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[at-l] More on first aid for burns



I decided to do a little more review of Wilderness Medical Society's advice 
regarding burns.

I will try to summarize for our sort of exposures, leaving out chemical 
burns such as White phosphorus and such. Our likely burns are thermal 
(scald, flame, flash and contact), and Radiation (sunburn). The first thing 
is to stop the burn by either smothering or extinguishing the burn.

Next is to assess airway: Singed nasal hair, carbon and soot in the nose 
and throat, hoarse voice, and facial or burns around the mouth are suspect. 
"Anyone trapped inside a burning structure has toxic inhalation until 
proven otherwise. CO poisoning is NOT uncommon in wilderness settings, 
especially when cooking inside tents or snow caves."

Evacuation is required for burns: over 5% of the body in 2nd and 3rd degree 
burns (an arm is 9%); any potential airway injury; burn with other 
significant trauma; hands, feet, face, eyes or genitalia; chemical burns; 
electrical burns; in the very young, very old, prior existing illness, or 
immunocompromised; circumferential burn of an extremity; burn complicated 
by toxic gas exposure.

For superficial burns, cool ASAP, apply aloe gel, give aspirin or similar 
agent for pain and inflammation.

For 2nd degree burns, stop the burning, treat the airway, treat shock, give 
pain relief, and irrigate burn with water or saline solution, debriding off 
any necrotic skin, dirt or debris. Drain large superficial blisters (over 1 
inch), debride and cover with topical antibacterial ointment and sterile 
dressing. Leave small, deep blister intact. Cover burns with antibacterial 
ointment and dry sterile dressing and change every 12 hours. Worry about 
hypothermia if over 20% of skin is burned. Keep the victim warm, covering 
burns in plastic wrap (Saran wrap for instance) to reduce evaporative 
cooling, but change dressing every 12 hours or when saturated. If the 
patient can drink, give balanced salt solutions by mouth and check urine 
output. Fluid requirements go up a great deal in treating burns, so plan 
accordingly.

Third degree burns are full thickness burns and receive initial first aid 
as above, with advice to prepare to deal with bleeding.

A couple of cases used for examples: First a 15 year old testosterone 
impaired scout pours stove fuel onto an animal carcass. 5 minutes later he 
finds a match and throws it on the carcass. The fireball causes flash burns 
to face and arms. Eyebrows gone, eyelashes charred, voice slightly hoarse. 
Location is 2 hours away from the hospital via ground transportation, 45 
minutes by helicopter air evac. What do you do?

Second, a 25 yo female using a camp stove inside her tent on the eastern 
slope of Mt Whitney, 6 hours walk from Whitney Portal. Stove flares up, 
tent catches fire, victim's clothing catches fire. Burns to the hands, arms 
and head, with melter synthetic fabric adhering to burned areas. Now what?

OrangeBug