Irrigation of burns

[daedalus]

Saline or sterile water?

Im having a hard time with this.

 

[Flight-LP]

What specifically are you irrigating?

Large surface area burns should be dressed with dry dressings and transported. Wet to dry bandages has lost favor pre-hospital for a number of reasons, one of the biggest being hypothermia.

For small burns, I use burn gel, works wonders for pain and comfort. Haven't had to use water or saline in a while................................

 

[TransportJockey]

Here in NM, neither. Unless it's a chemical burn with a powder that does not react with water

 

[Ridryder911]

One should not "irrigate" burns rather unless it is a chemical burn and then it does not matter if it is saline, sterile or unsterile water, just copious amounts.

I usually will apply saline (once) this is more for the psychological than the physiological affect, although saline does produce cooling effect. Then as Flight described dry sterile dressings.

Hypothermia is a great risk and wet dressings are no longer indicated or suggested.

R/r 911

 

[daedalus]

I ask because under protocol in a nearby area, it describes that thermal burns are to be "irrigated" and than dry sterile dressing applied, and that chemical burns are to be cleaned off and than "irrigated". It does not call for any specific type of solution.

Personally, as rid said, I like to pour a little sterile saline over the area as a calming measure, and than apply dressings. Anyways, thanks for the responses.

 

[Scout]

all the books here still state water for 10 min. Chemical gets 20+, who ever writes our protocalls did't think of chemical identification lol


can i ask what we are regarding a severe burn as. Alot of the burn units here dislike the application of gel to large surface areas prefering irrigation. There is now a trend here to water, apply cling film over the burn and then the water jel dressings.


I'd be interested to hear what ye do and the reasoning behind the differend methods.

 

[Hastings]

I remember my instructor telling us of a call he once got for a rather wealthy man who had been burned in some non-chemical manner. I remember him telling us that he used wet bandages, and from that point on, throughout the entire trip, the patient was screaming, begging him to put more water on the burns. Apparently he was so desperate for my instructor to put more saline on the burns that he was offering anything he wants. I believe the offer was up to a million dollars for just a few drips of saline by the end of the trip.

But alas, they're right. Dry dressings. At least, here.

 

[TransportJockey]

all the books here still state water for 10 min. Chemical gets 20+, who ever writes our protocalls did't think of chemical identification lol


can i ask what we are regarding a severe burn as. Alot of the burn units here dislike the application of gel to large surface areas prefering irrigation. There is now a trend here to water, apply cling film over the burn and then the water jel dressings.


I'd be interested to hear what ye do and the reasoning behind the differend methods.

Protocols here state no gel or topical ointment at all.

 

[snaketooth10k]

Anyone who has ever tried to wash sulfuric acid off with water knows exactly why water is not always best. Wipe with a towel first please. A Dry chemical fire extinguisher's powder can also be used to absorb liquids because they are designed to be non-reactive.

 

[mycrofft]

Hmmm I was going to say NO to extiguishers but ..

, while probably not USP, the contetns of a purple K extinguisher seem safe enough for addressing acid on the unbroken skin; slightly basic, essentially nontoxic, and contains Fuller's Earth which is a good adsorbent as well as absorbent.

I've been cursed by ER's for applying anything but sterile normal saline (SNS) (including aqueous gels) becuase they had to clean whatever it was all off before beginning their tx.

My take on this, does not reflect any protocols:

Open wounds require removal of debris if life/limb permits; normal saline.

Cooling the thermal burn STAT after exposure: whatever won't give the pt a lethal infection to stop the thermal burn including application briefly of ice if that's what rapidly available, then irrigate off the ad hoc irrigant asap with potable water, or sterile irrigant (water or SNS) if you have enough. Initally you cool, then you promote local vasoconstriction.

Large area thermal burns: STAT cooling as above, but once cooled (and you ought to be transporting already with IV's and airway) one fairly thick SNS dressing to prevent further contamination, keep burn substrate moist to promote debridement, and keep adherence to the dressing to a minimum without using grease (Xeroform, Adaptic, "burn cream"). Don't promote large area cooling once the burn is no longer cooking, that area has lost thermoregulatory function and can contribute to hypothermia, in theory.

Large electrical burns across distant points: you can only treat the surface burns, the deep ones are untreatable in the field besides IV.

