View Full Version : Burns
What do you do if you receive a burn? The reason I ask is because we tend to have a lot more fires in the winter months and the likely hood is that now is the most likely time to burn yourself.
We have a few medical people on the forum and some wise laymen. Some advice of what to do when miles from anywhere and you burn yourself?
:f:
C_Claycomb
22-12-2003, 15:50
Alovera is meant to be top stuff to put on burns, think that you can get something in tubes with it as the main ingredient, saves you carting a pot plant around with you! Not sure how this ties up with current thinking.
Don't quote me, but I believe that you are meant to keep burns dry and clean. The few burns that i have had did feel better after being immediately cooled in clean water, but after that kept dry. Don't use cotton pads, the fibres can stick to the burn surface. I think that there are special burn dressings that are meant to prevent this adhession.
Crash cool it as fast as possible. Cold running water is best.
For small burns, I'm fond of a product called Burn-Eze (Boots sell it still, I think) that is a small can of propellant and benzocaine. Chills the burn area and the benzocaine helpe numb the pain. Obviously, there would be liability issues with using this in any official capacity.
Checking the St John's manual, the order of events listed is cool burn (pour cold water on for at least 10 mins), remove constrictions, cover with clean sterile dressing, non-fluffy material, cling film or a plastic bag. Treat for shock & casevac. There's no mention of assessing severity of the burn.
ESPY IS RIGHT - you need to cool it quickly and stop the flesh cooking (damaging cells etc)
Immerse in water for 10 mins and then apply a dry sterile dressing - if its bad enough seek medical assistance.
Alternatively dont burn yourself - exercise more caution/common sense around the burny stuff.
I do have to point out here that I don't burn myself :f: but it is useful to know other peoples views. Mors book has some good stuff on it although I'm not sire how it translates to the UK
thats your excuse mate!! :nana:
Tony - congratulations on your carefulness - you are a credit to the Bushcraft world :notworthy
Cool it down quick is the right way to do it. If you are with someone who is burned - you may struggle to get them to keep it in running/cold water for 10 mins. Seems like hours. Shock will probably be an issue too.
As for covering it - definitely not fluffy stuff. I came across some "vaseline gauze" recently, which looked very good for a lot of different wounds. Didn't stick and made a good "bottom" layer to a dressing.
As for an assessment on the need for medical help, % burnt (using the palm method) and the severity of the burn would be the way to go. We have at least one GP on here, so I will let him chip in with some specifics.
usually when i burn myself i run around hooting, dancing and swearing profanely :roll: :lol:
cheers, and.
A whole lot of shouting and swearing normally fixes most things, or gets the job done :-D
Only time I can remember holding it in was soaking a dressing off of my thumb the day after some spoon carving unpleasantness - involving my thumb and a crook knife. :yikes:
Andrew Middleton
23-12-2003, 08:56
Cooling for ten minutes in cool/tepid rather than cold water will reduce the instant hit of shock.
All the advice about covering with non-fluffy material is sound. I would stay well away for creams and ointments though, unless you are likely to be away from medical help for a long time. Putting such substances on severe burns serves the purpose of acting as a barrier to infection and keeping the wound from drying and cracking. This is best left to the experts, if possible.
It is important to remember that the burn compromises the body's physical immune barrier. Therefore, it must be kept clean, hence the sterile dressings. If the burn is large, a surprising amount of fluid can be lost, which needs to be replaced.
That all said, swearing and running around also works for me, and many A&E medics will use the same tactic once you get to hospital.
I am a big advocate of cling film! I carry it folded. I fold the cling film into a 10-20cm section and then onto it's self, almost into a flat role. I then fold this in half. I have used this for cuts, and burns. It works a treat as for burns it keeps it clean and nothing gets into the wound like fluff. For wounds it stems the blood as it acts a bit like a torunique and also keeps the wound clean! I wouldn't bother with oinments as they are heavy to carry, messy to apply and for the short term they aren't worth it!
Mark
donkeyporge
23-12-2003, 09:34
I used to work with a Chef who swore by using the white of an egg to create a second skin over the burns. :oops:
It would usually be a hand that gets burnt, if this is the case are condoms good to use as a glove?
jatherton
23-12-2003, 13:23
I've heard a lot about lavender being extremely good for burns. Though, you'd probably wan't to be careful about infections from the flower head itself.
