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Speaker 1: This episode features descriptions that some listeners might find upsetting.

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Speaker 1: Please listen with discretion. Case one, a lady aged twenty

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Speaker 1: years in feeble health was extensively burned by her mosquito

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Speaker 1: curtains and calico bed cover being set on fire after

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Speaker 1: she had fallen asleep. The flames enveloped her head, neck,

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Speaker 1: and arms, and were not extinguished for twenty or thirty seconds.

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Speaker 1: Ardent spirits were first applied, then flaxied oil, and lastly

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Speaker 1: a calcareous soap of the same oil and lime water laudanum,

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Speaker 1: was administered freely, both externally and internally.

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Speaker 2: Case two.

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Speaker 1: The editor, while rescuing the patient described in case one,

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Speaker 1: was severely burnt on both hands from compressing the burning

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Speaker 1: clothes with his bare hands until the flames were extinguished.

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Speaker 1: The cuticle exfoliated from nearly the whole right hand, and

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Speaker 1: the cutis vera sloughed in seven places. The left hand

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Speaker 1: suffered much worse. The whole cuticle was separated and much

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Speaker 1: of it was rolled up, especially that which covered the

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Speaker 1: space between the wrist and hollow of the hand and

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Speaker 1: extended up the inner side of the thumb as far

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Speaker 1: as the middle of the second phalanx between these limits

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Speaker 1: and the metacarpal bone of the little finger on one

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Speaker 1: side and the corresponding bone of the thumb on the other.

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Speaker 1: The true skin was killed and turned black. Immediately after

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Speaker 1: the accident. He immersed both hands in whiskey, then in

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Speaker 1: a liniment of flaxeied oil and lime water, after which

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Speaker 1: the affected parts were wrapped in rags dipped in a

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Speaker 1: painter's mixture of the same kind of oil and white lead,

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Speaker 1: ground together.

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Speaker 2: In three days.

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Speaker 1: This was replaced by carrot poultices with yeast and peruvian bark,

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Speaker 1: the deeply burnt parts being stimulated at different times with

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Speaker 1: tincture of mir oil of turpentine, ammoniated alcohol, and other excitents.

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Speaker 1: After a few days, separation was established and the dead

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Speaker 1: skin sloughed off. Had the case presented nothing but what

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Speaker 1: has been stated, a report of it would have been

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Speaker 1: of little interest. There resulted, however, from this local injury,

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Speaker 1: a great constitutional disturbs, And to this I beg leave

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Speaker 1: to direct the attention of the reader. Several causes seem

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Speaker 1: to have conspired to depress the energy and disorder the

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Speaker 1: sensibilities of his nervous system. Number one, the acute sensibility

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Speaker 1: of the parts injured. The pain for several hours after

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Speaker 1: the accident was excruciating, notwithstanding the liberal use of laudanum.

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Speaker 1: Number two, the scene of concentrated horror under which the

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Speaker 1: injury was inflicted contributed not a little to overthrow the

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Speaker 1: powers of the nervous system. Number three. The immersion of

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Speaker 1: both hands extensively denuded of cuticle in a liniment of

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Speaker 1: oil and white lead, seems to me to have contributed

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Speaker 1: largely to the same effect. Number four.

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Speaker 3: Two.

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Speaker 1: Three or four days after the accident, when febrile symptoms

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Speaker 1: were developed, the patient, by his own advice, lost about

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Speaker 1: ten ounces of blood. This was done under the apprehension

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Speaker 1: that the fever and inflammation might run too high for

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Speaker 1: healthy separation, but it manifestly did harm. It would be

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Speaker 1: difficult to set forth the variety of physical and moral

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Speaker 1: suffering which were attendant on the protracted state of nervous

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Speaker 1: or constitutional irritation which these causes generated. A great variety

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Speaker 1: of applications were advised and employed for this formidable affection,

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Speaker 1: but with little good time only has been efficacious. But

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Speaker 1: even a period of nearly two years has not entirely

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Speaker 1: overcome the effect.

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Speaker 4: I can't believe that they survived.

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Speaker 2: Yeah, yes, I know, uh so that it is.

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Speaker 5: It is.

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Speaker 2: It's horrible.

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Speaker 1: It's horrible, and it exhibits I think there are some

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Speaker 1: it's There's an entire paper actually that I found this

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Speaker 1: in that was like discussing, uh what this represents in

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Speaker 1: terms of the history of burned treatment and where things stood.

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Speaker 1: So the author of that was a medical doctor named

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Speaker 1: Daniel Drake, who was actually one of like a famous

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Speaker 1: doctor at the time, and he wrote this about his

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Speaker 1: own experience, and he was the editor of a journal,

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Speaker 1: and he was like, I need to tell everyone about this,

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Speaker 1: like all of these and I think the realization that

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Speaker 1: he came to was, like all of these treatments. We

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Speaker 1: have so many different treatments and none seem to have

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Speaker 1: a positive effect.

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Speaker 4: Like, if anything, they might have made things worse. Yes. Yeah.

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Speaker 1: The article, if you're interested, is titled History of two

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Speaker 1: Cases of burn producing Serious Constitutional Irritations by Daniel Drake.

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Speaker 1: It was published in eighteen thirty. And the paper that

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Speaker 1: I found this in was called Daniel Drake's Account of

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Speaker 1: his Own hand Burns by Eric Mooney that was published

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Speaker 1: in like nineteen ninety eight. I think so yeah, truly

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Speaker 1: awful stuff. But Hi, I'm erin Welsh.

