it comes from the grill or that sparkler you thought had cooled off, all burns can be avoided. Given the upcoming holiday weekend, below is a list of things I think are most likely to burn you.

* Campfire
* Grill and grill tools
* Fireworks

And obviously...

*The friggin' sun

The below infographic gives a little insight on how hot things can get.



Most commonly we think of burns as thermal burns like what was mentioned above. Any degree of burn can also be caused by cold injury as well. For the sake of this article we will stick with thermal burns.

Burns are classified by first, second, and third degree. The following link presents a slideshow of what each degree can look like. Degrees of Burns
FIRST DEGREE BURNS

Generally speaking first degree burns are manageable at home. Typically the skin becomes red, irritated and inflamed, tender to touch, and itches like crazy. For those of us that don't use a whole lot of sunscreen, these symptoms are really familiar.

Sunburn/First degree burn
The treatment for any burn of any degree is to first stop the burning. This is accomplished by removing the source of burn and then cooling the burn with cool running water. As a throwback to my post about not bleeding to death, stop the burning and start the cooling. The other immediate treatment is re-hydration, achieved by increasing fluid intake (primarily water)

The disclaimer for cooling is to not use ice. Placing ice on skin that has been damaged by a burn can create a secondary burn with frostbite. Then we go from one end to the other and create another set of problems to deal with, but I digress.

I personally recommend one product for use after sunburn and other first degree/superficial burns. It's called Solarcaine Aloe Gel and can be found here. Like the name indicates it contains aloe and lidocaine. You can achieve better short-term relief with it by keeping it in the fridge so that it is cooler when applied. The other at-home pain control options include Tylenol and Ibuprofen. Just remember that Ibuprofen can dehydrate you more than you already might be from the burn. Like was mentioned earlier, you have to drink more water after having any burn.

SECOND DEGREE BURNS


Second degree burns become more difficult to manage and can indicate a trip to your local urgent care or emergency room. The initial treatment remains the same-remove the source of the burn and start cooling the burn with running water. Whatever you do, do not open blisters. Open blisters are a prime site for infection, even though you think you might get relief from opening a blister you only open yourself up for infection.

The other treatment is a dry, sterile dressing without adhesives. The debate among medical professionals about wet or dry dressings will rage on time immemorial. For this audience, the easiest thing to remember is to use a dry and sterile dressing. Let the ER doctor or burn specialist decide to use something else.

Second degree burns are probably the most painful because they irritate the most nerve endings simply due to burning deeper. Many of these types of burns are managed with narcotic pain medications in the field by EMS and hospitals. Notice how we just went from topical treatments with first-degree to narcotic pain meds with second? These burns can become serious business quickly.

Second degree burns can become circumferential burns, meaning they wrap around the entirety of a part of the body and have the potential to restrict circulation-similar to a tourniquet.

Mechanics ring that made contact with a battery.
Case report

These types of burns are true emergencies that need emergency management and burn center care.

Where I live in Utah, the closest burn center is located at the University of Utah in Salt Lake City. Almost everyone that comes in to my emergency room with second degree burns will, at a minimum, get a referral to the burn center. This is their website.

Depending on the consult that the emergency doc gets, these burns have the potential to be flown by medical helicopter to the burn center. Think about it, not only have we just surpassed topical and then narcotic treatment, now you might have to be flown to a burn center for care. Again, burns can become very serious very fast.

THIRD DEGREE BURNS AND INHALATION INJURY

When anyone thinks of third degree burns they tend to think of people that have been burned in a house fire or industrial accident. I will not post pictures of third degree burns because of how graphic they can be. You are welcome to conduct your own search.

These kind of burns typically do not hurt, because the nerves have been burned and are no longer able to send pain impulses. Surrounding burns and tissues may still hurt, but the third degree burn itself does not hurt. 

Usually these burns require extensive treatment, surgery, and follow-on care. These burns are life changers. They can appear as black char, fully white, or can expose tendon, muscle, and bone. These are always emergencies that require immediate medical intervention.

I would be remiss if I did not include inhalation burns with these types of burns. The respiratory tract is incredibly sensitive. If inhalation injury is suspected or the mechanism of injury, i.e. explosion or steam, indicates possible respiratory involvement do not delay seeking professional medical care. Victims with respiratory involvement have a very small window of treatment before airway compromise.

RULE OF NINES

The rule of nines is a quick way to estimate percentage of body surface area affected by a burn.


Anything circumferential or covers an entire side of a body part needs emergency medical treatment. As a parent, if my children have anything that I even suspect is second degree, they will get seen at urgent care or the emergency room.

TAKE HOME POINTS

If you remember anything from this it should be

* All burns are avoidable
* Stop the burn start the cool
* Dry and sterile dressings
* Burns can become true emergencies very fast

Please be careful this holiday weekend. Use your sunscreen and some good sense. I hope none of you have to make a trip to the emergency room because you got burned.