Unlike first-degree burns (which was covered last week), there is a huge range in the severity of second-degree burns. Anything with a blister qualifies as second degree, but a smaller burn, for example, due to contact with a curling iron or hot skillet, is managed much differently than a blistering sunburn from spending a day at the beach without sunscreen. Likewise, treating a substantial second-degree sunburn in an infant is a whole lot different than treating the same in an adult. Location is also important in determining the approach to treatment. A smaller burn on the face, hands, feet, or genitalia (like from driving with hot coffee) needs greater attention and care than something similar on an arm or leg, due to the risks of infection, scarring, disability, or proximity to delicate, vital structures.
In a functioning medical system, patients with second-degree burns covering more than ten percent of the body would be referred to a specialized burn unit. Assuming that the world has completely fallen apart, how do you calculate how much of the total body surface area has been burned? And why is it important?
It's called the "rule of nines." The palm of the patient is considered to be about one percent of the total body surface area. For the rest of the body, the rule of nines works pretty well:
Head and neck
|
9%
|
Each arm
|
9%
|
Chest
|
18% (2x9)
|
Back
|
18%
|
Each leg
|
18%
|
Genitals
|
1%
|
This is important to be able to calculate because in a patient with burns covering more than ten percent of the body, dehydration is a real concern. The patient needs to be rehydrated with an oral rehydration solution. The formula for calculating the amount is called the Parkland Formula:
2-4 ml of ORS x body weight in kilograms x % of the total body surface area burned.
Even with "only" second degree burns, the patient will need intensive
care, particularly with regard to fluid loss. Dehydration and renal
failure can easily happen here. Keep the patient very well hydrated.
Second-degree burns, sometimes called partial thickness burns, may occur in numerous ways:
- serious sunburn
- hot liquids
- steam
- hot skillets
Regardless of how you plan to manage treatment of patient, the following must be done:
- As with first degree burns, place the affected body part under cool (not icy), running water for 15-20 minutes, without giving the patient hypothermia.
- As the body part is under running water, remove all jewelry from the afflicted limb, even if the burn is higher up on the arm or leg. Swelling on a burned limb can be far worse than you might imagine.
- Lance only large blisters.
- Do not remove burned skin.
All popped or decompressed blisters and areas where the skin that has sloughed or peeled should be covered with a non-stick dressing like Telfa. Any creams or ointments should not be applied directly to the skin to avoid inflicting pain and damage, but rather should be applied to the non-stick dressing. Antibacterial ointment or cream such as bacitracin is available OTC. Silver sulfadiazine (Silvadene) is available by prescription only and is generally reserved for more extensive burns. You might be able to get your doctor to prescribe some for emergency use.
Change the dressing daily to inspect for signs of infection. If the site has become infected, the burn may present with expanding areas of pinkness around edges. Other signs include bad odor, pus, increased pain and warmth, fever, and red streaks.
Conventional Treatments
In addition to the antibiotic ointment and silver sulfadiazene mentioned above, ibuprofen may be taken for pain. Other options for topical relief include benzocaine and lidocaine ointments or burn gels. When shopping around, keep in mind that some burn gels only contain 1/2% lidocaine, while others contain 4-5%. Make sure you're getting the maximum pain relief possible.
If infection develops, most doctors would prescribe cephalexin, Augmentin, or erythromycin as first choices. Second-line options would be doxycycline, ciprofloxacin, or levofloxacin. Treatment would be continued for two days beyond resolution of the infection. In order to conserve the supply of antibiotics, bacitracin, silver sulfadiazine, and/or honey might also be recommended.
Alternative Treatments
When it comes to alternative treatments for burns and pain management, options abound, many more than can possibly be included here. This article will only include those most applicable in a post-disaster scenario.
- Aloe vera is good for first and second-degree burns. If you have a plant, cut off a leaf, open it up, remove the gel and apply it to the burn four to six times per day.
- Baking soda--add 1/4 cup to a warm bath and soak for fifteen minutes or more.
- Black tea has a couple of options.
- Soak 2-3 tea bags in cool water for 5 minutes. Dip cotton compresses or gauze in the tea and apply it to the burn area.
- Steep 3-4 tea bags and 2 cups fresh mint leaves in 4 cups boiling water. Strain the liquid into a jar and let cool. Dip cotton compresses or gauze in the tea and apply it to the burn area.
- If the patient has to be mobile, use 2-3 wet tea bags that have cooled down. Wrap in place with gauze and tape.
- Essential oils
- Lavender may be applied without dilution. (I have found it to be far more effective than burn gel for small burns--fortunately, I haven't had any personal experience with substantial burns.)
- Tea tree oil should be diluted in a little water before applying it to the skin.
- Vinegar, any kind.
- Dip a clean cloth into a 50-50 dilution of vinegar and cool water and apply to the burn. When the compress feels warm, re-soak and re-apply as often as desired.
- For a burn on the trunk of the body, soak a cotton t-shirt in the solution above.
- Witch hazel. Dip clean cotton compresses in full strength witch hazel and reapply as often as desired.
- Whole milk or full-fat yogurt may be applied to a compress and then used on the burn.
- Honey. More clinical research has been conducted with using honey for burn treatment than with any other alternative treatment. Research studies demonstrated that honey-treated wounds healed more quickly with less bacteria. If you're rich, or just like being able to buy things without thinking too much, you probably want really expensive Medihoney (gauze impregnated with manuka honey). If not, regular raw, unprocessed honey will work just as well. Right after cooling the skin as above, apply a thick layer of honey all over the burn. Then cover it with cling plastic wrap. (The colored stuff, if you can get it, is the best--it's a little thicker and easier to manage. It's also most easily found in grocery stores during holidays, especially Easter and Christmas.) Change the dressing if fluid begins to ooze out, and regardless, change it at least 3 times per day for 7-10 days. Do not remove or wash off the honey for 3 weeks, unless healing is complete before that time. Add more honey often and fill in depressed areas as needed. Do not leave any burned skin exposed to the air.
Also, when working with hot liquids, cooking, or machinery, have a supply of clean cool water, preferably running, available for burn treatment. If running water is not an option, at least have some basins to pour water back and forth in case of an accident.
Links to related posts:
Burns--First Degree
Sugar
Honey
Hypothermia
Dressings
For more information:
Dr. Cynthia Koelker, Armageddon Medicine, pp 263-269.
Dr. Joseph Alton, The Survival Medicine Handbook, pp 315-322.
22 january 2020
No comments:
Post a Comment