Wilderness and Rescue Medicine 8th Edition

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Section IV: Trauma

Ideally, transport the patient directly to a burn center. 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. 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 t-shirt, 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 blister from forming. Advise your patient to change their socks, adjust shoelaces, and cover the sore area with a liner sock, smooth surface tape, gel dressings, or mole skin. You can also

Treatment of Burns The initial treatment for burns is to remove the heat energy. The fastest way to do this is to immerse the patient, or injured part, in cool water but not ice; 20 minutes will suffice. Fortunately, this is almost instinctive as it serves to relieve pain as well. If the burn is greater than about 10% BSA, limit your cooling to prevent hypothermia. For most chemical burns, continued irrigation with water will not only cool the area but help remove the chemical itself. Irrigation of chemical burns should continue in cool water for at least 20 minutes. If the burn is not a life-threatening emergency, clean and dress it with antibiotic dressings like you would for a minor abrasion or use a long- termwound care product. This can be done along with the application of cool soaks for pain relief. Monitor for infection as you would with any open wound. Dressing a burn is generally similar to any other open wound. For burns specifically, the Xeroform type of gauze or other occlusive dressing will reduce pain by excluding air. For a temporary dressing, simply covering it with plastic wrap will work.

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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© 2018 WMA

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).