BURNS - Medicine for Mountaineering and Other Wilderness Activities - page 177

the area. Persons with major burns are often deceptively alert for several hours until fluid
losses become severe.
Many individuals with less extensive burns must also be evacuated, particularly with
burns of the hands or face, but speed is not as crucial. Fluid loss occurs with all burns,
bothpartialandfullthickness,butinpreviouslyhealthyyoungadultsdoesnotachievelife-
threatening proportions if the burns cover less than 10 to 15 percent of the body surface.
Careofaseriouslyburnedindividualdemandsamajorcommitmentoftimeandperson-
nel. Only a large group would have enough members for some to continue the expedition
while others take care of even one burned individual.
TREATING THE BURN
Immediate Care
Immediately after the burn, all clothing and jewelry around the injury should be re-
moved. If the burn is small and not full thickness, immediate application of cold helps re-
duce pain. Holding a towel soaked in ice water against the burned area, or immersing it in
cold, soapy water usually is effective. More extensive partial-thickness and full-thickness
burnsshouldnotbetreatedinthismanner.Fullthicknessburnsareusuallypainlessbecause
the nerves in the skin have been destroyed.
The burn,like anyother openwound,shouldbecleaned andcovered with adressing. In
the field, cleaning can be done best with sterile cotton, liquid soap, and warm, disinfected
water. If these materials are not available, the burn should be cleaned in the best way pos-
sible. All debris, dirt, and fragments of loose skin must be removed. These measures may
be surprisingly painless if carried out gently.
The burn should be covered with a thin layer of an antibacterial ointment such as silver
sulfadiazine in a petroleum jelly base (Silvadene®), over which should be layered gauze, a
bulky dressing, and a snug bandage that applies pressure but does not interfere with blood
circulation. The dressing or slings can be used to immobilize a burned extremity and re-
duce pain. Burned hands should be splinted in the “position of function,” the position the
hand assumes when holding a pencil ( Figs. 12-2 and 12-3 ).
Ointments or creams that do not contain appropriate antibacterial agents increase the
risk of infection and should not be used.
Subsequent Care
The bandage on a burn should be left undisturbed for six to eight days. Changing the
dressing increases the risk of introducing dirt and bacteria that could produce an infec-
tion. Furthermore, an accurate distinction between partial- and fullthickness burns can be
made only about a week after the injury. If the burn is very superficial (first degree) and
no blisters are found when the bandage is removed, no further treatment is required. Sub-
sequent bandaging would be needed only to protect a sensitive area from trauma.