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Welcome back, Scriptmonsters! Here we are again, talking about that most unappealing topic: burns. In particular, today I want to talk about special cases that occur with burns. Two of them are special types of burns, while two more are problems that are actually metabolic issues that come from inhaling the byproducts of combustion.
So let’s get this party started!
Special Cases – Electrical Burns
Electrical burns can be bad news. That’s because the burn itself doesn’t simply affect the skin, the way a thermal or chemical burn might.
Electricity is always seeking ground, and it will travel the fastest way it can to get to ground. And if that path happens to include going through your character, well, it doesn’t care. Electricity will go to ground.
Electrical burns are internal burns. The character may have external wounds at the contact points, where they made contact with whatever the source of electricity was and wherever the electricity went, but what can’t be seen from the outside is the burn along the path that electricity took moving through the body. Burns to muscles and organs are common. Arrhythmias from electricity moving through the heart can be deadly.
Characters with electrical burns require management in a burn center to make sure they’re getting cared for in the best way. They may also require defibrillation to restore their heart rhythm, and more. And their recovery could be a very, very long process.
Special Cases – Chemical Burns
I want to take a moment and talk about chemical burns, which could occur with any one of a number of different classes of chemicals. Acids can cause burns, but so can alkali products. Dry powder chemical products should be brushed off before water is applied, but the concept of “pour lots and lots of cool water on it” still applies, even if the chemical involved reacts to water. Why?
There’s a saying in chemistry: SOLution to POLlution is DILution. If your reagent reacts with water, the solution is more water.
Characters shouldn’t try to neutralize acid burns with a base, or alkali burns with acid; they may create an exothermic reaction that might be worse than the burn itself. Rather, the solution is lots of cool water, both to stop the burning and to flush away the chemical causing the burning.
One other fact: a character who gets covered in a dry chemical powder who’s wearing clothing, especially if it includes a shirt with long sleeves, can remove 95% of the contaminant by removing their clothing. This is, in fact, one of the things a HazMat team will do: strip the person down to their skivvies.
Special Cases – Cyanide Inhalation
I know what this sounds like: Cyanide?! Who’s going to poison our characters?
But cyanide isn’t just for poisoning your characters with a taste of bitter almond. Cyanide is a byproduct of burning synthetics. Synthetic carpeting, synthetic foam in beds and couches, and all kinds of other things can produce hydrogen cyanide gas as a byproduct of combustion. And when that gas is inhaled, it’s really bad, because it stops cells from being able to use oxygen.
This is seen most often in people who were trapped in house fires or other fires in an enclosed structure.
Cyanide poisoning can cause hypotension, altered mental status, seizures, coma, or even death. It’s a critical illness, and without intervention, characters can die.
Fortunately, EMS professionals are prepared for this eventuality. There’s an infusion of a medication called hydroxocobalamin that binds with cyanide to produce cyanocobalamin – vitamin B12. We turn cyanide into vitamins, which I think is quite magnificent.
A second medication will be infused, called sodium thiosulfate, which has some ancillary benefits. The two drugs come packaged in a kit called a Cyanokit. Oh, and as a nice detail, the hydroxocobalamin is a nice, rich, dark red, which is very very pretty, and a good detail to use in your stories.
Special Cases – Carbon Monoxide Inhalation
Carbon monoxide poisoning is poisoning by a different problem. Hemoglobin, the part of the red blood cell that actually binds to and carries oxygen, has a much stronger affinity for CO than for O2. So when a character inhales CO, either from a fire or from another source such as a leaky oven or heating system, they suffer a cellular asphyxia: there’s plenty of oxygen in the air, but they’re chemically incapable of using it.
Carbon monoxide is a colorless, odorless, tasteless gas, so characters can be exposed or even killed by it even if they don’t know it’s there.
The treatment of CO poisoning is oxygen, and lots of it. So much, in fact, that severe CO poisoning will require dives in a hyperbaric oxygen chamber, where 100% oxygen is pumped into a dive tank, and the pressure in the tank is elevated to several times our atmospheric pressure.
That’s It for Round 3!
Part 4 is going to include the topic of inhalation burns and airway management in the burn patient, while Part 5 will cover ER and ICU care, including debridement, more on pain management, fluid balances and more.
Thanks so much for reading!
xoxo, Aunt Scripty
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