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 Post subject: Burns 101
PostPosted: Tue Sep 09, 2014 3:05 pm 
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A very basic overview of burns for the lay persons or anyone not familiar with how to treat a burn.

RULE 1: Know the type of burn involved...
1.) Thermal: heat from flames, hot liquids, and hot surfaces.
2.) Electrical: Involving an electrical current.
3.) Chemical: Involving a caustic agent.

RULE 2: Know the depth of the burn...
1.) 1st degree: Superficial, only outer layer of skin involved. Red, dry, painful (ex. sunburn). This burn is only partial thickness.
2.) 2nd degree: Involves damage to the epidermis and the dermis layers of skin. Characterized by BLISTERS and is painful. (ex. hot liquids, flashes, flames) This burn is only partial thickness as well.
3.) 3rd degree burns: Involves damage to the epidermis, dermis, subcut and possible damage to muscle and/or bone. Full thickness wound. Not painful due to the destruction of nerve endings. Characterized by dry, leather-like, brown, black, or gray skin. (Ex. flames, electrical, or chemical)

RULE 3: Know the extent of the burn (Total body surface area burned)...
-Use the "rule of nines" to calculate what percentage of body surface area is burned.
A.) Adults
-Face 4.5 %, back of the head 4.5% (Total head =9%)
-Front torso 18%, back torso 18% (Entire trunk =36%)
-Each arm, front 4.5%, back 4.5 % (Entire arm=9%, both arms =18%)
-Each leg, front 9%, back 9% (Entire leg=18%, both legs =36%)
-Genitals account for 1%
B.) Infants
-Entire head=18%
-Front torso 18%, Back torso 18% (Entire trunk 36%)
-Each arm is 9%
-Each leg is 14%

At first glance, a 15% burn of the body surface area is considered serious!

RULE 4: Emergency Scenario
The burn wound itself is the lowest priority! An inhalation injury is the most life threatening cause of death of burn victims. Signs of inhalation injury include: ashes/soot in mouth, singed nasal hair, hoarse voice, cough (soot in sputum), facial burns. Treatment includes: early recognition, airway management, administering O2 (if available) have person maintain a seated position.
After you've assessed for the above, next stop the burning! lower the temperature of the burn by using sterile water (again if available, but most of you have fancy first aid kits anyway). The primary response is to cool whatever caused the burns (ex. plastic, tar, etc.) you want to stop it from causing increased damage. You can worry about removing the plastic and cleaning it once the initial worries have been dealt with.
If it's an electrical burn, there are 2 wounds (the entry and exit points). Watch for cardiac abnormalities and prepare for CPR. Assess the scene first!!! Make sure your safe before you help anyone else. SUSPECT and MONITOR for internal damage. Internal damage may be significant despite only two minor burns externally.
For chemical burns, neutralize and remove the caustic agent. IRRIGATE, IRRIGATE, IRRIGATE (with room temp, sterile water). Wet dressing application is ok in small burns that are <10%. Use clean, dry sheets or blankets in burns >10%. WATCH FOR INFECTION AND HYPOTHERMIA. Bacteria can set in within 6 hours. Keep the victim warm, dry, and clean.

RULE 5: If you have the supplies, knowledge, and skill necessary, start an IV asap.
Burn victims require IV fluids (Either NS or LR) within the first 24 hours of being burned. To determine a person's fluid requirement for the initial 24 hours of the burn, follow Parkland's Formula for Burns...
- Fluid requirements for the 1st 24 hours = % TBSA (percentage of total body surface area) burned x weight (kg) x 4mL
Give half of the total requirement's in the first 8 hours, then give the second half over the next 16 hours.

Ex. Let's say a 170lb adult male burned his entire front torso (refer to RULE 3, on the rule of nines that the front of an adult torso is 18%) first step: 170 divided by 2.2= 77.3 kg. Following the formula, 18(%) x 77.3(kg) x 4(mL)=5566 mL in the first 24 hours total (yes, round off) 5566 mL divided by 2= 2783mL to be given within the first 8 hrs, and 2783 mL to be given over the next 16 hrs. To configure mL/hr, divide 2783 by 8=348mL/hr. Then 174mL per hour for the next 16 hours.

So yes, sorry if it was a little "hairy", but this is just the basics. Hope this helps someone!