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Speaker 3: And I'm erin aman Upnike and this is this podcast

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Speaker 3: will kill you.

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Speaker 4: Welcome to Burns. Yeah, part one, Part one, two parts,

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Speaker 4: because this is a big this is a big one.

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Speaker 1: I mean each there are as I was working on

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Speaker 1: the second episode and like the way that I split

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Speaker 1: up the history for this is that I did, like

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Speaker 1: most of history, most of history, stand right, most of everything,

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Speaker 1: and then like the last eighty years basically, and like

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Speaker 1: the various developments in the last eighty years, each one

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Speaker 1: of those could be its own episode, not to mention

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Speaker 1: burn Centers being its own episode, multidisciplinary like all these things.

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Speaker 4: Anyway, I know, there's so there's so much and like

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Speaker 4: even in the newer like the techniques and the newer

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Speaker 4: technologies and things that we have, Like there's so much

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Speaker 4: more detail that we listen. We've got a lot to

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Speaker 4: cover though today and next week. Yes, today is Burns

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Speaker 4: Part one. Should we tell people like kind of what

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Speaker 4: we're covering today, what we're covering next week? Sure? Sure,

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Speaker 4: let them know a little biting to I don't know,

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Speaker 4: if you want to know.

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Speaker 2: Here's a preview.

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Speaker 4: Here's a preview. Today, we're going to talk about the

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Speaker 4: biology of burns, what is happening in our bodies to

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Speaker 4: our bodies when we suffer a burn, and then Aaron,

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Speaker 4: you're going to walk us through, like you said, the

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Speaker 4: most of humans's history with burns, and then next week

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Speaker 4: we're going to pick up with more modern history and

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Speaker 4: how we actually treat and deal with burns. Today.

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Speaker 2: Yeah, yeah, there's a lot. There's a lot. There's a lot.

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Speaker 2: And before we can do any.

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Speaker 4: Of this, it is quarantine time any time.

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Speaker 2: What are we drinking this week?

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Speaker 4: We're drinking by degrees? By degrees it is technically still

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Speaker 4: how we measure burns is ish okay, okay, ish, we'll

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Speaker 4: get there, but kind of okay okay. It's still all

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Speaker 4: over the literature.

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Speaker 1: It is when when I was like, oh, degrees and

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Speaker 1: you were like, no, we don't talk about that anymore,

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Speaker 1: it's like it's fine, We're going to okay, okay, okay. Well,

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Speaker 1: by degrees is the name of the quarantini, and the

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Speaker 1: quarantini is a non alcoholic bee's knees basically, so some

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Speaker 1: non alcoholic gin. Lots of different varieties out there, take

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Speaker 1: your pick. Lemon juice honey.

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Speaker 4: Yeah, just a great anti septic for.

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Speaker 2: It is it is historically used as well as today.

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Speaker 4: As well as today. Yep. Yeah, you can find the

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Speaker 4: full recipe for that on our website. This podcast we

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Speaker 4: kill You dot com and all of our socials This

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Speaker 4: podcast will kill you most places.

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Speaker 1: Just search this podcast kill you and you'll find us.

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Speaker 1: You'll find us and if you if that searching lands

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Speaker 1: you on our website. Other things that you can find include.

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Speaker 3: Bookshop dot org, affiliate page, Goodreads list, links to music

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Speaker 3: by Bloodmobile, a Furtian account, form of contact us form,

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Speaker 3: links to merch Patreon, transcripts, et cetera.

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Speaker 4: There's a lot there, isn't there a lot there? Yeah?

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Speaker 4: This podcast will kill You dot com. Thank you for

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Speaker 4: rating and reviewing and subscribing to this podcast on your

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Speaker 4: favorite podcasterer and or on YouTube hello or on YouTube

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Speaker 4: on YouTube satchers Yep. The end? Shall we have got

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Speaker 4: a lot to cover? Yeah, let's get into it.

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Speaker 5: Yeah, Okay.

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Speaker 4: For today's episode, I wanted to take us through how

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Speaker 4: exactly we classify burns in medicine and what this classification

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Speaker 4: means for how our body responds to a burn injury.

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Speaker 4: Because although a burn is a type of trauma to

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Speaker 4: our skin. And there's a lot of other traumas that

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Speaker 4: we could get to our skin right scrapes, cuts, et cetera.

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Speaker 4: Our body's response to burn injuries is actually fairly unique.

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Speaker 4: Even though it is still the same inflammatory response, it

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Speaker 4: is also unique. It's kind of interesting, huh. Okay, And

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Speaker 4: what I really think and what I took away from

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Speaker 4: digging really deep into this is that what burns really

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Speaker 4: show us is just how incredible and how important of

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Speaker 4: an organ our skin is, true, and how severe damage

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Speaker 4: to that skin has life threatening consequences and long lasting consequences.

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Speaker 4: So I'm gonna walk us through the types of burns

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Speaker 4: that we can see, burn severity and how we actually

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Speaker 4: determine severe versus minor or major versus minor burns, and

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Speaker 4: what is happening to our whole entire body as a

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Speaker 4: result of a burn injury, and then save the like,

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Speaker 4: what do we do about these burns for next week's episode?

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Speaker 2: Okay, sounds good.

