Care of the Burn Patient

Linda Asks:

In my middle grade novel my main character’s dad was a fireman in NY.
He was present during the collapse of the World Trade Center buildings.
He was burned severely and is in the hospital – near death.

My main character remembers his last conversation with his Dad in the hospital right before he dies.

The dad is hooked up to all kinds of beeping machines and is wrapped in white gauze.
After he talks to his son for the final time, he pushes a button for more morphine.

Questions:

Do they still wrap burn patients in gauze?
Is morphine used on severely burned people?

Jordyn Says:

From the point of view of your character– yes, burns are wrapped in gauze. They are specialized dressings, but a character aged 10-13 could perceive it as gauze only.

Yes, morphine is still used for pain.

My only concern is this character having a conversation with his dad. You don’t describe the nature of how he was burned, but a severely burned patient, particularly one close to death, is likely on a breathing machine and, therefore, unable to speak to his son.

You could change the scene to be that he’s so sick that they are getting ready to intubate the character’s father, and the medical team gives them a few moments to talk before they put the father on the breathing machine. He could still die quickly after from his injuries.

Authors Question: Treatment of Burns in Children

I got this question in my blog comments and thought I would also provide the answer here.

Latedra asks:

How would they treat burns in children? I imagine as they grow the burn scar would shrink right? My heroin received a burn as a child and I write it like she still has this big burn that is a part of her life. Is that possible? Maybe I’m over thinking it. I’m just now taking her burn seriously.

Jordyn Says

Hi Latedra!

Thanks for leaving a question. It depends on what kind of burn you’re talking about. Burns that need a higher level of care would be those that would inhibit function. We get concerned about burns that cover a large portion of the feet, hands, face or genitalia (including breasts). The larger the burn area or the deeper the burn– the more it may require skin grafting to heal.

Let’s take a simple burn. Red with some blisters but covers maybe a palm size of the thigh. We would wash it with mild soap and water. Apply a copious layer of triple antibiotic ointment. Then we put something over top that won’t stick to it– we use a Vaseline impregnated gauze called Adaptic– then it won’t stick as the dressing comes off. More extensive burns would be referred to a burn center.

Scars generally stay the same size. They don’t grow as the child grows so it may appear that they are shrinking because the child is bigger but really they are the same size.

Hope this helps!

Author Question: Burn and Crush Injuries

Amitha Knight returns to give her medical insight in this reader question.

Welcome back, Amitha!

Q:

I am writing a novel and understand that you give medical information online which I would be really grateful for.  The two main characters in my current book are hurled out of a burning bus which has smashed into a building after going out of control.  They land on concrete.  One of those characters has been in the smoke-filled bus about 15 minutes.

I would appreciate it if you could tell me the following;
1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents. What equipment would they use? 
2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.
3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he’s
unconscious …. what machinery would he be attached to.
  
Thank you in advance for your help!!!
M.G.
Amitha says:
I will help you the best that I can. My specialty was pediatrics and not intensive care or emergency medicine, so keep that in mind.
1) What type of injuries would they have received, burns, fractures, concussion etc and what procedures are followed by medics who turn up at such accidents.  What equipment would they use. 
The types of injuries sustained could range from anything from a few bruises to severe cranial fractures and multiple broken bones. When medics show up, they will place a neck collar in case there are spinal injuries and basically follow the “ABC” rules for emergency medicine. (some links to read more about this: http://en.wikipedia.org/wiki/ABC_(medicine)) This means if the patient isn’t breathing, they’ll make sure there is no obstruction, then they will intubate the patient as necessary. They will also start IV fluids and take them immediately to the hospital. What they would do *exactly* would depend on the extent and severity of the injuries. For fiction purposes, I would think hard before going into too much medical detail.
2) I want one of the characters to be in intensive care for about 3 days and then be allowed onto the ward, what type of follow up treatment could she receive, what machines would she be attached to etc.
This depends on the type an extent of the injuries. if there was a perforation to the lung, they may have a chest tube. They probably can’t get up and thus would need a foley catheter for urine. they would definitely have some kind of IV fluids attached. This website has some good information about smoke inhalation injuries: http://www.emedicinehealth.com/smoke_inhalation/article_em.htm
3)I want the second character to be unconscious for about three weeks and then wake up with temporary amnesia.  Is this plausible and what treatment would he receive while he’s
unconscious …. what machinery would  he be attached to.
This person who is unconscious might be intubated for at least some of that time, which means they would have a ventilator machine in the room in addition to everything I said in #2. As far as amnesia, there is a blog post on Jordyn Redwood’s blog that may help with this: http://jordynredwood.blogspot.com/2011/08/remember-me-use-of-amnesia-in-fiction.html 
Her website is a great place in general for information like this!
I hope this helps.

*************************************************************************

 Amitha Knight is a former pediatric resident turned writer of middle grade and young adult fiction. She’s also a blogger, a book lover, an identical twin, and a mom. Follow her on twitter @amithaknight or check out her website: http://www.amithaknight.com/. 

Burn Injuries

One thing that has changed recently is how medical professionals talk about burns or burn terminology.

Burns used to be classified as follows:

  • First Degree: Skin is pink, but no fluid-filled blisters.
  • Second Degree: Skin had fluid-filled blisters of varying sizes.
  • Third Degree: Multiple layers of the skin are involved. There may be charring of the wound. The picture would denote, at the very least, a third degree burn.
  • Fourth Degree: Charring and burning that involves muscle and bone.

Now, we refer to burns as partial thickness or full thickness. Partial thickness would include first and second degree burns. Full thickness would be considered third and fourth degree burns.

Here is a good resource that discusses the difference. 

Treatment of burns depends on location, size and depth. 

Very simply, localized burns are usually treated by cleaning, leaving blisters intact, slathering them with triple antibiotic ointment and then dressing them.

Not all burns need to be followed up by a specialist at a burn clinic but burns that involve the hands or feet (because of functionality), the face (for cosmetic reasons or if they could hinder the senses), or genitalia (including nipples) are usually referred for further care.

Also, burn injuries need to be estimated on what percentage of the skin is involved. Based on the percentage– a patient can be referred for follow-up or flat out admitted if the burn injury is severe. You may have heard this referenced to as the “Rule of Nines”. Pediatric patients have different ratios so keep that in mind.

Here are a few links that help estimate burn percentage based on skin area:
  
 http://www.medstudentlc.com/page.php?id=85
  
http://www.emedicinehealth.com/burn_percentage_in_adults_rule_of_nines/article_em.htm:

http://www.ncbi.nlm.nih.gov/books/NBK27240/

Most patients with significant burn injuries have significant pain. We do tend to give something that has a narcotic to help their pain. Also, based on the percentage of burned skin, some patients will also need fluid resuscitation, ICU admission, intubation— etc, to manage the injury.

So, if you’re writing about burns and your POV character is a medical professional, keep these things in mind so your character can be treated the right way with the medical professional using the right language.