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 Post subject: Re: Burns 101
PostPosted: Tue Sep 09, 2014 6:17 pm 
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Good write up. I'd say it's easier to use the patient's palm size as 1% and do the BSA off that, especially under pressure. With the chemical burns, if it's a dry agent, DO NOT IRRIGATE, instead, brush the agent off as H2O may activate it.


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 Post subject: Re: Burns 101
PostPosted: Tue Sep 09, 2014 7:59 pm 
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IANMCDEVITT wrote:
Good write up. I'd say it's easier to use the patient's palm size as 1% and do the BSA off that, especially under pressure. With the chemical burns, if it's a dry agent, DO NOT IRRIGATE, instead, brush the agent off as H2O may activate it.


Thanks! I knew I'd forget something!


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 Post subject: Re: Burns 101
PostPosted: Fri Sep 12, 2014 2:04 pm 
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Very good. I want to emphasize that the specialists in the Burn Centers do NOT like it when you slather a burn with vaseline, ointment, cream, or anything else: this stuff will trap heat if applied before the burn is cooled, does nothing to assist the victim, and creates a lot of painful work for the burn team who has to clean all that shit off to care for the wounds.

I'd also like to add a reminder not to try to get fancy by using your chemistry knowledge to attempt to neutralize any chemical burns with other chemicals, because most of the time the neutralization reaction is exothermic (gives off a lot of heat) and will add its own thermal injury.

What is very surprising to most people is just how little heat it actually takes to cause an injury. Even tap water can be hot enough to cause serious burns, particularly in the elderly. I did a quick search for a temperature chart, and the Bothin Burn Center says that a 3rd-degree burn will occur:
•in 1 second at 156 degrees F
•in 2 seconds at 149 degrees F
•in 5 seconds at 140 degrees F
•in 15 seconds at 133 degrees F
Many people's tap water spits out at 140-150 degrees.

I know of one guy who went home from bar-hopping and passed out in his hot tub. He woke up that morning with a 3rd-degree burn from his neck down. He lingered in a burn center for a brief time before succumbing.

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 Post subject: Re: Burns 101
PostPosted: Fri Sep 12, 2014 8:26 pm 
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painiac wrote:
Very good. I want to emphasize that the specialists in the Burn Centers do NOT like it when you slather a burn with vaseline, ointment, cream, or anything else: this stuff will trap heat if applied before the burn is cooled, does nothing to assist the victim, and creates a lot of painful work for the burn team who has to clean all that shit off to care for the wounds.

I'd also like to add a reminder not to try to get fancy by using your chemistry knowledge to attempt to neutralize any chemical burns with other chemicals, because most of the time the neutralization reaction is exothermic (gives off a lot of heat) and will add its own thermal injury.

What is very surprising to most people is just how little heat it actually takes to cause an injury. Even tap water can be hot enough to cause serious burns, particularly in the elderly. I did a quick search for a temperature chart, and the Bothin Burn Center says that a 3rd-degree burn will occur:
•in 1 second at 156 degrees F
•in 2 seconds at 149 degrees F
•in 5 seconds at 140 degrees F
•in 15 seconds at 133 degrees F
Many people's tap water spits out at 140-150 degrees.

I know of one guy who went home from bar-hopping and passed out in his hot tub. He woke up that morning with a 3rd-degree burn from his neck down. He lingered in a burn center for a brief time before succumbing.

Hell of a shitty way to go. I saw one case on "Trauma: Life in the ER" where a dude with Cerebral Palsy had like 25ish (from memory so I'm likely wrong) with 2nd and 3rd degree burns due to hitting the hot water knob and not being able to turn it off and lying there for a few minutes. I felt bad for that guy. Either way, Burn Trauma fucking sucks IMO. Smells bad, painful for the patient, and has tons of other complications possible with it like infection.

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 Post subject: Re: Burns 101
PostPosted: Sun Sep 21, 2014 6:28 am 
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weatherdude wrote:
Either way, Burn Trauma fucking sucks IMO. Smells bad, painful for the patient, and has tons of other complications possible with it like infection.


I agree. Burn unit definitely wouldn't be my area.

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 Post subject: Re: Burns 101
PostPosted: Sun Sep 21, 2014 6:36 am 
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Very informative!

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