BURNS - Medicine for Mountaineering and Other Wilderness Activities - page 181

CONTROL OF PAIN
Inexperiencedpersonsoftenarehorrifiedbytheappearanceofamajorburnandmistakenly
administer unneeded pain medications, thinking the wound must be painful. However, the
pain from a burn is quite variable. Superficial burns hurt at first but are usually relatively
painless once they are covered and not exposed to air. Full-thickness burns are usually less
painful because they destroy the nerves and produce anesthesia in the area of injury. In ad-
dition, shock tends to dull the pain. If the individual complains, pain should be controlled
with as little medication as possible. Drugs stronger than a moderate analgesic are rarely
needed.Ifstronganalgesics arenecessary,smallerdoses(onehalftothree-fourthstheusual
dose) should be tried before resorting to a full dose. Strong analgesics may aggravate the
general effectsoftheburnandarealmost neverneeded.Furthermore, iftheindividual isin
shock when the drugs are administered, they are poorly absorbed. If absorbed later when
the shock is corrected, an overdose can result.
FACIAL BURNS
Burns around the face and neck are particularly dangerous because the flames and hot
smoke may be inhaled, damaging the lungs. Persons with such injuries must be evacuated
with extreme urgency. Burns of the face, nose, mouth, and upper respiratory tract cause
swelling and obstruction of the airway. Treatment requires intubation with an endotracheal
or nasotracheal tube or creation of an alternate airway by tracheostomy or cricothyrotomy.
If the flames and smoke reach the lower portion of the respiratory tract and the lungs are
seared, no effective treatment is possible in the field. If the individual survives the initial
injury,theburnandsmokecausefluidtocollectinthelunginquantitiesthatareoftenleth-
al. Subsequently, severe pneumonia is common. Fortunately such injuries are rare.
Burns of the upper airway should be anticipated after any facial burn, particularly if
the skin around the nose and mouth is burned or the nasal hairs are singed. The individual
typically becomes hoarse and begins to have difficulty breathing. Wheezes may be heard
when listening to the chest. The most critical sign of an airway burn is coughing up black,
sooty material, which should be considered diagnostic. Sometimes these signs do not be-
come detectable until twenty-four to forty-eight hours after the injury, so individuals with
facial burns must be closely watched.
OXYGEN
Oxygen, if available, should probably be administered immediately to all individuals with
severe burns occurring at high elevations. Burns can reduce respiratory effectiveness, and
at high altitude such persons may not be able to breathe rapidly and deeply enough to
compensate for lower environmental oxygen pressure. Fires in enclosed quarters such as a
small tent, in which air circulation may be further reduced by a covering of snow, produce
large amounts of carbon monoxide. Individuals burned in such circumstances may have to