BURNS - Medicine for Mountaineering and Other Wilderness Activities - page 175

CHAPTER 13
BURNS
James A. Wilkerson, M.D.
Principal Contributor
Minorburns,suchasburnsofthehandsorfingersfromhotpotsorstoves,arecommon,and
their care is straightforward—although they must not be neglected. Major burns are rare in
the wilderness. Possibly the greatest risk is at high altitude when food is being cooked or
snowisbeingmeltedforwaterinsideatent.Inthesesituationsfuelspillsorevenexplosions
occur due both to the notoriously poor performance of stoves at high elevations and to hyp-
oxicimpairmentoftheindividualsusingthem.Suchaccidentsarecatastrophicifdestruction
of tents, sleeping bags, and clothing leave people with severe burns exposed to an extreme
environment.
Successful rescue of individuals with major burns from this kind of situation would re-
quireanincrediblecombinationofmedicalknowledge,evacuationskills,dedicationandde-
termination, and sheer luck. The intravenous fluids and other supplies needed just to keep
burn victims alive for the first twenty-four hours would almost never be available in such
circumstances. However, severe burns can occur in less remote circumstances, and few wil-
derness users would not try to provide the best care possible. Therefore, a discussion of the
basic principles of care for major burns appears worthwhile, even though few opportunities
for its successful application can be expected.
EVALUATING BURN SEVERITY
Depth,size,andlocationdeterminetheseverityofaburn.Inthepast,burnshavebeenclassi-
fied according to their depth as first, second, or third degree. First-degree burns were super-
ficial, did not kill any of the tissues, and only produced redness of the skin. Second-degree
burns damaged the upper portion of the skin, resulting in blisters. Third-degree burns des-
troyed the full thickness of the skin and could extend into underlying tissues. This termino-
logy has been modified, and first- and second-degree burns are lumped together as “partial
thickness” because generally they are treated the same. Third-degree burns are labeled “full
thickness.”
The size of the area covered by the burn is of critical significance. Before the develop-
ment of burn centers, few individuals have survived fullthickness burns that covered more
than 50 percent of their body surface. In contrast, few burns covering less than 15 to 20 per-
cent of the body are lethal when given proper care.
Location is also important. Burns of the face and neck, hands, or feet are more incapacit-
ating due to the specialized organs and complex anatomy of these areas. Burns of the face