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Thermal, Chemical and Electrical Burns

Jody: Yeah, yeah, just a minute. I've got the grill going right now. It's just about

ready. Just give me a se- , oh, oh, ah, ah, ah, oh, I can't believe I did that. Ah. Roy:

Burns can be a complex injury because there's different degrees of a burn. There's also

different sizes of a burn. We're gonna take a quick look here at the different degrees

by the way that you can see this bullseye shape as we go from the less of a degree to

the most extreme. The pink outer ring is noting the first degree burn. It's noted with redness

and pain. Then we move to the second degree which is usually blistering, whether they

are intact or they're popped, blistering skin is a second degree burn. And then lastly the

dark charred area in the center of the burn which is dry looking, could be split open

or a full thickness burn all the way to the bone. This is a third degree burn. This can

be life threatening, has a lot of complications, and is nothing to mess around with. I don't

care what the size of it, it needs to be seen at the emergency care center appropriate for

burns. Now how do we treat these burns. Well, if I saw this, immediately we're calling 911

and getting emergency medical services on the way. But the sequence of treatments are

such: Remove the body from the burn. So if he was unconscious and lying in embers, we

would remove that. If it was clothing that was still smoldering, we would move the clothing,

safely. But remove the person from the burning agent. Secondly, cool the burn. Now cooling

of the burn means potable water, clean water. It doesn't need to be sterile. If it were

sterile, that would be great. Cool to cold water is what we're looking for. And we're

going to not touch the wound with the bottles, but we're going to basically just keep pouring

water over the burn. We're gonna do this for between five and ten minutes, long enough

to actually cool the full thickness of the tissue and stop the burning process. So let's

say that we've cooled this burn now for up to ten minutes. The tissue is cool. There

was a lot of talk in years gone by about a pre-antibiotic treated gauze or some petroleum

based gauze. Now the recommendation for the current standards is a loose, dry, sterile,

if possible, dressing. I am going to just lightly begin to wrap from above the burn

where it started. I'm going to not put a lot of pressure. Again, in the third degree burn

area, most of the nerves have already been damaged to the point where they're not actually

sensing any pain. But the surrounding tissues of the first and second degree are going to

be excruciating. So we want to keep that idea in our head as we're carefully handling the

patient. We're gonna watch this person to see if they're showing any signs of dizziness.

If at any point, they seem to be losing their balance, we want to make sure that we get

them sitting or lying down in a position of comfort. So now after we've gone ahead and

bandaged this burn, there are some significant points that we need to make. Number one is

we need to make sure that we are watching this person for any signs of inhalation burns.

Do they have any swelling or any kind of wheezing. Do they have burn marks on the facial hair,

the eyebrows, the nose hair. If they open their mouth and we look inside, do they have

any soot or granulated burn stuff inside their mouth. Which would suggest that when the flame

exploded, they got scared and inhaled quickly and may have inhaled that superheated temperature

of that air. So it's all important for us to keep those in mind because these symptoms

might develop into a respiratory problem. And if that were to happen, we would simply

move to treat them. If they become dizzy or lightheaded, we sit them down, lying them

down. But keeping them in the position of comfort and keeping them out of shock is the

most important thing while we wait for EMS to arrive. Now there's other forms of burns

as well that we should be aware of. And that is chemical burns. If it was a dry chemical,

it would important to carefully, while keeping ourselves safe, brush off as much of the dry

chemical first before we begin to rinse it off. And then rinsing off the remainder of

the wet or dry chemical, we're going to do that for no less than fifteen minutes. The

solution to pollution is dilution. And that's a rhyme that we use so that we understand

that even if it's not washing it off, it's diluting the chemical and weakening the chemical.

So we just keep diluting that chemical down helping stop the burn. If it is smoldering

clothing, remember we're gonna remove that without becoming a patient ourselves either.

And then we're gonna monitor the patient and watch them until EMS arrives and until the

next level of care can take over. So we've covered thermal burns. We've covered chemical

burns. And the last one I wanna talk about is electrical burns. Before we ever come in

contact with the patient, we need to understand that the energy source must be removed from

the patient. That means deenergizing the source, getting the professionals out to cut the power

to that line that's fallen down. Whatever it is that needs to be done, but we cannot

risk becoming a second patient by touching the primary patient and being electrocuted

ourselves. Now some significant differences in electrical burns compared to the other

two. Electrical burns tend to have an entry point and an exit point. The entry point,

though it can be small, could have that small bullseye of the first, second and third degree

burn. But the exit point could be explosive damage. That energy can literally show like

an shotgun wound where it exits the ground of the body. And so on one end of the body

we might actually have soft tissue and bleeding control, while at the entry point we have

a burn to take care of. That burn will be managed the same way we described before with

the removing of the burn source, the cooling, and the dressing. Now some other things to

think about, though, is the fact that if that electric power was so much that it exploded

as it exited, it might also have fractured long bones. So that's something to keep in

mind. And then lastly, remember that the electricity as it travels through the body could also

affect the conductivity of the heart and damage those conduction points in the heart. And

in the next 24 to 72 hours, we can sometimes see the development of life threatening dysrhythmias

develop as this person is pretty relatively stable from the burn or the wounds themselves,

but then develops cardiac issues secondary to the electrocution. All these things should

be kept in mind as we're treating these different burn patients and keeping ourselves safe in

the meantime as we wait for EMS to arrive and take the patient to the next level of

care.