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Speaker 4: So a lot of different things can actually cause the

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Speaker 4: type of damage that we would refer to as a burn,

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Speaker 4: and the source of a burn really does matter a

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Speaker 4: lot because the pattern of injury that you see can

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Speaker 4: be really different depending on the source of that burn. So,

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Speaker 4: as an example, electrical burns, which we've talked about in

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Speaker 4: our Lightning episode, we talked a lot about electric burns.

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Speaker 4: They can cause really severe deep damage to our internal

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Speaker 4: structures with very minimal visible surface injury. But those are

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Speaker 4: still going to be burn injuries, but deeper. A burn

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Speaker 4: from a chemical, like say a strong acid, might cause

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Speaker 4: coagulation necrosis, so your blood vessels are all clotting and

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Speaker 4: all your blood is clotting, while a burn from an

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Speaker 4: alkaline chemical might actually liquefy your tissues completely. WHOA, Yeah,

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Speaker 4: So burns from chemicals are going to act a little

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Speaker 4: bit differently, and they might differ in how we need

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Speaker 4: to treat them. You can think of frostbite as a

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Speaker 4: type of cold burn, and those need to be rewarmed

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Speaker 4: and watched. See our two episodes on cold and cold injuries.

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Speaker 4: Hypotheth that what we call them, I think, So, yeah,

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Speaker 4: I was like, what did we call this? Whereas a

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Speaker 4: heat burn is going to be different, and so most

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Speaker 4: of what I'm going to talk about, though it pro

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Speaker 4: probaly applies to most all burns. They're really I'm talking

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Speaker 4: mostly about thermal burns. So burns as a result of

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Speaker 4: heat injury.

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Speaker 2: Did you mention radiation burns?

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Speaker 4: I didn't, But those are yet another type of ok

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Speaker 4: that might be more like more similar to maybe a

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Speaker 4: chemical burn, or or somewhere in between a little bit different. Okay, Yeah,

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Speaker 4: So yeah, there's a lot of different kinds of burns,

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Speaker 4: but so I'm focusing mostly on thermal burns. These are

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Speaker 4: the most common types of burns worldwide. And these can

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Speaker 4: be flame burns so from a fire, as well as

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Speaker 4: skaled type burns, so think hot liquid and those sorts

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Speaker 4: of things, and those are the two most common types

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Speaker 4: of burns worldwide. Once we know what caused the burn,

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Speaker 4: then the next thing that we need to know is

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Speaker 4: the severity of that burn. And the severity is a

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Speaker 4: combination of the body surface area that's affected, so how

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Speaker 4: much of your body got burned and the depth of

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Speaker 4: that burn. And then of course we also need to

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Speaker 4: look for whether there was any additional injury or traumas,

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Speaker 4: especially in the case of something like a flame burn,

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Speaker 4: you might have inhalational injuries or a chemical burn, you

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Speaker 4: might have other toxin exposures. You could even have like

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Speaker 4: blunt trauma injuries, right, depending on how the burn was sustained.

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Speaker 4: And then there's patient factors that might make someone more

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Speaker 4: susceptible to severe outcomes from a less severe burn, like

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Speaker 4: say a very young child or a very old person,

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Speaker 4: et cetera.

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Speaker 2: Underlying health issues.

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Speaker 4: So exactly diabetes that might interfere with wound healing things

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Speaker 4: like that. So let's go through how we kind of

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Speaker 4: get to the severity we already mentioned. And a lot

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Speaker 4: of us have heard of the idea of a first, second,

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Speaker 4: and third degree burn, and that is like classically how

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Speaker 4: we classify burns. And I say that we don't quite

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Speaker 4: use it as much today because we now get a

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Speaker 4: little bit more specific based on the thickness or the

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Speaker 4: depth of the burn in our skin, but colloquially we

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Speaker 4: still use for second, third degree. So we'll just go

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Speaker 4: a little bit more detailed, Okay, And first I want

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Speaker 4: to take us through our skin. And we've talked about

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Speaker 4: our skin on a number of episodes before, including like

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Speaker 4: our retinoid's episodes. Yes, but our skin is an incredibly

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Speaker 4: important organ, and it's a layered organ, the largest organ

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Speaker 4: in our whole entire body, and it's made up of

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Speaker 4: several different layers. The top layer, the outside what you're

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Speaker 4: touching and what you see, is called the epidermis. And

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Speaker 4: this is very very thin layer, and it differs in

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Speaker 4: thickness depending on where on your body. So it's a

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Speaker 4: lot thicker in places like the soles of our feet

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Speaker 4: and our back, and it's a lot thinner in places

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Speaker 4: like say, your eyes or you know, the backs of

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Speaker 4: your hands or things like that. Underneath the epidermis is

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Speaker 4: the dermis, and this is the layer that has a

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Speaker 4: lot of structure to it. It's a little bit thicker still,

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Speaker 4: only on the order of millimeters, but the dermis is

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Speaker 4: underneath that. And then underneath the dermis is a layer

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Speaker 4: of subcutaneous tissue, so this is like fa and things

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Speaker 4: like that. And then below that is when we get

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Speaker 4: to muscles and bones. Okay, So the degree of a

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Speaker 4: burn depends on how far through that skin layers. Through

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Speaker 4: those layers of skin, we actually get. A superficial burn,

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Speaker 4: or a first degree burn, is one that burns only

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Speaker 4: the uppermost layer, the epidermis. This you can think of

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Speaker 4: as a bad sunburn, right, okay, blister, no, not a

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Speaker 4: blister type of thing. Okay, So a bad sunburn. Your

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Speaker 4: skin is red, angry, and it's painful, but beyond that,

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Speaker 4: it's generally does not blister, okay, And it does not

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Speaker 4: need any kind of specialized treatment, and you're not going

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Speaker 4: to get a scar or any residual defects or anything.

