Burn Treatment

[Submariner]

While it [Combat Gauze or equivalent] could be used as such, I don't think it is the best option. It may be the only thing in your IFAK, but if I was in a high threat environment I would save it if possible.

It also depends on what degree of burn it is. On severe burns, what are the chances of it leaving particulate matter in the burn? My company is trained to the UK standards of trauma medicine, and thus we love to use cling film on burns (saran wrap). We also have special burn cloths that don't leave behind lint, and sterile plastic burn bags for the hands, etc. But, our med kits are set up for major burns as often result from explosions. I would think for the average person, minor burns are the norm and probably on the hands.

I once received some 2nd degree burns to my hands and the US Army medic washed my burns with normal saline, and wrapped it with standard gauze. I think that was all he had with him, since he was using a CLS med bag.

Maybe we should start a discussion in the first aid forum on burns?

Good idea!:D

How are burns best treated?

[rob_s]

I'd like to know too. From brass burns on the neck & such all the way up.

[NinjaMedic]

Small burns, irrigate with copious amounts of saline or clean water, apply antibiotic ointment, bandage with sterile bandage.

Large burns wrap in dry sterile gauze and move that person the most expeditious way to the nearest burn center. I have called for helicopters less than a mile from a level 1 trauma center in order to fly them to the nearest burn center (BAMC). Big concerns are temperature management (hypothermia is a big problem with the patients so keep the person covered in a blanket) and compartment syndrome. IV fluids are important for these pt's but the worst thing you can do is give them fluids that are lower than body temperature. Also while sterile is preferred speed is the most important. The burn center is going to clean and debride the burned areas anyway and then put that person on IV antibiotics.

[cqbdriver]

What about Watergel? Any one have any experience with these?

http://www.waterjel.com/professional-products/emergency-burn-care/burn-dressings/

[mkmckinley]

Small burns, irrigate with copious amounts of saline or clean water, apply antibiotic ointment, bandage with sterile bandage.

Large burns wrap in dry sterile gauze and move that person the most expeditious way to the nearest burn center. I have called for helicopters less than a mile from a level 1 trauma center in order to fly them to the nearest burn center (BAMC). Big concerns are temperature management (hypothermia is a big problem with the patients so keep the person covered in a blanket) and compartment syndrome. IV fluids are important for these pt's but the worst thing you can do is give them fluids that are lower than body temperature. Also while sterile is preferred speed is the most important. The burn center is going to clean and debride the burned areas anyway and then put that person on IV antibiotics.

Great post.

They make something called silvidine cream that you can slather on a burn before you dress it to combat infection but like NM said, for serious burns hypothermia is the biggest worry between the point of injury and the hospital.

[Danny Boy]

IIRC, the burn center at BAMC is kept at some swelteringly high temperature to help keep the patients from becoming hypothermic. After seeing some of the patients who have survived what appear to be some of the most horrific injuries, it is truly amazing what they are able to do there.

I was taught to clean wounds as best as possible without causing further trauma and to package them with rolled gauze and then roll them up the chain of care. We have the Watergel dressings at work, though I am yet to have a guinea pig to use on one.

[cqbdriver]

Actually, I did use watergel once when I accidently put my arm against my ATV muffler & left a quarter-size piece of skin stuck to muffler.

I can’t say if watergel did any better than the regular treatment. Only way to test would be to put my other arm against the pipe & compare the two. I decided may be next time. :D

[Iraq Ninja]

Many folks may not know that there is a free online version of Where There Is No Doctor. It has been awhile since I read it, and some of the material may be dated, but it is still a good source of info for austere environments.

Chapter ten has first aid and burns...

http://www.hesperian.org/publications_download_wtnd.php

[variable1]

Watergel is fine for smaller burns, but for larger burns dry sterile dressing is the best. Keep the chance of infection down, and conserve the PT's body heat.

[onado2000]

Depends on the type of burn and % body injury. In the field the key is to get the critical 2nd (blistered skin) or 3rd (full thickness) burn victim to a hospital asap. So first thing is to make sure the burning has stopped! Maintain ABCs and hemodynamic stability as with any other emergency trauma/medical call. Facial burns are also emergent situations due to swelling around the airway. These patients also need to be transported to a critical care area. Maintain airway and watch for shock, access large bore IV, keep pt. warm and NPO.
Silvadene cream is used on dead tissue to prevent bacterial /fungal infections on new skin growth (the silver prevents pathogens from proliferating in wound). There are many other treatments for burn victims; which ever is the latest & greatest will be used. Im a RN, I worked in critical care and in the burn unit. Here is one treatment used on a 2nd & 3rd burn victim; bath of warm water w/ Epsom salt, betadine & Mylanta (liquid).

