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Paramedics from Hell 16
From : Phil Arnold 30 Sep 95
Subj : Paramedics from Hell 16
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The severity of a burn can be described by degrees:
1st degree - limited to the most superficial layers of the skin,
producing redness and pain, as in a scald or moderate sunburn.
2nd degree - penetrates the skin deeper, producing pain and blistering,
as well as some subcutaneous swelling. Blister formation may not be
apparent until several hours after the injury; before the blisters
become visible, the skin may simply be red and mottled. Severe pain is
characteristic of these burns because nerve endings are irritated and
hypersensitive; the slightest pressure or other stimulation of the
burned area causes exquisite pain. Second degree burns are most commonly
caused by contact with boiling liquids.
3rd degree - involves damage to or destruction of the full thickness of
the skin and can involve underlying muscle, bone (military definition of
'4th degree'), and other structures as well. The skin in a third degree
burn may appear charred and leathery or may be dry and pale. Pain is
usually absent because of destruction of nerve endings. Patients with
third-degree burns are prone to lose massive quantities of fluid; since
they lack the usual protective mechanism of the skin. Massive infections
are not uncommon.
If a person sustains a third-degree burn, there is usually an expanding
ring of burns of lesser severity surrounding it.
I know, I know ...
ObTasteless:
Received a call for 'woman with burns.' Arrived at an elderly housing
complex, where the fire department was already on-scene, and was
hurrying us up the stairs to the woman's apartment. The smell of burning
plastic and hair wafted through the hallway as we reached her door.
Entered the apartment to find - what else - an elderly woman in some
sort of polyester night-gown, sitting in an easy-chair. Apparently, she
had been in her bedroom, and had fallen asleep while smoking a
cigarette. The cigarette had dropped on her night-gown, which promptly
burst into flame. She awoke to find herself on fire, got out of bed,
walked to her easy-chair, sat down and dialed the fire department. Her
night-gown had melted over her body, leaving large black patches of
plastic molded to her skin, which cracked every time she shifted in the
chair - much to the consternation of the firefighters. Patches of her
hair were singed, the smell of which was overpowering. Initially, the
fire department had thought that she'd fallen asleep in the chair, but
revised their estimate once someone pointed out the black, melted
foot-prints in the carpet leading from the bedroom to the chair, and the
bits of melted flesh that trailed the footprints. By the time we lifted
her out of the chair to place her on the stretcher, the burning plastic
that had melted onto her back had had time to cool and mold itself to
the chair. The result was that a large portion of the skin on her back
remained with the plastic - on the chair. Her back now looked like oozy,
grey leather - if you could picture that.
In the ambulance, I tried to start an IV, which was hard, since both her
arms had received burns. I applied a tourniquet to her arm, and tried to
clean her forearm with an alcohol swab, only to watch as the entire top
layer of her skin roll off - like a glove, with only gentle rubbing.
This gal was fucked.
A helicopter had been requested to airlift her to Boston. Our unit
arrived at the LZ, and the flight crew jumped in the back of our
ambulance. The flight nurse must have been new, since she took one sniff
and started retching.
Of course, the woman died.
: I may be wrong, but it seems that liquid burns produce a lot more
: tasteless looking injuries than flames or dry heat/flash fires.
That's because liquids - especially thick, viscous ones, stick to the
patient, allowing more heat transfer and damage to occur than a simple
'flash' burn. Steam injuries of the same temperature are even worse,
since there is additional heat transfer from the steam going from a gas
phase to a liquid phase - which results in a double-whammy. Not to
mention when the airway is involved, such as a car radiator explosion.
People usually have a sharp intake of breath when surprised - and take
in some superheated steam from the radiator. The swelling of the airway
takes place some time later, and their windpipe closes completely,
necessitating a tracheotomy - messy.
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