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Speaker 4: These type of superficial or first degree burns generally heal

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Speaker 4: within a week or so, but no blistering. That is

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Speaker 4: when we get into second degree burns, okay. And what

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Speaker 4: used to be just lumped as second degree burns is

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Speaker 4: now into two different types. So the first is a

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Speaker 4: superficial partial thickness burn. This is the one erin that

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Speaker 4: will blister, okay. And so this is a burn that

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Speaker 4: burns completely through the epidermis and then into the first

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Speaker 4: part of the dermis, but does not go like deeply

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Speaker 4: into the dermis, okay. And so this is something that

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Speaker 4: you might get if you burn yourself on a pan

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Speaker 4: or the oven or like really hot you know, liquid

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Speaker 4: that spills on you or something. These burns are very

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Speaker 4: very painful. They might be red, they might be blistered,

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Speaker 4: they might be very wet and kind of weep and

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Speaker 4: you have to take care of these wounds. But you're

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Speaker 4: not going to need surgery to fix these wounds. Ye,

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Speaker 4: because the layer of the dermis has not been completely

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Speaker 4: burned through, and so your skin is going to be

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Speaker 4: able to it's called re epithelialize. It's going to be

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Speaker 4: able to make new skin to cover up this wound

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Speaker 4: without a lot of additional help. Most of the time,

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Speaker 4: you're not going to get a scar from these types

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Speaker 4: of burns. If you do, it might just be pigmentation

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Speaker 4: changes because of losses of like the melanocytes that are

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Speaker 4: in more of the epidermal layer. Okay, okay. Next is

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Speaker 4: again within this considered second degree burn is called a

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Speaker 4: deep partial thickness burn, and the deep partial thickness burns

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Speaker 4: actually tend to hurt a little bit less than the

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Speaker 4: first two, and that's because they burn deeply enough that

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Speaker 4: they're actually destroying our pain receptors in our skin. These

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Speaker 4: burns tend to be a lot drier than a superficial

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Speaker 4: partial thickness burn, so you don't necessarily have blisters, or

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Speaker 4: if you do, they're just not quite as wet as

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Speaker 4: a superficial burn. They often look either very dark pink

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Speaker 4: or sometimes almost white, where they just look like it

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Speaker 4: doesn't really look like there's anything there. It's just like

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Speaker 4: completely white, regardless of your skin color. And they're almost

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Speaker 4: kind of pearly looking, rather like or like waxy looking

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Speaker 4: a little bit. These generally do need surgery very often.

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Speaker 4: These are deep enough that the skin is not going

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Speaker 4: to be able to completely heal over this without some

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Speaker 4: kind of surgical intervention, and that means that they're at

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Speaker 4: much higher risk of some kind of scar formation. There's

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Speaker 4: not a huge leap then, from a deep partial thickness

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Speaker 4: to a full thickness burn or a third degree burn,

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Speaker 4: and this is one that extends completely through the dermis,

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Speaker 4: so the epidermal layer and the dermis are completely burned

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Speaker 4: through all the way down into that subcutaneous tissue. In

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Speaker 4: some cases it a burn can extend all the way

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Speaker 4: down into our deeper tissues, which is sometimes called a

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Speaker 4: fourth degree burn, or sometimes it's just lumped under this

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Speaker 4: third degree, and that means that there's damage to the

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Speaker 4: muscles or the bones, depending on how deep it goes.

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Speaker 4: These full thickness burns are not painful because all of

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Speaker 4: our nerve endings have been destroyed. And I asked risk

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Speaker 4: that erin, Yeah, because that just means that at the

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Speaker 4: time of the injury, that specific area that sustained a

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Speaker 4: full thickness burn, if you touch it, you will not

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Speaker 4: feel that the way that if you touch a burn blister,

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Speaker 4: it really hurts. But that doesn't mean that they're not

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Speaker 4: painful in the long run, or.

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Speaker 1: That you only have a third degree burn and that

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Speaker 1: other parts of your body are not experiencing first and

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Speaker 1: second degrees.

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Speaker 4: Yeah, exactly, exactly, very very often, almost always, if someone

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Speaker 4: has severe burns, not every part of the burn is

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Speaker 4: the same degree. Right, You have a mix of burns

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Speaker 4: of varying degrees or varying thicknesses on different parts of

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Speaker 4: that burn, which means, yes, things are likely going to

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Speaker 4: be very painful, even if parts of those burns have

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Speaker 4: completely destroyed the nerve endings and everything.

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Speaker 1: Okay, So I have a question about like surface area

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Speaker 1: and degrees. Yeah, because it's a big like we just

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Speaker 1: talked about, there's a mixture of, yes, different degrees or

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00:20:06,560 --> 00:20:09,600
Speaker 1: severities of the burn in different parts of your body.

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Speaker 1: So how is that calculated? How does that get incorporated

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Speaker 1: into total body surface area?

