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Old 01-17-2008, 20:57   #16
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I'll repeat, because it's worth repeating: The level of expertise on this discussion forum is simply amazing.
Not to mention: The "Zero-Bullshit-Level" that is maintained is quite refreshing!!!

Take care.
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Old 01-17-2008, 20:58   #17
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Not to mention: The "Zero-Bullshit-Level" that is maintainrd is quite refreshing!!!

Take care.
Martin
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Old 01-17-2008, 23:20   #18
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Thank you Sir

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All,

This has been a very interesting string on burns and I wish to add a couple of comments if I might. Let me share what I have gathered as an associate director of burns for roughly the last 5 years. Last year at our burn center we saw nearly 4900 burns of which over 920 were admitted while all the rest were outpatient or clinic follow-ups. Many simple and complex hand burn injuries presented at all hours of the day and night. Thank goodness many of the simple hand burns were self limiting, meaning that no matter what you do they will go on to heal with good basic wound care and a physician's vigilent eye. That is true if they do not get infected. Remember that burn injuries are essentially dead tissue. If the area is small enough the body can use its white blood cells to breakdown the small burn eschar and new skin will grow. We use silvadene, bacitracin and Aquacel Ag for different types of burn injuries for different reasons, all at different stages of healing to help expedite the process and to minimize discomfort. The healing skin has damaged nerve endings which in a first degree or second degree burn hurts tremendously. Again, third degree is total destruction of all nerves and tissues so is painless, except, as stated above, if there remains first or second degree burn around the third degree burn.

It is important to understand that bacteria loves dead tissue. That is why with the severely burned patients with third degree burns (hopefully, no fourth degree) and large surface area burns, infection is an enormous risk. Yes, even small area burns can get infected. I have had to admit small burns for raging cellulitis because the hand burn became infected. At times this has led to abscesses that required incision and drainage, worsening of the second degree burn to third degree burn and then on to skin grafting, joint involvement, tendon involvement, loss of motion, etc. The best thing that happened with this initial case is that the dead blister was debrided (or so it sounds), that the wound was bandaged and that ointment was applied frequently.

As for home remedies, they are "quick fixes" and have been tested by people throughout the centuries. Years ago, moms would grab butter sticks from the old ice box because butter was soothing and cool to a child's burn. Many of my patients from "south of the border" that get burned in the US smear toothpaste on their burns as it soothes their burns as well. How many of us have grabbed an ice cube from the frig and soothed a finger burn after we errantly touched the stove? The problem with anything ice cold is that it causes vasoconstriction and starves the area of burn from getting blood and can therefore extend the zone (or area) of injury, so please avoid putting burns in ice or iced water. If someone is barbequeing and they catch, yes, push them in the pool or spray them with the garden hose but usually swimming pools in July do not have ice cubes in them. They are luke warm and so it puts the fire out and cools the wound but does not make the wound ischemic. But also rememeber that hypothermia kills, so the burn victim gets dried off and wrapped in a blanket to keep warm as 911 is called.

The American Burn Association, which is the accrediating body for all US burn centers and is further given its accrediation by the American College of Surgery, recommends that all hand burns should be seen at a burn center. Hands are valuable and they are irreplaceable. They are often treated with disregard as we bang them around in our daily lives, but they are so invaluable to what every human does everyday. Today, hand surgery is its own defined subspecialty in medicine with its own training programs. So, we strongly urge that if you have a hand or finger burn, please come in to one of the 43 burn centers or one of the 120 burn units around the US. If you do not have a local one, go to the local emergency room and get advice from the ED physician. Many plastic surgeons and general surgeons have burn experience as well, but the wound should be seen by a physician. These are small injuries but they can be devastating if not cared for and followed. I have seen amputations of hands and digits due to too many carefree attitudes and the mindset that, "Well, it will be better tomorrow". There is something one of my professors taught me many years ago, and I quote, "You don't know what you don't know". He was right for as I study and see patients everyday I learn more all the time. That is why general surgeons train for 5 to 8 years after medical school and we still learn new things everyday (I did even today from your website and is the reason I joined).

Many diseases are self-limiting. Thank goodness this one sounds like it was. But be careful! Simple problems can sadly be the tip of the iceberg. If you use a home remedy remember it is not in place of sound medical advice.

Thank you,

Dutch
Sir,

Thank you for taking the time to post this information. It is absolutely invaluable.
I cannot tell you how many times people thought "it was nothing" and it turned out to be something absolutely terrible and debilitating. My latest case was a high pressure injection injury / chemical destruction with FREON into the dominant hand. Very ugly 48 hours after (when I saw him and asked what happened -> subsequently bringing him in for treatment / debridement and transfer. Eventual outcome was (unfortunately) poor.
On behalf of us "lesser medical beings"...your time and input is greatly appreciated.

v/r
Joe
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Old 01-18-2008, 08:22   #19
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I am not a medical professional but I did suffer 2nd and 3rd degree burns on my left leg, left arm and 1st degree burns on the face. As stated already in the 3rd degree burn areas I felt virtually no pain, how ever the 2nd degree burs on the larger portion of my leg and arms were terrible. I was in an ER within about 20 minutes of the incident and the two priorities I kept hearing was infection and dehydration. I hallucinated a lot, I seen everything from spiders to bears trying to get me. As I was only 12 at the time (yes years ago) and medical practice was a bit different then as they are now. I was in a burn unit for almost a month, having the wounds treated, physical therapy and whirl pool baths that were suppose to remove dead tissue. I have had broken bones, teeth knocked out, and cut but of all injuries I have ever sustained the burn was by far the worst for me as far as pain and sheer discomfort.