[Abraxas]

Many folks may not know that there is a free online version of Where There Is No Doctor. It has been awhile since I read it, and some of the material may be dated, but it is still a good source of info for austere environments.

Chapter ten has first aid and burns...

http://www.hesperian.org/publications_download_wtnd.php

Thanks

[rosalind]

Good idea!:D

How are burns best treated?

Assimilate the burn in cool water for 15 minutes. If the burned area is little, put cool, neat, cloths which is wet on the burn for a some times daily. Then apply on it antibiotic cream, or other creams or ointments advice by your doctor. Cover that particular area.

[jknopp44]

Small burns, irrigate with copious amounts of saline or clean water, apply antibiotic ointment, bandage with sterile bandage.

Large burns wrap in dry sterile gauze and move that person the most expeditious way to the nearest burn center. I have called for helicopters less than a mile from a level 1 trauma center in order to fly them to the nearest burn center (BAMC). Big concerns are temperature management (hypothermia is a big problem with the patients so keep the person covered in a blanket) and compartment syndrome. IV fluids are important for these pt's but the worst thing you can do is give them fluids that are lower than body temperature. Also while sterile is preferred speed is the most important. The burn center is going to clean and debride the burned areas anyway and then put that person on IV antibiotics.

This sums up what you need to know nicely.

[USAFPararescueDoc66]

This is an article on burns I wrote for another publication Hope it helps:

When a burn occurs, seconds count! Burn injuries should be cooled immediately, otherwise the heat will continue to destroy the surrounding and underlying tissue, and may progress a partial thickness (second degree) burn into a full thickness (third degree) burn injury. This, in turn, will present serious consequences for the patient and considerable extra cost for the receiving hospital/burn unit.
Patient with burns
HERE ARE FOUR CRITICAL STEPS YOU SHOULD TAKE TO TREAT A BURN:

1. Immediately stop the burning process-seconds count!

2. Cool the burn-don’t over cool the victim.

3. Provide pain relief.

4. Cover and protect the burn area against contamination.

All burns should be treated with concern. It is important to keep in mind the golden rule of burn management: If someone has a burn on his or her body exceeding the size of the palm of his or her own hand, where blisters are present, burns to genitalia, face or to any flexion point, this person should seek medical attention. All electrical burns require medical attention.
TYPE OF INJURY

Experts classify burns into three major types, depending on their cause:

Thermal-Burns caused by flame, steam, hot liquid or hot metal.
Electrical-Burns caused by direct contact with electrical current, or the passing of electrical current through the body, including lightning.
Chemical-Burns caused by direct bodily contact with acids, lye, strong detergents or chemicals, or by inhalation of chemical fumes.

Each kind of burn has unique characteristics, and as a result, appropriate care should be taken for each type of burn.
Procedure for treating Burns:

Thermal burns are caused by flame, steam, hot liquid or hot metal. When a thermal burn occurs, seconds count!
Immediately move the victim from the source of the burn. If the victim’s clothing is still on fire, prevent the burn victim from running, which will only fan the flames. However, standing still makes the ignition of hair and inhalation of flames more likely. Instead, instruct the victim to stop, drop to the ground and roll to extinguish the flames.
Spray the victim with water or wrap him or her in a blanket, heavy coat or rug to smother any residual flames-or place a Water-Jel Fire Blanket on him or her to extinguish the flames. The U.S. Military uses this method as many times there is not a fire extinguisher available and the water-jel blanket will seep through the soldiers garb and onto the burn.
If the flames were caused by a flammable liquid, like gasoline, make sure the burned individual avoids further exposure to heat or fire, which could trigger reignition of flames.
Do NOT put butter, grease, dry dressings, ointments or salves on a burn; experts contend that they don’t cool the burn or relieve the pain, and some may leave behind a greasy residue that must be physically removed if the victim later requires medical attention. Instead, a one-step burn care product, such as Water-Jel First Aid Emergency Burn Dressing, is recommended. This first aid burn dressing from Water-Jel Technologies promptly relieves pain, protects the wound from further contamination, cools the burn and inhibits its progression, and helps promote healing.
If burned on a clothed area, apply the Water-Jel Burn Dressing or Fire Blanket directly over the burned clothing. The gel will soak through the clothing to cool the burn, relieve the pain and allow easy removal of clothing prior to treatment by a medical professional. If Water-Jel dressings are not easily accessible, quickly remove all burned clothing, as it can continue to be a source of heat even after the fire has been extinguished.
All burns should be treated with concern. It is important to keep in mind the golden rule of burn management: If someone has a burn on his or her body exceeding the size of the palm of his or her own hand, where blisters are present, burns to genitalia, face or to any flexion point, this person should seek medical attention. All electrical burns require medical attention.
If practical, elevate a burned extremity above the level of the heart while waiting for medical attention.
If a clear vein or central IV line maybe started, begin a .9% Saline IV and push steroids (depending on victims weight) to control the swelling in vital areas that are very susceptible to swelling from burns such as the vocal chords.

