Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Wilderness and Rescue Medicine

with the application of cool soaks for pain relief. Monitor for infection as you would with any open wound. If the burn falls under the category of high-risk, plan to have the patient to medical care within 48 hours if possible. If the burn involves significant damage to the respiratory or circulatory system, emergency evacuation should be initiated with early access to advanced life support (ALS). Ideally, transport the patient directly to a burn center.

covered with a waterproof clothing layer or plas- tic kitchen wrap. Immediate attention should be given to maintaining hydration and body core temperature. The patient will need food, fluids, and protection during evacuation. Prophylactic antibiotics may be indicated for large or contami- nated burns. Aloe vera gel is useful to relieve pain, and to provide some topical antibiotic and anti- inflammatory effect. Blisters Blisters, like the kind you get on your heel while hiking, are caused by the heat generated as your boots and socks rub against your skin.The damage results in swelling and inflammation. Although a blister is only a superficial wound, it can become a major transportation problem. Blisters progress through three stages, beginning with a hot spot, progressing to a partial-thickness burn, and then bursting to become a contami- nated superficial wound. The stage at which you confront blisters, and your logistical situation, will determine your treatment. Generally, blisters are treated the same as other partial-thickness burns. Treatment of Blisters If you can stop the friction, you can prevent a blis- ter from forming. Advise your patient to change his or her socks, adjust shoelaces, and cover the sore area with a liner sock, smooth surface tape, gel dressings, or mole skin. You can also apply antibiotic ointment to lubricate the area and reduce friction.

General Principles

Burn Treatment

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• Immediate cooling. • Continue cooling for several minutes. • Irrigate with water or 1% PI solution. • Remove dead skin. • Decompress blisters only if necessary. • Dress to prevent contamination. • Monitor for infection. • Hydration

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In a wilderness setting, even sunburn can be a significant problem if it occupies a large area of skin surface. Ultraviolet radiation causes inflam- mation of the dermis and epidermis, inhibiting skin function and causing pain and redness. You should anticipate all the same problems inher- ent in any large surface area burn: volume shock, thermoregulatory problems, pain, and infection.

General Principles

High Risk Burns

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• Grossly contaminated • Cosmetic or functional risk • Circumferential Burns • Full thickness • Respiratory burns • Chemical burns • > 10% BSA partial or full thickness

General Principles

Blisters

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Prevent Friction and Heat: • Moleskin, donut dressing

• Smooth tape • Gel dressings Treatment:

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• Unroof blister if it appears infected • Drain blister if it prevents travel • Dress as partial thickness burn

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Dressing a large surface area burn can be dif- ficult. The goal is to minimize contamination and to reduce evaporative cooling. An improvised dressing can consist of a clean cotton tee-shirt,

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