We've previously covered prevention and treatment of first- and second-degree burns. In general, dealing with those doesn't present much of a challenge or concern. We've all had them and had to care for family members who've had them.
Third-degree burns, however, are an entirely different matter. Fortunately, they are much less common, but that doesn't make them any less challenging to treat.
Third-degree burns are full-thickness burns. There is no skin left, and no skin cells to re-grow new skin. These burns penetrate all the way into subcutaneous tissue and even muscles and bones. Naturally, there is going to be nerve damage. The edges of the remaining skin may appear black, brown, yellow, or white. That affected area of the body may appear sunken if a lot of tissue has been lost. And it is a bad sign when a substantial burn is not painful, as this suggests a very deep injury.
The immediate treatment is the same as for second-degree burns: Cool the burn with cool running water for 15 minutes and remove all jewelry and constrictive clothing above and below the burn. In a functioning society, most third-degree burns are treated at burn centers. In a disaster scenario, this may not be an option.
Before getting into treatment options, let's take a look at the numbers you need to know.
- Use the Rule of Nines (covered in the post on second-degree burns) to calculate how much of the body has been burned. Basically, the palm of the hand is 1% of the body surface. The head and neck and each arm are 9%. The chest, back, and each leg are 18% (2x9). The genitals are 1%.
- If the burn covers more than 10% of the body, the patient may go into shock. This is a life-threatening situation.
- If the burn covers more than 30% of the body, it is probably going to be fatal.
- If the burn covers more than 40% of the body, it is definitely going to be fatal. You don't have the resources to manage it.
Treatment for the burn itself is not complicated. After the burn has been cooled under running cool water for at least 15-20 minutes (but without causing hypothermia), apply pure raw honey generously all over the burned area and beyond the edges. Always maintain a thick layer of honey that extends beyond the edges of the burn. Cover this with plastic wrap (colored Saran Wrap is thicker and easier to handle) or waterproof dressings.
If and when the dressing begins to fill with fluid, change the dressing. More severe and extensive burns will necessitate more frequent changes. Regardless of the amount of fluid oozing, change the dressing at least three times per day. Continue this process for at least seven to ten days, and up to twenty days. Do not remove or wash off the honey for the first twenty days, unless healing is complete. Throughout this process, watch for any signs of infection.
Alternatively, if honey is not available, studies on animals show excellent results using coconut oil may also be used, especially if it is combined with silver sulfadiazine. Yes, we've been told forever to never use butter or anything like it on a wound. Coconut oil is different. Read the blogpost on coconut oil and this article.
A substantial burn is going to cause dehydration, and as stated above, even with a burn covering only ten percent of the body, there is a significant risk of dehydration and shock. The patient must somehow increase fluid intake. The Parkland formula is what medical personnel use to calculate the volume of fluid to be administered in the first 24 hours following a burn: 3 ml/kg times the percent of body surface area burned.
So if a patient weighs 50 kg (about 110 pounds) with ten percent of the body burned, we have 3 ml times 50 kg times 10, or 1500 ml.
One-half of this amount must be administered in the first eight hours. The other half is given over the next sixteen hours. After twenty-four hours, the amount of fluid administered is based upon urine output and other signs of perfusion. The goal in urine output is at least 50 ml per hour in an adult. If urine output is less than this, give more fluids. If there is low blood pressure or other signs of shock, administer more fluids. Oral rehydration solution may need to be administered. And if the patient is unable to drink, fluids may have to be administered using an enema bag (have several of these in your stockpile) or hypodermoclysis.
Burn patients need a lot of additional protein and calories. Those with burns covering less than 20% of the body can manage by eating and drinking more, but normal eating will likely not be sufficient for those with burns covering more than 20% of the body.
The book Survival and Austere Medicine, 3rd Edition provides details on skin grafting for dealing with burns covering 5-10% of the body surface. It looks like it would work. That book is a free download and covers some conditions that other grid-down medicine books omit. I highly recommend it.
There's not a lot more that can be done for a burn patient. The pain is going to be substantial. The likelihood of infection is high, as is the demand for supplies. Keep in mind that large burns to limbs may not heal and the disability may be to such an extent that amputation is preferable.
Links to related posts:
First Degree Burns
Second Degree Burns
Oral Rehydration Solution
Medicinal Uses of Honey
Does It Have To Be Manuka Honey?
Coconut Oil for Third Degree Burns
Survival and Austere Medicine, 3rd Edition book review
For further reading:
https://insidefirstaid.com/burns/how-to-treat-different-types-of-burns
Survival and Austere Medicine, 3rd Edition, p 125.
The Survival Medicine Handbook, p 317.
Armageddon Medicine, p 264.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792613/ Research article on use of coconut oil to treat burns
© 2019, PrepSchoolDaily.blogspot.com 05.24.23