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Speaker 4: That's a great question. So total body surface area is

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Speaker 4: the next thing that we have to look at. So

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Speaker 4: once we know, and I say it as if these

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00:20:20,600 --> 00:20:23,280
Speaker 4: are separate things, they're really not. Like we're looking at

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Speaker 4: all of this at the same time. If someone comes

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Speaker 4: into a hospital with a burn, but total body surface

348
00:20:28,240 --> 00:20:31,680
Speaker 4: area is how much of your body surface is covered

349
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Speaker 4: by this burn, regardless of the degree, So you don't

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Speaker 4: need to separate it by oh, you know this much

351
00:20:36,800 --> 00:20:39,400
Speaker 4: surface area was a first degree versus second versus third.

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Speaker 4: Here we're just looking at how much of your skin

353
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Speaker 4: got burned. And this is actually the most important part

354
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Speaker 4: in looking at mortality is surface area. So how we

355
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Speaker 4: classify something as a so called minor burn, This is

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Speaker 4: actually a lot more. I won't even say contentious in

357
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Speaker 4: the literature because I don't think anyone's fighting over it.

358
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Speaker 4: But it really depends on the situation whether something is

359
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Speaker 4: considered a severe or a minor burn. In general, most

360
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Speaker 4: people don't require hospitalization for burns that cover less than

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Speaker 4: ten percent of their body surface. But that's a huge

362
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Speaker 4: generalization because a burn on the face, a burn on

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Speaker 4: the groin, a burn on the hands, even if it's

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Speaker 4: significantly less than ten percent, might still require hospitalization as

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Speaker 4: well as depending on the thickness or the degree of

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Speaker 4: that burn.

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Speaker 1: Or other injuries sustained or types of exact type of

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Speaker 1: burn that it is.

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Speaker 4: Yeah, exactly, So that is really an over generalization. Most

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Speaker 4: of the time, if we're thinking about what is going

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00:21:38,000 --> 00:21:42,760
Speaker 4: to cause more likely to cause systemic symptoms, then we're

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Speaker 4: looking at burns that are maybe more than fifteen or

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Speaker 4: twenty percent of your body surface area, depending on the

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Speaker 4: person and their age and like how big they are, right,

375
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Speaker 4: Like a kid might have a less body surface area

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Speaker 4: to cause severe effects. But all of that is really

377
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Speaker 4: like it so depends on the person, right, So there's

378
00:22:01,240 --> 00:22:03,240
Speaker 4: not like a clear cut definition of like this is

379
00:22:03,520 --> 00:22:06,359
Speaker 4: a major burn versus a minor burn, or a severe

380
00:22:06,400 --> 00:22:09,919
Speaker 4: burn versus a non severe burn. But calculating that body

381
00:22:09,920 --> 00:22:13,960
Speaker 4: surface area is a really important part of the care

382
00:22:14,119 --> 00:22:17,479
Speaker 4: of a person and understanding how severe their outcomes are

383
00:22:17,480 --> 00:22:19,479
Speaker 4: going to be. And the way that we do that

384
00:22:19,880 --> 00:22:21,760
Speaker 4: is there's a couple different ways. There's a fast and

385
00:22:21,800 --> 00:22:24,560
Speaker 4: ready way kind of that is called the rule of nines,

386
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Speaker 4: and that is that we just split up an adult

387
00:22:27,640 --> 00:22:31,320
Speaker 4: body area into areas that are about nine percent. So

388
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Speaker 4: our head is about nine percent of our body surface.

389
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Speaker 4: Our chest, the front side of our chest, and the

390
00:22:36,760 --> 00:22:39,439
Speaker 4: front side of our abdomen are each nine percent, and

391
00:22:39,480 --> 00:22:42,120
Speaker 4: same thing with the back, so that's like eighteen and eighteen,

392
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Speaker 4: and then the front of our legs are nine percent,

393
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Speaker 4: the back of our legs are nine percent, on our

394
00:22:46,560 --> 00:22:48,760
Speaker 4: two arms put together are nine percent, and then an

395
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Speaker 4: extra one percent for the genitals.

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Speaker 2: Okay.

397
00:22:51,720 --> 00:22:54,399
Speaker 4: The other way that you can do it though, because

398
00:22:54,400 --> 00:22:58,480
Speaker 4: that calculation does not hold true for children because children

399
00:22:58,560 --> 00:23:03,080
Speaker 4: their head is a magnificantly larger body surface than especially

400
00:23:03,160 --> 00:23:06,399
Speaker 4: for babies, So there's different calculations that we use for

401
00:23:06,560 --> 00:23:10,800
Speaker 4: children and babies. But you also could use a person's hand,

402
00:23:10,960 --> 00:23:14,720
Speaker 4: so not my hand to calculate your burn area, but

403
00:23:14,880 --> 00:23:19,320
Speaker 4: your hand to calculated mind to calculate mine our palm.

404
00:23:19,560 --> 00:23:22,240
Speaker 4: So the entire surface of our hand, including our fingers

405
00:23:22,280 --> 00:23:25,639
Speaker 4: on our palm is about one percent. Okay, that's considered

406
00:23:25,640 --> 00:23:27,600
Speaker 4: about one percent total, so you can use that to

407
00:23:27,680 --> 00:23:31,000
Speaker 4: kind of estimate if it's less than nine percent or something.