Joel
Pre-hospital burns management in a nutshell.
1) Extinguish flames, ensure safe to approach.
2) Cool down with water. Be aware of hypothermia risk if outdoors of course.
3) Check airway and breathing ok (if patient talking and not breathless, airway is ok. Smoke inhalation can cause later swelling of airway, so keep under review.)
4) Estimate area. Rule of Nines – in an adult 1 arm is 9%, head is 9%, front of chest and abdomen 18%, back of chest and abdomen 18%, 1 leg is 18%. This leaves a mere 1% for the wedding tackle. Sorry guys.
5) Estimate thickness. The old ‘third degree burns’ terminology is no longer used. Full thickness burns destroy the full thickness of the skin, including the nerve endings, so they are painless and have no feeling. Unless very small they need grafting. They look white or grey or charred. Partial thickness burns are painful, red and blistered.
6) More than say 5% burns in an adult (even less in kids) should be assessed in hospital. Ditto full thickness burns.
7) Clingfilm from a roll is sterile on the internal surface. It is the dressing of choice after cooling.
8) If more than 15% burns in an adult or 10% in a child, fluid loss may be a problem. If you have the equipment and skill, then iv access and colloid infusion are appropriate. Transfer should usually be to a hospital with a burns unit.
9) Dead burned skin can form a black/grey inflexible layer which can restrict breathing and circulation. In extremis, this may need to be divided (escharotomy). Bit beyond the scope of this though
Very interesting Doc, we were always taught to add a dry dressing but i like the cling film idea as that will keep the wound moist and fresh.
And if the patient dies still leave plenty for your sandwiches!
To answer Tonys last question yes condoms make good burn dressings for hands
for full thickness burns
after cooling a burn down dont appy anything to it except flamazine
(its a cream used in hospitals) after covering the burn in copious anounts of flamazine (i hope i'm spelling that right) stick your hand in a sterile plastic bag and tape the top closed around the wrist or put a condom over it which has the advantage of being sterile and self sealing around the wrist
their is also a neat trick using a condom for chest Decompression after a pnumothorax :-D
What would the bushcraft world do without condoms and tampons?
the other good thing about cling film is that you can see the wound heeling which is a big help. vasaline is good for scoulds but it must be very clean (i keep a film pot of it just for that) i also carry sterile trianglar bandages as part of my firsdt aidd kit whichcan be loosly wrapped round it just to keep the burn clean
the other good thing about cling film is that you can see the wound heeling which is a big help. vasaline is good for scoulds but it must be very clean (i keep a film pot of it just for that) i also carry sterile trianglar bandages as part of my firsdt aidd kit whichcan be loosly wrapped round it just to keep the burn clean
Vaseline! Be interesting to hear a professionals view on this as every first aid course I have ever done stresses not to put greases or ointments onto a burn.
I have used in the past water gel dressings after the initial 10 minute cold water cooling period to keep a burn cool on the way to hospital. Any views on this? I was recommended these as a good way of minimising tissue damage post burn.
ditchfield
03-01-2004, 14:21
Before rapping in cling film, burns must be cooled completely, as it holds in the heat which would continue to burn you.
can i point out that i did say it must be clean. the idea comes from miners who works with the oily stuff which is what vasaline is made from. also I do have an advanced first aid qualification through St Johns which i was a member of for six years.
Fallow Way
03-01-2004, 17:52
Another tip:
When using cold water to cool the burn, once the aera is back down to body temp and more cleaning of the wound is required, use water that has been warmed to body temp. Have someone stand with a water bottle under their armpit or under their jumper etc. The body works best at body temp (stating the obvious I know :-) ) so continuuing to use cool water once the process of cooling the wound is complete will slow the healing process down.
