BURNS - Medicine for Mountaineering and Other Wilderness Activities - page 176

may be associated with burns of the air passages or lungs, which often are lethal. Burns of
the genitalia or buttocks are difficult to keep clean and usually become severely infected.
BURN SHOCK
Theimmediatelife-threateningproblemassociatedwithmajorburnsisshock—specifically
burn shock. When tissues are burned, the damaged capillaries allow blood serum to flood
burned tissues. This fluid loss reduces blood volume and produces shock just like a ma-
jor hemorrhage would. A person with a major burn usually dies in shock within twelve
to eighteen hours unless appropriate fluid therapy is instituted. Such fluids almost always
must be administered intravenously. Individuals with severe burns are often unconscious
or too stuporous to swallow fluids. If they can swallow, they often vomit anything taken
by mouth. If they are not vomiting, the fluids often remain in the stomach and are not ab-
sorbed. Appropriate fluids are rarely available in wilderness situations; a major burn in a
remote area usually requires immediate evacuation by the fastest means available.
EVACUATION
As a general rule, all full-thickness burns larger than one inch in diameter eventually re-
quire surgical therapy: debridement and skin grafting. Therefore, the only decision that
must be made for individuals with burns of that size or larger is how urgently they should
be evacuated. Help with this decision can be obtained from the following criteria for the
classificationofburninjuriesestablishedbytheAmericanBurnAssociationandtheAmer-
ican College of Surgeons:
Major
Blistering partial-thickness burns of more than 25 percent of the body surface
Full-thickness burns of more than 10 percent of the body surface
Significantburnsofthecriticalareas:face,eyes,ears,hands,feet,orperineum(genitals
and buttocks)
Significant associated trauma or coexisting disease
Moderate
Blistering partial-thickness burnsof15to 25percent ofthe bodysurface, with less than
10 percent full-thickness burns, and no involvement of critical areas
Mild
Blistering partial-thickness burns of less than 15 percent of the body surface, with less
than 2 percent full-thickness burns, and no involvement of critical areas
Individualswithmoderateormajorburnsrequirehospitalizationandmustbeevacuated.
If any question about the severity of the burn exists, the person should be evacuated. Ex-
perts have difficulty determining whether a burn is partial or full thickness immediately
after it occurs, and inexperienced persons almost always underestimate both the depth and