I would tell anyone if you suffer a burn go see the physician, get expert care!
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Old 01-18-2008, 23:29   #20
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Originally Posted by Eagle5US View Post
Sir,
My latest case was a high pressure injection injury / chemical destruction with FREON into the dominant hand.
Not to hijack the thread, could I get some more detail of this injury. I have been in the refrigeration feild for sometime and I have not heard of such an injury. I am curious as to how it happened.

Doc Dutch,
Thank you sir. The Burn specialist takes a very special kind of person. Highest respect to you and your kind.

BC
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Old 01-20-2008, 14:25   #21
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Originally Posted by NousDefionsDoc View Post
I'll repeat, because it's worth repeating: The level of expertise on this discussion forum is simply amazing.
+1 And it just boggles my mind that it's all here for free.
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Old 01-21-2008, 17:46   #22
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Doc Dutch,

First off Sir, thank you for the great information you have provided us about burns and your service to those people including children that look to you and your staff for help.

Secondly, I would like to know your opinion of the old adage: "When in doubt, go to the hospital! would apply to burns too?

Lastly, we here in Northeastern Ohio are fortunate to have Akron Children's Hospital Burn Center and they are magnificent at what they do, especially with children.
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Old 01-21-2008, 18:29   #23
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Just an FYI

Doc Dutch is the "Director of Trauma" for a large Phoenix hospital. He also specializes in burns and he works with the burn surgeons that saved Jason Schechterle's life (Drs. Daniel Caruso, Kevin Foster). I know all of them as Doc T works with them on a daily basis. Trust me when I say Doc Dutch knows his stuff....

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Old 09-24-2010, 22:43   #24
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Today I worked a call involving a pretty serious burn. Let me describe the situation, and then I have a question for the experts here.

The pt was Hispanic with so-so English skills, so getting a good history was a little problematic. He was working on his truck and somehow released hot fluid from the radiator. I don't think it came from the cap, because he had no burns to the chest/neck/face, which you'd expect from a guy standing over the radiator. I suspect he was on his back messing around with the inlet/outlet lines or a leak; the burn pattern looked like the fluid dropped onto his abdomen and then flowed down into the groin and thigh. He was burned across the lower abdomen, right hip, right thigh, into the right groin (including the scrotum), and on the right forearm. The abdominal and hip burns had split skin across them. The other lower area burns were fiery on scene and developed blisters during transport. The forearm burn was reddened but did not blister during our contact time.

On scene we found the pt standing in the shower dousing the burns with water, so he had done a good job of cooling things down already. We covered the burns with dry dressings, started a line with LR, gave him some morphine and got truckin'.

Upon evaluation at the ED (a level 1 trauma center), the doc decided to send this pt to the burn center at Augusta, Georgia. He felt the overall status of the burns was not too bad for them to handle locally but the involvement of the scrotum was what pushed him to send the pt to the burn center.

So now to my questions, spurred by this call: what are your recommendations for dealing with a non-trivial burn in a wilderness/austere situation involving extended evac? Wet dressings or dry? Bacitracin ointment or not? Occlusive dressings or breathable? In my research and in personally questioning various docs I have gotten a wide range of answers that are sometimes divergent.

Most of the info out there (especially textbooks) assumes quick transport to expert care.
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Old 09-27-2010, 08:42   #25
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alot to answer.......
- wet if less than 5% Total body surface area (TBSA), dry if larger. Wet will bring down the patient's temperature then hypothermia is an issue.
- antibiotic ointment is perfect
- I always carry my 'anti-inflammatory cocktail' when out in austire conditions as well as in my swat gear: a) antiinflammatories aspirin and ibuprofen, b) strong multivitamin like centrum or the like with high vit A,C,E, c) antihistamine (H-1), preferably non-sedating as well as an H2 blocker like pepcid or zantac.
Notice, no oral or IV antibiotics, burns generally don't need them in the field.
All of these act on the bodies ability to rev up the inflammatory cascade which I don't want rev'ed up. I give them for a burn, a GSW, crushed limb, etc. This cocktail will attack pain on several fronts and the bodies general reaction to a major/moderate insult from the burn. I use the same thing in the hospital on patients....it does work.

ss
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Old 09-27-2010, 09:47   #26
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Originally Posted by swatsurgeon View Post
-- antibiotic ointment is perfect
- 'anti-inflammatory cocktail': ibuprofen, centrum , antihistamine (H-1 blocker), zantac.
ss
THanks Syd. Will be Updating my FAK for travel with multivit and zantac. I already had the other goodies. Good tips
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Old 09-29-2010, 19:54   #27
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Exactly the kind of info I was looking for, SwatSurgeon; thank you.

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...antihistamine (H-1), preferably non-sedating
Which one do you recommend? I carry Benadryl now but that's definitely sedating for most.

Last edited by LeakyBandage; 09-30-2010 at 15:04.
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