Thats something i picked up from my gf, a Nurse
Justin Time
04-01-2004, 09:38
The use of Vasline on burns seems a tad controversial with a couple of letters in the BMJ last year
One from A&E docs making this statement:
"Grease should never be applied to a fresh burn where the superficial part of the skin is missing. In addition to being occlusive, it is non-sterile, promotes bacterial proliferation on the surface of the wound, and may lead to infection.1 2 We propose that the manufacturers change their labelling system, to clearly state that Vaseline is not to be used as an immediate first aid measure for burns, but can be used as a subsequent dressing for minor burns"
Here's a link to the search page which has the above letter, the manufacturers reply and a summation of the evidence base:
http://bmj.bmjjournals.com/cgi/search?pubdate_year=2003&volume=&firstpage=&DOI=&author1=&author2=&title=&andorexacttitle=and&titleabstract=&andorexacttitleabs=and&fulltext=vaseline&andorexactfulltext=and&fmonth=Jan&fyear=2003&tmonth=Jan&tyear=2004&fdatedef=1+January+1994&tdatedef=3+January+2004&resourcetype=1%2C2%2C3%2C4%2C1 0&RESULTFORMAT=1&hits=10&hitsbrief=25&sortspec=relevance&sortspecbrief=relevance&sendit=Search
Justin
ps, can anyone tell me how to "hide" a URL behind a title like I do on other forums?
Alovera is very good for burns, In my first aid kit there's usually a small vial of SOLACAINE It's for sunburn really but I've found it works well on minor burns as well
Hello all.
There's been some very astute respones so far. Expecially Doc's.
2) Cool down with water.
3) Check airway and breathing ok
7) Clingfilm from a roll is sterile on the internal surface. It is the dressing of choice after cooling.
8) If more than 15% burns in an adult or 10% in a child, fluid loss may be a problem. If you have the equipment and skill, then iv access and colloid infusion are appropriate. Transfer should usually be to a hospital with a burns unit.
9) Dead burned skin can form a black/grey inflexible layer which can restrict breathing and circulation. In extremis, this may need to be divided (escharotomy). Bit beyond the scope of this though
The first thing to always do is cool down the burn victim. Cool water is choice. Not cold water as stated. Unfortunately, there's really nothing that will relieve their pain that much.
Remove clothing, rings, barcelets, watches, etc. A really bad and painful situation could develope if a burned extremity swells around a ring. If clothing is burned into the skin, leave it, and cut the excess off. If there is a full thickness (3rd degree) burn that goes all the way around an extremity or the chest/abdomen (called a circumferential burn) it can truly be a life threatening emergency. In such cases escherotomy may be necessary, which is basically perforations cut into the burnt skin to allow circulation and/or breathing by letting the skin expand and contract. Really a nasty lookin thing, but the patiient won't feel any pain associated with the full thickness burns.
In the US there is an uncertainty/mixed opinions about bandaging burns. Some say bandage wet some say dry. I'm with the dry crowd. As for vaseline, I'd never use it because of the reasons stated. Vaseline will seal all the muck and nasties in the wound. Infection as well as hypothermia are major concerns with burns, so treat them accordingly. (I do, however, keep some "burn-eze" burn gel in my FAK. Mainly it's for superficial burns (first degree) and making people feel better.)
If you're going to close it up, make sure you use a burn sheet (don't know what they're called over there). Unlike gauze, it will not stick in the wound like a gauze when you pull it off.
For very minor burns (1st degree, superficial) I've read that honey works fairly well. I personally love aloe and keep a large plant on the patio. Other than that, I keep nothing other than the burn gel and burn sheets in my FAK for treating burns. Although, I'm heading down to the everglades for a week next weekend, and have decided to bring a fairly large bottle of 100% aloe with me. I'm sure we'll all be sunburned by the end. (i.e. supeficially burned. :-D )
Doug Ritter swears by this stuff http://www.gtandco.com/burnaway.htm
Burnaway plus contains Tea Tree Oil, Aloe Vera, Hawaiian Ginger and Vitamin E.
I always ment to try get some but their email had problems. Might have to give them a call.
Never heard of the clingfilm idea before...thanks for that
nigel
Interesting info re: burns. I wonder, though if we have not got too
carried away with the question? Yes be careful, yes use cool water for at least ten mins. (it seems a long time but is worth it) and as people who use homoeopathy the remedy Cantharis works well for us. We normally take it in pillule form. It is part of our travelling first aid kit , along with Arnica etc..
Homoeopathy, with advice is available from
www.helios.co.uk
i have just noticed that they do a first aid emergency kit.
Hope this helps
Jeremy
www.islaybirding.co.uk - what are you doing today?
maybe it was scoalds that the creams were for. oh well ill use the stuff on my lips instead