Interviewer: What would you do if you get burned and help isn't coming soon? We'll explore that next on The Scope.
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Interviewer: Annette Matherly is the outreach and disaster coordinator for the Utah Burn Center. What should you do if get burned and help isn't coming soon, say you're out maybe hunting or backcountry camping, or something like that? Is there anything a regular person can do or are they out of luck?
Dr. Matherly: No, absolutely. There are so many simple things that can be done when you get burned and help isn't coming. So I like to keep it simple. I think of the four Cs. The four Cs are cool it, clean it, cover it, and call for help.
Number one, cool it. If you get burned with some kind of hot fluid, and to cool it and take that heat out of your tissues would be incredibly important and that's because the longer that heat stays in those tissues, the deeper your injury will become. So to take that heat out over a five or 10-minute period would be really important.
Number two would be to clean it because who knows what you've been rolling around in, or what you've got on your fingers or your toes, or wherever it is that you've been injured. So you want to keep that clean. And so just having some regular soap and some water, preferably nonperfumed because the perfume will make it sting a little more, but just your common soap and cleaning that wound to get all those bacteria off of that open area. Because if you have that top layer of your skin missing, now you can have bacteria in the environment. Bacteria that's crawling around on our bodies, by the way, those gram positives that are all over us, now they can get into that opening into our bodies and can make us sick.
Interviewer: So for number one and number two, cool and clean it, what about stream water? Should I avoid that?
Dr. Matherly: If that's all you have, then you use stream water. You've got to take out that burn. And is it optimal? No, but there's not many of us, you know. Or maybe we have bottled water hanging around and we can get our soap out and open that bottled water or we're trying to save the universe, we can get out our little reusable bottle and pour it over. So another good reason to carry those around with you.
Interviewer: Yes, so that's optimal. Stream water, though. If you have to, you've got to do these things.
Dr. Matherly: Absolutely.
Interviewer: All right. So we've got cool it and clean it. Number three?
Dr. Matherly: So number three is cover it because now we have this opening into our body. The skin is kind of a coat of armor. And what we want to do when we lose that piece of the armor is we want to still cover that area that has the opening. So now we want to cover it and we want to use something that won't stick because if you don't have any skin in that area, then it's nice, and oozy, and weepy. And you don't want to put something on it will stick, but sometimes you may not have that option.
So hopefully, in your backpack because you've been thinking this through before you went on your trip, you've got some Bacitracin, or some Polisporin or some Neosporin or something that will have some kind of bacterial coverage. You pop that on that opening and you'll cover it hopefully with something non-stick, but if all you've got is a t-shirt of a friend, then you put a clean t-shirt of a friend over that opening and you make sure that nothing else can get into that opening.
Interviewer: What if you don't have such a clean t-shirt? Still covering it with that is better than not covering it?
Dr. Matherly: Yes.
Interviewer: You have to cover it?
Dr. Matherly: Covering it is better than leaving it open because if you think about as you're walking through the forest or the amount of times that your hand comes into contact with something, then again, it's picking potentially picking up bacteria on mold, or spores or something from the environment. So you want to keep that area as covered as possible.
Then number four would be your call for help if you need help. Now, obviously, that might not be very timely, depending on how deep on the woods you are, but as soon as you're able to make a call and to seek assistance, especially if it's something larger, then that has to be done because even a small injury can cause an infectious process that can make somebody very sick.
Interviewer: When does that infectious process start? How long after the burn?
Dr. Matherly: Well, the burn is pretty clean, right? Let's think about the ideology of burn injury. It involves something hot touching the skin and what that means is it's just burned off all the existing bacteria, so you've got a little while before that bacteria starts to multiply again. We usually say that about 24 hours is a safe bet. So after 24 hours if a patient has a temperature, then now they're growing some kind of bacteria that can be associated with the burn injury. So before that, it was probably something that the patient came in with.
Interviewer: So if I'm not in the middle of nowhere and I get that burn, as long as I do some of these steps, I've got 24 hours before I need to really start worrying about something setting in if it's going to set in?
Dr. Matherly: Absolutely.
Interviewer: It's not going to set in after eight hours necessarily?
Dr. Matherly: Well, they can start, right? I mean, bacteria are so small and we're crawling with it. With that it's all over us so can it start? Absolutely. Is it likely to make us sick right away? No, it won't. So we'll be maintaining enough that we can do what we need to do to get us somewhere safe, hopefully, and then we can have somebody else take care of business for us.
Interviewer: Physical activity okay? Getting that hurt rate up, that's not going to affect the burn in any way?
Dr. Matherly: No. Obviously your heart rate's going to increase because this burn is going to be painful. So if you have some over the counter medication that you take with you, that might be great because that will help decrease the pain so that you can hike out or you can walk out. But, other than that, we encourage activity in all patients that have been burn injured. You don't want to splint something, you want to keep using the body parts so that it kind of won't contract in place. That's the worst thing possible so you want to keep moving that area that's been burned, which will decrease the inflammation and will help it to be useable.
Interviewer: What about the skin? The skin gets tight, that's going to hurt, isn't it?
Dr. Matherly: Absolutely.
Interviewer: But still keep moving it?. That's more important? Okay. Any final thoughts if you get burned and help is not coming soon?
Dr. Matherly: I think that what's most important is to remember how resilient we are as human beings. We can do anything. That fight/flight response is absolutely amazing. We have seen people coming with some really large burn injuries that have driven themselves down from the getting burned, walked into the emergency department, and they have still been okay. So remember, your catecholamine response to injury is huge and you can do it and you can get out if you're stuck somewhere, even if you may have a pretty significant injury.
An exception to that would be your airway, so hopefully your airway will not occlude That's really important. But on other body parts you usually have some time.
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