Burns and Cold

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skyemt

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hi folks...

in our system, we have been instructed not to apply COLD to burns...

the reason being, that while cooling the burn more quickly, it will constrict the blood vessels to the injury site, preventing needed nutrients from getting to the injured tissue...

however, i'm fairly certain that others have learned differently...

without there being a "right or wrong", would like some feedback about this...

thanks!
 
One should not apply cold therapy to major burns for several reasons. The main point for not applying cold to burns is the receptor sites is damaged and cannot tell if the area is getting to cold and as well the patient will tend to become hypothermic.

Hypothermia is a common event of burns, and one of the major triggers of shock, especially since many of the burn patients do not have brown fat and cannot maintain body heat.

R/r 911
 
thanks Rid... that was my understanding as well...

however, i was asked how you stop the burning process, if you do not apply cold?

i really did not have a good answer for that...
 
It is my understanding that the evaporation process is cooling. The water doesn't need to be cold, but merely wet in order to cool.

I know this is what we teach for hyperthermia, it should be appropriate for burns as well??
 
Stop the burning process? It depends on the kind of burn and the degree (how much) of burn, from my understanding.

Thermal: Put the fire out (if safe to do so).
Friction: Stopped when they stop tumbling on the pavement.
Electrical: Stop the current (if safe to do so).
Chemical: Get it off the pt (if safe to do so).

ABLS is a 6 year cert, mine's about out, and it's hard to find another one so my info might be a little off.

If the pt is significantly burned, >15% (I believe) 2nd - 3rd degree burns, covering them with water will increase pt's temp loss resulting in hypothermia. Use dry dressings.

Some burn ICU's like to keep their room temps around the mid 90's to prevent their pt's from getting cold. It's hotter 'n' hell in there; just the way they like it.
 
Someone mentioned to me te other day about applying dry dressing to burns. My thoughts are still devided as this is not was is was tought...

Anyway, with burns as many other injuryies, you get dialation of vessels in the surrounding areas in order to increase bloodflow which deliver the needed WBCs and other chemical to fight any infection and begin the heeling process. By applying something that is cold (Relative), you may well decrease the bloodflow.

Maybe i can supply you with some more insight on your second question: Does it make sense to say that should you place something that hotter than the temperature of the burnt tissue, that it will burn further? And vice versa for something that it colder (Burn less, or slow the burning down to a point)?? The concept is that of absorbtion of temperature by a substance. Lets take the cold dressing. This dressing will absorb the heat from the burnt (Hot) tissue (this is the temperature gradient). Now the greater the gradient, the quicker the rate of absorbtion!! (Take a hot glass and submerge it in ice water, it shatters, whereas if you take a hot glass and place it room temperature or luke warm water, nothing will happen). Or you can look at it this way: Do you take a limb that has severe frostbite and treat it with hot water, no you take something that is much less hot. So the idea is to slow down the burn, if the tissue is still burnig, but not with cold water, but rather water/dressing that is closer (but lower)to the temperature of the burn...

For us this side the dressing of choice for burns is Burnshield, containing 96% H2O and 4% Tea tree oil!!
 
You don't put cold on them because it can cause hypothermia.
 
Be flexible, be smart.

Thermal burns: immediately apply safe coolant (yes, ice works if used quickly and for short time on relatively small area) to stop the cooking. This isn't treating the burn, it is stopping the process and takes seconds. Putting your burned finger into your mouth does work, water in saliva conducts heat away and your mouth really ought to be cooler than the burn temp for your finger. This is like using a fire extinguisher; you knock it down, but you don't stand there and pour Purple K onto the site once it has stopped burning. Of course you don't plunge your patient into shock, use some sense, watch your pt and treat accordingly.

I've seen plenty of minor but painful thermal burns and applying cold packs for comfort initially (within safe limits) has never appreciably extended healing time IF the wound was treated properly as far as cleaning and dressing were concerned. The vasoconstriction which theoretically denying the tissues nutrients and immune protection was not that prolonged.

I wish that tissue insuilts from electricity, radiation, abrasion, chemicals, whatever, were NOT equated as "burns" along one another and especially with the most common type, thermal burns. While they reach an area of commonality of treatment at some point, each requires a unique initial field treatment.
 
I ask why are we reopening a year old post?

R/r 911
 
Ridryder911 said:
I ask why are we reopening a year old post?
Click to expand...
Certainly a valid question. But since probably over ninety-percent of the people here are completely unaware of the current science, it's not a bad idea to bump this thread back up for review by the n00bs.
 
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