408
00:23:31,000 --> 00:23:33,840
Speaker 4: You're trying to get a rough estimate. So that's how

409
00:23:33,880 --> 00:23:39,080
Speaker 4: we sort of calculate and estimate how severe a burn is.

410
00:23:40,160 --> 00:23:42,520
Speaker 4: And of course, like I said at the very top,

411
00:23:42,640 --> 00:23:47,080
Speaker 4: our skin is the largest organ in our body, so

412
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Speaker 4: damage even to a small portion of that organ has

413
00:23:52,920 --> 00:23:58,159
Speaker 4: the potential to cause a whole body response, and the

414
00:23:58,280 --> 00:24:02,199
Speaker 4: response that we see really depends on the depth of

415
00:24:02,240 --> 00:24:06,080
Speaker 4: that burn, the surface area of that burn, and the

416
00:24:06,119 --> 00:24:09,879
Speaker 4: person who sustained that burn and what their underlying conditions is.

417
00:24:10,920 --> 00:24:13,480
Speaker 4: But we can kind of understand how this process is

418
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Speaker 4: going to go if we understand our basic inflammatory response

419
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Speaker 4: and how our body responds to wounds in our skin,

420
00:24:21,040 --> 00:24:23,080
Speaker 4: which we've talked about on previous episodes. I think on

421
00:24:23,119 --> 00:24:27,639
Speaker 4: our Maggot's episode, we talked about this inflammatory response because

422
00:24:27,640 --> 00:24:29,960
Speaker 4: anytime that our skin is wounded from a burn or

423
00:24:30,040 --> 00:24:33,360
Speaker 4: a scrape or a scratch, our body follows a very

424
00:24:33,359 --> 00:24:36,399
Speaker 4: predictable series of responses to try and repair that wound.

425
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Speaker 4: The very first thing is hemostasis right. We have to

426
00:24:39,880 --> 00:24:42,639
Speaker 4: stop the bleeding because most of the time wounds bleed

427
00:24:43,240 --> 00:24:45,840
Speaker 4: very often they don't in the case of burns, and

428
00:24:45,880 --> 00:24:49,200
Speaker 4: we'll get to why that is. But the second thing

429
00:24:49,480 --> 00:24:52,959
Speaker 4: that's going to happen is inflammation, and this is to

430
00:24:53,200 --> 00:24:56,879
Speaker 4: bring helpers to the area in order to start the

431
00:24:56,960 --> 00:25:01,000
Speaker 4: repair process. The third step is prolifer. We need to

432
00:25:01,040 --> 00:25:04,040
Speaker 4: start making new cells to fill in the gaps that

433
00:25:04,080 --> 00:25:07,879
Speaker 4: are left by this wound, and finally we have maturation

434
00:25:08,040 --> 00:25:12,440
Speaker 4: or remodeling. That's the finishing up that is really scar formation,

435
00:25:12,600 --> 00:25:16,880
Speaker 4: because our skin pretty much always heals by scarring, so

436
00:25:17,040 --> 00:25:19,960
Speaker 4: in the event of a burn, our body is going

437
00:25:20,000 --> 00:25:26,240
Speaker 4: to attempt to heal by this similar process. However, because

438
00:25:26,280 --> 00:25:28,960
Speaker 4: of some specific things that happen, especially in the case

439
00:25:29,000 --> 00:25:32,840
Speaker 4: of a thermal burn, so a heat related burn, as

440
00:25:32,880 --> 00:25:36,800
Speaker 4: well as the potential for a very large portion of

441
00:25:36,840 --> 00:25:40,720
Speaker 4: our skin to be affected, the end result is often

442
00:25:40,760 --> 00:25:45,040
Speaker 4: a pretty disregulated body response that can be really severe.

443
00:25:45,640 --> 00:25:48,960
Speaker 4: So unlike say a cut or a scrape that just

444
00:25:49,119 --> 00:25:54,159
Speaker 4: has damage wherever that scrape actually happened, a burned wound

445
00:25:54,320 --> 00:25:58,920
Speaker 4: actually has several different zones of injury. In the very

446
00:25:59,200 --> 00:26:02,480
Speaker 4: center or like where the burn was actually sustained is

447
00:26:02,520 --> 00:26:05,760
Speaker 4: what's called a zone of coagulation. You can think of

448
00:26:05,800 --> 00:26:08,720
Speaker 4: this as not necessarily the deepest part of the burn,

449
00:26:08,760 --> 00:26:12,040
Speaker 4: but like the part that actually had contact with the

450
00:26:12,080 --> 00:26:14,400
Speaker 4: hot liquid or the flame or whatever it was that

451
00:26:14,440 --> 00:26:18,720
Speaker 4: caused the injury, and in that area the tissue is dead,

452
00:26:19,680 --> 00:26:23,000
Speaker 4: the blood cells are coagulated, so there's no bleeding in

453
00:26:23,040 --> 00:26:26,800
Speaker 4: that area because of the strong heat that was applied

454
00:26:28,119 --> 00:26:35,240
Speaker 4: and that tissue in that area cannot be completely salvaged. Okay, Okay.

455
00:26:35,840 --> 00:26:40,320
Speaker 4: Immediately around this there is a zone of stasis, and

456
00:26:40,400 --> 00:26:44,960
Speaker 4: in this area there is a lot of inflammation. So

457
00:26:45,040 --> 00:26:49,240
Speaker 4: our body is trying to respond to that central area.

