Myth Busting: Treating Burns
Over the past year, I’ve been writing a regular column for SisterShip Magazine. It’s a fun format where I take a medical myth and bust it wide open, replacing misinformation with the real thing. My goal, as always, is to educate boaters on handling medical emergencies on the water in a quirky and entertaining way. Please join me for the fourth installment where we talk about burns.
When I was working in the ER, I was always joshing that I wanted to have a bright red “hot phone” installed in the department for anyone thinking of doing something that they weren’t quite sure was their best idea. You call me and I’ll tell you what I think. Fairly often I’d have had to say “Please don’t do that!”
In offshore medicine circles, I am asked questions that bring back thoughts of my old “hot phone” idea. This is where my beloved red phone meets paper. We’re going to bust medical myths, kick a few Old Wives’ Tales to the curb, grab Urban Legend by the ears and maybe learn a thing or two about handling medical emergencies on the water.
The Three Types of Burns
There are more than a few bits of misinformation out there about treating burns. Maybe you’ve heard that you should pop the blisters that form, or slather a burn in butter? Please don’t do that!
Burns can be caused by exposure to heat, electricity, chemicals, inhalation, or friction. They’re classified by how deeply the burn penetrates the skin. First-degree or superficial burns don’t penetrate the skin. The small blood vessels and nerves are intact. These burns cause redness, pain, and warmth. Think simple sunburn.
Second-degree or partial thickness burns go a little deeper and damage small surface vessels and nerves. They cause redness, pain, and warmth just like the first-degree burn, but also cause blisters. Examples of a second-degree burn would be a blistered sunburn or rope burn.
The worst type of burn, the one that makes even battle-hardened ER nurses quake a little in their boots is the third-degree or full thickness burn. This burn penetrates down into the deeper layers of the skin, called the dermis, where it destroys blood vessels and nerves. Third-degree burns may appear grey or black, have no blisters and may not even be painful due to the destruction of nerves. This type of burn might come from a galley fire or engine fire.
How to Assess a Burn
In the ER, we look at the big nasties first. Offshore is the same. Is this burn really bad? On the water, when deciding how deeply you’re standing in alligators, consider three things:
- the degree of the burn;
- the location on the body; and
- how much of the body has been burned.
When to Evacuate
Begin the process of evacuating your patient off the boat, ideally to an ER or Burn Center, when you see any of these things:
- Partial thickness burns of hands, feet, face, genitals, or over joints. These cause problems as they swell, potentially compromising circulation; later, as they scar, compromising movement.
- Circumferential burns. When a burn goes completely around a part of an arm or leg, the swelling can cut off circulation.
- Burns greater than 10% body surface area. We lose a lot of fluid from burns, so a larger burn can cause fluid loss shock. A quick guide to determine the percentage is to use the patient’s palm size to estimate the burn size. The palm is about 1% of the body’s surface area.
- Full thickness, electrical, and chemical burns require advanced treatment. Full thickness burns are at increased risk of infection. Electrical burns can cause damage to the body’s internal organs and tissues that can’t be seen with your eye. Chemicals are difficult to remove from the skin and can go on to burn for hours after exposure. Most chemical burns need to be rinsed with clean water for at least 30 minutes.
- Singed nasal hair, burned lips, a cough, or sooty phlegm. These signs indicate that the airway may have been burned. Swelling of the airway or fluid collecting in the lungs from a burn can be life threatening.
- Very young or very old patients. These two groups can get worse really quickly with zero notice.
These are MAJOR burns with an increased risk of infection, fluid loss, respiratory problems, and circulation issues, and should be taken very seriously with the patient evacuated from the boat as quickly and safely as possible. In the meantime, if it’s safe for you to approach the person, make sure they keep breathing. Begin CPR if needed; watch for signs of shock like fainting, pale skin, and shallow breathing; protect them from further injury; remove any rings, jewelry or other restrictive items from the burned area; and cover the burn loosely with a clean cloth or cool moist dressing. If appropriate, provide food and fluids while you seek or await help.
Treating Minor Burns
For minor burns that we can treat on the boat, start with cooling the burn by running it under cool (not cold) water. If no running water is available, use a bucket of cool water or a cool, moist compress. Please don’t immerse large burns greater than 10% of the body’s surface area in cold water, however. This might cause the body temperature to drop.
Be very careful removing any clothing from the burn as it may be stuck. Pulling clothing away quickly may pull a person’s skin off with it. No one wants that! If clothing is stuck to the burn, pour the cool water right over the clothes. Remove any rings or jewelry from the area quickly and gently before swelling occurs. Removing jewelry from the area of any injury is good practice. This keeps us from having to cut off your favorite ring later.
Leave blisters intact please. I know it’s hard. I’m a popper too, but the fluid inside of a blister aids in healing and the roof of the blister acts as a natural bandage to prevent infection. Blisters should be decompressed only if absolutely necessary. Any loose dead skin can be trimmed away with a clean scissors if necessary. The fancy medical word for this is debridement.
Use Aloe, Not Butter!
Once the burning process has been stopped and the burn cooled, treat it like an abrasion. Gently wash any dirt or debris from the burn using clean water and mild soap and pat the area dry with a clean cloth. Apply a thin layer of aloe or antibiotic ointment. Opt for the real deal, 100% pure aloe vera gel. Avoid the creepy green stuff from the sunburn aisle. Aloe has many amazing properties including anti-inflammatory, anti-microbial, moisturizing, and pain-reducing magic. It promotes the healing of minor burns, abrasions, and skin irritations. Butter should never be used on a burn. It traps heat and increases the risk of infection. Butter is for toast, not burns!
Cover the burn with a non-stick or specialized burn dressing to prevent contamination and infection. Large areas of burn can be difficult to dress, for example a sunburned back and shoulders. Be creative. An improvised dressing in this case could be a clean t-shirt. Change the dressing daily. This is also a good time to check the burn for any signs of infection such as increased redness, swelling, pain, or pus coming from the wound. If evidence of infection is noted, follow up with a medical provider immediately as antibiotics may be necessary.
OTC Pain Medications for Burns
Burns can be incredibly painful. Over the counter pain medications are helpful if your patient is able to take them, especially the anti-inflammatory medications such as ibuprofen. They treat the pain directly and also treat the source of the pain which is the inflammation. Over the counter topical anesthetics, such as Burn Jel can be helpful as well. These contain a medication called viscous lidocaine which numbs the surface of the skin. It can be used in small amounts, no more than two ounces every four hours. For a large area, like the sunburned back example, mix the Burn Jel with aloe so it will cover more territory. It’s also important to verify that your patient’s tetanus immunization is up to date.
If You’d Like to Learn More
The good news is that most burns are minor, can be cared for easily using basic wound care techniques, and usually don’t require emergency medical attention.
Further reading suggestions:
- A Comprehensive Guide to Marine Medicine: Eric Weiss MD and Michael Jacobs MD
- Wilderness and Rescue Medicine: Jeffrey Isaac PA-C and David Johnson MD
Your own internet search may give other advice but remember that you can’t always trust Dr. Google. He’s only as good as the questions we ask him, and he doesn’t have malpractice insurance.
Have a medical myth you want busted? I’m all ears. Contact me and we’ll get to the bottom of it!
Medical Disclaimer: I am not a physician. I am an offshore medicine certified RN with 20+ years of ER experience and a heck of a lot of common sense. Follow up with your healthcare provider for any questions or concerns. Read my full disclaimer here.