"pre-treated" burn victim

[Juice]

I have taken burn creme/ointment out of the first aid kits at work (30+ kits). People seem to think they should throw burn creme on right away when that can do more damage in the first half hour or so. The creme holds in the heat. A dry, sterile dressing is the best course of action and to help cool the burn, an ice pack on and off will help alleviate some of the pain. If the creme is already there, I would put a dry, sterile dressing over it to keep out contaminates and if the pain is too severe, maybe an ice pack on/off.

I do still have burn creme in the safety office and allow employees to use it on small burns or healing burns with a clean dressing. I have found that they respond well to triple antibiotic ointment instead of the cremes.

My .02

[Dsmittty911]

The one thing that I haven't seen mentioned yet is documenting that the cream was on prior to arrival. There have been several comments about the damage already been done. The only thing left after the dry sterile dressing is to CYA. In this time of lawsuit happy people I would think seriously about noting that it was already on there. I know you would note it if you did apply it but cover your rear end since you didn't do it. Just my .02.

[xselerate]

Is the patient on fire, or what? :?

Seems like every text I have seen in years very clearly says "dry sterile dressings."

If you have an isolated, minor burn area, then cooling is a valid option. However, removing cream would not be part of the plan. However, when you describe "a good portion of his body" being burned, attempts to cool the patient are likely to result in profound hypothermia. Not a good idea. Morphine would be a much better plan.

My protocols require moist sterile dressings to no more then 20% of the body at one time... dry sterile dressings go over that...

On a completly different and undiscussed note...

How about beating the guy over his head that put burn cream on a second degree burn?

[heavydutyfd]

I might be off the wall with this but

Isn't a burn with debris (debris being clothing, burned skin, ointment)also like an impaled object? Leave it and let the trauma team/doctors remove it. By pulling it out (in this case wiping the area) you will be doing more damage to the already affected area and beyond. If you have a burn patient who still has clothing embedded in the burn it self would you pull it out? My opinion leave it and let then people who specialize in burns take care of it the way it needs to be.

If it is a isolated burn then when you apply a sterile dressing and normal saline (or what ever you use) wouldn't that wash some of the ointment away? My thinking "YES" it would. But to wipe the ointment off of a burned area you could pop a blister. And what is a blister... the body's "Band-Aid".

Again this might be off the wall.

[Ridryder 911]

Trauma team for a burn... WOW! .. Actually burns are not really classified as trauma. Lets not make a mountain out of a molehill. 1'st & 2 second degree burns are usually easily managed... No burns are NOT impaled objects....

C'mon folks let's use some common sense.... Even Boy Scouts are taught how to treat burns.

R/R 911

[Nate]

I don't do burns, I just fly them out. <~~Joke

[csr]

I work at a Steel mill. Many of the injuries I am called to end up being burns. Most are minor but about once a month we get a bad one. I will never get used to the smell of burned hair no matter how many times I am exposed to it. It just lingers.

Our protocal is to cool, dress with dry dressings and transport either to the Company off site clinic or local ER based on orders from the on call physician. Burn cream isn't applied until the employee has returned to work and reports to the facility clinic where we apply the cream and fresh bandages at the start of each shift or before they go home after shift.

[Doczilla]

Isn't a burn with debris (debris being clothing, burned skin, ointment)also like an impaled object? Leave it and let the trauma team/doctors remove it. By pulling it out (in this case wiping the area) you will be doing more damage to the already affected area and beyond. If you have a burn patient who still has clothing embedded in the burn it self would you pull it out? My opinion leave it and let then people who specialize in burns take care of it the way it needs to be.

Pieces of burned clothing should not be removed in the field if adhered to the skin. Cut around the adhered areas and remove any non-adhered sections.

Impaled objects are not removed prehospital or in the ER because removal may sever more blood vessels or release tamponade on vessels that are occluded by the object's presence. This is done in the OR setting, where bleeding can be rapidly controlled and further exploration undergone emergently as needed. While the removal of burned clothing will likely not result in serious life-threatening bleeding, it will result in unnecessary pain and expose more of the subcutaneous tissue, increasing the potential for infection. This should be done under conscious sedation or general anesthesia.

'zilla

[Asysin2leads]

I had one poor 86 year old lady who set her shirt on fire, 1st degree burns to half her chest (9%), with pockets of second degree and localized third degree burn. Covered with Vaseline by home health aide s/p being burned.

We took her to the shower and used a gentle stream of water to try and remove gross amounts of the Vaseline, as we believed it was still trapping some heat. It worked with mixed results. I suggested using a mild emulsifier (baby shampoo) to try and break up the oil and do some impromptu decon, but my partner, not being as adventurous as I, said we had to work in protocol.

I still think it woulda worked.

[xselerate]

I had one poor 86 year old lady who set her shirt on fire, 1st degree burns to half her chest (9%), with pockets of second degree and localized third degree burn. Covered with Vaseline by home health aide s/p being burned.

We took her to the shower and used a gentle stream of water to try and remove gross amounts of the Vaseline, as we believed it was still trapping some heat. It worked with mixed results. I suggested using a mild emulsifier (baby shampoo) to try and break up the oil and do some impromptu decon, but my partner, not being as adventurous as I, said we had to work in protocol.

I still think it woulda worked.

I think I may have been adventurous with you... if you seriously thought heat was being trapped then your first treatment of a burn should be to stop the burning process... but I can understand your partner's concerns...