458
00:26:49,400 --> 00:26:53,440
Speaker 4: It knows that there's something wrong here, but there's very

459
00:26:53,520 --> 00:26:56,840
Speaker 4: low levels of blood flow. There's a lot less profusion

460
00:26:57,040 --> 00:27:00,040
Speaker 4: in this zone because of damage that was sustained and

461
00:27:00,240 --> 00:27:03,000
Speaker 4: our body's response of kind of clamping down to try

462
00:27:03,040 --> 00:27:07,160
Speaker 4: and protect that area, which has the effect that if

463
00:27:07,160 --> 00:27:09,679
Speaker 4: that area is not addressed, then the damage from the

464
00:27:09,680 --> 00:27:13,080
Speaker 4: burn can actually extend out over the next twenty four

465
00:27:13,080 --> 00:27:13,959
Speaker 4: to forty eight hours.

466
00:27:14,440 --> 00:27:15,879
Speaker 2: How can it do that.

467
00:27:16,400 --> 00:27:19,760
Speaker 4: Because that area, that zone of stasis, is not getting

468
00:27:19,880 --> 00:27:22,760
Speaker 4: enough blood flow. If that blood flow is not restored

469
00:27:22,840 --> 00:27:25,760
Speaker 4: to that area, then that area is also going to

470
00:27:25,800 --> 00:27:28,639
Speaker 4: die because of a lack of blood flow. Okay, that

471
00:27:28,760 --> 00:27:29,760
Speaker 4: kind of makes sense, I think, so.

472
00:27:30,000 --> 00:27:30,760
Speaker 2: Yeah.

473
00:27:31,119 --> 00:27:34,000
Speaker 4: And then outside of that zone is called the zone

474
00:27:34,000 --> 00:27:37,320
Speaker 4: of hyperaemia. And this is non damage tissue where perfusion

475
00:27:37,480 --> 00:27:40,800
Speaker 4: hasn't been affected, and this is all like viable tissue essentially.

476
00:27:41,840 --> 00:27:44,879
Speaker 4: So in the first forty eight hours, it's important to

477
00:27:44,880 --> 00:27:49,240
Speaker 4: be able to find those areas and see how much

478
00:27:49,280 --> 00:27:52,520
Speaker 4: tissue can be salvaged, especially and I'm talking really in

479
00:27:52,560 --> 00:27:56,040
Speaker 4: the case of deep partial thickness, so like those more

480
00:27:56,080 --> 00:28:01,160
Speaker 4: severe second degree burns or third degree or full thickness burns, right, Okay,

481
00:28:01,480 --> 00:28:04,640
Speaker 4: this isn't necessarily happening in a superficial burn where it's

482
00:28:04,760 --> 00:28:06,359
Speaker 4: just the epidermis.

483
00:28:06,520 --> 00:28:09,080
Speaker 1: Okay, So just so I want to go over this,

484
00:28:09,160 --> 00:28:11,679
Speaker 1: so I think make sure I understand this. So you

485
00:28:12,119 --> 00:28:14,600
Speaker 1: experience a second degree burn, Let's say it's like on

486
00:28:14,640 --> 00:28:18,080
Speaker 1: your leg, there's the area that is like the most

487
00:28:18,119 --> 00:28:23,119
Speaker 1: severe part that things are bad. The burn has happened

488
00:28:23,119 --> 00:28:28,119
Speaker 1: directly there, and then surrounding that area there's sort of

489
00:28:28,119 --> 00:28:31,280
Speaker 1: the area that has also been kind of affected but

490
00:28:31,400 --> 00:28:36,480
Speaker 1: not directly by the thermal injury. But it's that area

491
00:28:36,560 --> 00:28:41,120
Speaker 1: that needs to be like looked after because it's at

492
00:28:41,200 --> 00:28:43,440
Speaker 1: risk of dying. And so that's where a lot of

493
00:28:43,480 --> 00:28:47,960
Speaker 1: the inflammation comes into there. Yes, Yes, not necessarily the

494
00:28:48,000 --> 00:28:51,120
Speaker 1: central point of the burn itself, because there's nothing left.

495
00:28:51,760 --> 00:28:54,040
Speaker 1: There's no more tissue left to go to that is

496
00:28:54,080 --> 00:28:58,720
Speaker 1: alive and receptive, right, right to do the remodeling first, exactly,

497
00:28:58,920 --> 00:29:02,040
Speaker 1: So yes, in that tissue that is completely dead, our

498
00:29:02,080 --> 00:29:04,000
Speaker 1: inflammatory response can't kick in there.

499
00:29:04,040 --> 00:29:05,800
Speaker 4: We don't have blood flow there, there's.

500
00:29:05,720 --> 00:29:09,240
Speaker 1: No blood flow, there's no opportunity for anything. So then okay,

501
00:29:09,320 --> 00:29:10,440
Speaker 1: everything has to be restored.