I am still trying to find a good use for sterile water (not saline) as an irrigant. Tastes good. (Yes, seriously).

 

[snaketooth10k]

I am still trying to find a good use for sterile water (not saline) as an irrigant. Tastes good. (Yes, seriously).

I've tried sterile water, and personally i think it tastes like crap. What brand do you have?

 

[thatrescueguy]

I've always been told that as far as irrigation goes saline and sterile water are essentially interchangeable. I've used both with no complaints from patients, but only for smaller lacerations. As for burns, we use Water Jel. The hospital also uses it.

 

[BossyCow]

We haven't been cleared to use burn gel yet. Our protocols are if powder is present, brush it off and then flush with water. Reg burns. apply moist dressings, keep them moist. Had a kid with facial burns from a propane water heater. He would use cold packs over the dressings on his face to keep the pain down.. tough little bugger.. his dad is one of our volunteers.. he was about 11 and not a tear or a whimper from him the whole ride in.. just asking for new cold packs as they warmed up.

 

[mycrofft]

Used a garden hose once...worked really well.

No, seriously. Faucet wide open, first a quick flood, then nozzle on MIST...high PSI low volume, move it really close. The initial flood diluted and evacuated the agent (in this case, a lawn chemical, but the same principal applies) and if a thermal process were involved would have cooled it rapidly. The high pressure short range mist knocked loose the little clingy particles without causing skin trauma, drowning the pt, or creating a river.
When we (I) prepped for the anticipated mass arrests in 2003 (Ag Ministers' Conference) I stopped at Walmart on the way in, bought his and hers nozzles, hoses, and four bottles of baby shampoo for OC decon. Didn't need it, but was ready. (PS: U.S. Army says use sodium bicarbonate, baking soda).

 

[Scout]

Speaking from a chemistry point of view (I know nothing of the specific make up of waterjel, but a fair amount about thermodynamics), it will make little difference. I know nothing of your understanding of chemistry, so forgive me if this is a little simplisitic.

Everything wants to have the same temperature. If something feels hot, what you are actually feeling is the transfer of heat from the hot plate to you. This is hotter than you, so the heat transfers to you. Obviously something that is colder than you will take heat away from you, and therefore feel cold.

Now, imagine you have 4 identical objects. two are at 100C, one at 50, and the other at 0. If we connect one of the hundreds with the 50 (assuming no other factors), the two will even out to a uniform 75C. If we connect the other 100C with the remaining 0C, they will even out ot 50C. Here, we have demonstrated that the colder the item, the more it can cool an object.

Heat is technically a form of energy. The hotter someting is, the more energy it has. The transfer of heat is transfer of energy. Different materials have different Specific Heat Capacities. This is a measure of the amount of energy (measured in Joules) required to heat 1g of water by 1 degree C (NB, degree C and Kelvin, K, are units with identical intervals). The higher the SHC, the greater the cooling capacity.

Basically, if it takes more energy to heat a substance the same amount, that substance will transfer more heat away from a hot object, as a lot of temperature reduction in the hot body actually causes little increase in the temperature.

Water has an SHC of 4.2 J/g/K.

What makes burns gel so good at heat dispersal will be that it has a high SHC, even higher than that of water. It is "the chemicals", but its not a reaction on the skin, so there is no need in terms of temperature reduction for the burns gel to be in contact with the skin, as long as the layer of clingfilm is thin enough for heat from the burn to permeate to the gel

I do think, however, that there are probably chemicals in the gel which help with the healing process. If there are, the gel would then need to come into contact with the burn.



Sorry if the chemistry lesson wasn't interesting, but I thought it might potentially be useful to the OP's friend

Found this interesting an informative, seems to back our approach of using jel over cling film for bigger burns.

 

[mikie]

There was a single post about sterile water vs saline solution...are they truly interchangeable? What about the saline solution (isotonic?)?

I've heard for abd. evisceration that a moist saline dressing should be used. Is this true (for saline purposes)?

 

[thatrescueguy]

Just to clarify with burns: I don't just go about throwing burn gel on everything. If it's a powder, we brush it off, and then we irrigate as appropriate. Burn gel comes after.

 

[Jon]

I don't think they are interchangable, really. I'm sure they each have their purpose.

But for our purposes... I'm not sure it really matters. It's clean. It's wet. It isn't going to hurt anything, right?