What are the guidelines for emergency treatment of ELECTRICAL BURNS and recommendations regarding NFPA 70 ARC FLASH?
Electrical burns are caused by direct contact with electrical current or the passing of an electrical current through the body, including lightning. Before touching the victim, stop the source of the current, if possible, turn off the source of the power and deactivate the main circuit breaker.Use a nonconductive item, such as a wooden broom handle, rope, dry towel or wooden chair, to disengage the victim from the current source. Cool the burned area with a one-step burn care product, such as Water-Jel First Aid Emergency Burn Dressing. This first aid burn dressing from Water-Jel Technologies promptly relieves pain, protects the wound from further contamination, cools the burn, reduces its progression and helps promote healing.Seek prompt medical attention for all medical burns.

What are the guidelines for emergency treatment of CHEMICAL BURNS?

Chemical burns are caused by direct bodily contact with acids, lye, strong detergents or chemicals, or by inhalation of chemical fumes. When a chemical burn occurs, seconds count!

Immediately flush the affected areas with large quantities of water. Do not waste time looking for specific antidotes to the chemical that caused the burn and do not take time to remove the victim’s clothing until the flushing process is well underway.
For a known acid burn, irrigate the area for at least 15 minutes; for a known lye burn, irrigate for one hour.
Apply a one-step burn care product, such as Water-Jel First Aid Emergency Burn Dressing, to the burn wound. This first aid burn dressing from Water-Jel Technologies promptly relieves pain, protects the wound from further contamination, cools the burn and reduces its progression, and helps promote healing.

EXTENT OF INJURY

Image, rule of 9% for determining severity of burnsThe extent of a burn wound is defined as the percentage of total body surface damaged and may be determined by the Rule of Nines. This divides the body into areas of 9% or multiples of nine and is modified for estimating the extent of burn injury in children. (Check the above graphs of burn portions)
The depth of a burn injury refers to the amount of skin, and on some occasions other tissue, damaged or destroyed. Skin has two layers, the superficial epidermis and the deeper dermis that overlies subcutaneous tissue. Burn injuries are defined as Superficial (1st Degree), Partial Thickness (2nd Degree) and Full Thickness (3rd Degree).
Superficial Burn (1st Degree Burn) 112 degrees F
minor damage of the epidermis. red, tender, dry, no blisters i.e., sunburn, heals in three to six days
Partial Thickness Burn (2nd Degree Burn) 140 degrees F
impacts epidermis and dermis, blisters are thick walled and sometimes ruptured color is mixed red and white painful, especially if pressure is applied heals in three to six weeks, potential scarring, may require hospital admission, surgery

Full Thickness Burn (3rd Degree Burn) 158 degrees F destruction of epidermis and dermis, high risk of infection, loss of temperature control, skin appears white, black, gray, leathery and charred, dry, requires hospital admission, surgery usually skin graphs to repair the damaged tissue. months, years to heal

Stay Safe
-PararescueDoc66

[chuckman]

Im a RN, I worked in critical care and in the burn unit.

I worked in the burn center, SICU, and neuro surg ICU at UNC Hospitals. Where do you work?

Good gouge here, can't add anything better.

My 'worst' burn story was from when the planes collided near Pope AFB back in the early-90s. I was a flight paramedic then and flew up some of those patients. I think UNC saw 20ish patients that day, some minor, most full-thickness <75%.