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: Treatment of Burns circa 1807


Michelle G asks
:

I’m working on a historical (surprise, surprise) 1807, to be exact, in England, and wondered if you could give me a little medical advice? I’ve burnt the leg of one of my characters, a little boy, like 9, and I want him up and about in 3 weeks or so, but he can use a crutch. What would that leg look like? How much pain? How would he react that first week? I don’t want to overdo it, nor do I want to gloss over it either. What’s your .02?

Here’s what happened to him…

“Thomas leaned over the hearth to scoop a ladle of stew from the pot. He moved too fast, with too much force. The hook broke. The pot fell into the flames. Coals shot out, catching the fabric of his trousers. He tried to whack it out, brave boy, but ended up fanning it larger. He ran. I stopped him. I thought he was…” She gulped back the lump in her throat. “I thought he was dead.”


Jordyn Says:

This sounds like a pretty significant burn– his pants catching on fire. Easily partial thickness and could even be full thickness in some places. Have you considered just having the pot of stew fall on him– maybe with bare legs? This would be more partial thickness and could more likely heal in your time frame.

Full thickness burns are problematic because they usually require grafting so back then treatment was likely very limited. We also do fluid resuscitation for significant burns and if both of his legs were this severely burned– he’d need quite a bit of fluid, and again, I’m not sure this would be available during your time period.

So, I might try to back down the injury to second degree burns. Those should heal up pretty nicely in your three week time frame. Second degree or partial thickness would include skin blistering and peeling, big concern for infection (intact skin is your largest protector against infection) and dehydration initially because burns also leak a lot of fluid. He could probably walk with crutches. It’s not really a muscle injury (it would be if you go with full thickness burns– like his pants catching of fire) so he should be able to walk.
Pain is going to be a big issue. Burns are very painful. So, he’s going to need something.

Here is a very interesting link that has tons of information on the evolution of burn surgery. It will give you some treatment options for your time period. 

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