502
00:29:10,760 --> 00:29:12,760
Speaker 4: Everything has to be restored. So that's the first challenge

503
00:29:12,800 --> 00:29:16,600
Speaker 4: is identifying those areas that need restoration that we need

504
00:29:16,640 --> 00:29:19,640
Speaker 4: to do something otherwise that repair process is not going

505
00:29:19,680 --> 00:29:22,520
Speaker 4: to be able to start. That's the first challenge. The

506
00:29:22,600 --> 00:29:26,080
Speaker 4: second challenge is that all of the surrounding tissue will

507
00:29:26,200 --> 00:29:30,200
Speaker 4: have a lot of inflammation right because our body knows

508
00:29:30,240 --> 00:29:32,520
Speaker 4: that something is going on and they're trying really hard

509
00:29:32,720 --> 00:29:35,080
Speaker 4: to send in all the troops. That means in the

510
00:29:35,160 --> 00:29:39,120
Speaker 4: surrounding areas we have a lot of vasodilation. That means

511
00:29:39,160 --> 00:29:41,680
Speaker 4: our blood vessels are getting larger, and that's to accommodate

512
00:29:41,720 --> 00:29:46,360
Speaker 4: more flow. We see an increase in vascular permeability, so

513
00:29:46,400 --> 00:29:48,920
Speaker 4: that means that our blood vessels are more leaky, and

514
00:29:48,960 --> 00:29:51,960
Speaker 4: that is to allow all of the plasma that has

515
00:29:52,000 --> 00:29:54,800
Speaker 4: our white blood cells and the inflammatory markers and the

516
00:29:54,840 --> 00:29:57,960
Speaker 4: cytokines and all these things into the area to try

517
00:29:57,960 --> 00:30:01,760
Speaker 4: and help. But unfortunate only what that ends up resulting

518
00:30:01,800 --> 00:30:04,680
Speaker 4: in is a lot of edema. So a lot of

519
00:30:04,880 --> 00:30:08,280
Speaker 4: fluid in the area because the degree of inflammatory signals

520
00:30:08,320 --> 00:30:11,320
Speaker 4: is so high, and this can be in and of

521
00:30:11,360 --> 00:30:15,320
Speaker 4: itself very dangerous, especially in the event of like a

522
00:30:15,440 --> 00:30:18,920
Speaker 4: circumferential burn. So think like a burn that goes around

523
00:30:19,080 --> 00:30:23,520
Speaker 4: your entire arm, for example. Basically the fluid has nowhere

524
00:30:23,560 --> 00:30:26,200
Speaker 4: to go and so that's going to increase pressure in

525
00:30:26,240 --> 00:30:28,760
Speaker 4: that area. Does that make sense, yes?

526
00:30:29,080 --> 00:30:33,240
Speaker 1: How how does blood pressure overall play, Like what happens

527
00:30:33,240 --> 00:30:34,080
Speaker 1: to your blood pressure?

528
00:30:34,280 --> 00:30:37,760
Speaker 4: Yeah? So the path of physiology of burns, severe burns

529
00:30:37,800 --> 00:30:40,840
Speaker 4: especially is divided into two phases. The first phase is

530
00:30:40,880 --> 00:30:43,680
Speaker 4: in these first twenty four to seventy two hours, okay,

531
00:30:43,720 --> 00:30:46,760
Speaker 4: and that's called the hypodynamic phase, and that is when

532
00:30:46,880 --> 00:30:49,960
Speaker 4: all this inflammation is happening. Our bodies kicking into high gear.

533
00:30:50,360 --> 00:30:54,400
Speaker 4: Inflammatory markers are going everywhere, Vascular permeability is up, so

534
00:30:54,440 --> 00:30:57,000
Speaker 4: we are at very high risk of going into shock.

535
00:30:57,640 --> 00:31:00,240
Speaker 4: And shock, as we learned in our sepsis episode, means

536
00:31:00,280 --> 00:31:04,000
Speaker 4: a drop in your blood pressure enough so that all

537
00:31:04,040 --> 00:31:09,080
Speaker 4: of your other organs are not getting enough blood. So

538
00:31:09,280 --> 00:31:13,720
Speaker 4: this is incredibly dangerous. It can result in multi organ failure,

539
00:31:14,320 --> 00:31:17,440
Speaker 4: kidney failure, liver failure. Your heart is not pumping out

540
00:31:17,560 --> 00:31:21,600
Speaker 4: enough blood, and really it's because you're not losing blood,

541
00:31:22,320 --> 00:31:24,440
Speaker 4: so you're not bleeding out, but you are losing so

542
00:31:24,560 --> 00:31:27,880
Speaker 4: much fluid from this process that your blood pressure just

543
00:31:27,920 --> 00:31:31,160
Speaker 4: can't keep up. We can also see really bad fluid

544
00:31:31,200 --> 00:31:35,440
Speaker 4: imbalances and electrolyte imbalances as well. So in this period

545
00:31:35,560 --> 00:31:41,880
Speaker 4: what's really important is fluid resuscitation as well as management

546
00:31:41,960 --> 00:31:44,440
Speaker 4: of these wounds to try and prevent all of this

547
00:31:44,440 --> 00:31:46,360
Speaker 4: stuff from getting worse. And in the case of those,

548
00:31:46,600 --> 00:31:49,560
Speaker 4: if we have circumferential burns and things, there has to

549
00:31:49,640 --> 00:31:52,080
Speaker 4: be like pressure relief, so you have to do some

550
00:31:52,160 --> 00:31:55,000
Speaker 4: kind of surgical intervention, even if it's something small, to

551
00:31:55,080 --> 00:31:57,520
Speaker 4: literally release that pressure so that you don't cause further

552
00:31:57,600 --> 00:32:01,200
Speaker 4: damage to the tissue or the tissue downstream. That Okay,

553
00:32:02,520 --> 00:32:07,360
Speaker 4: after that initial twenty four to seventy two hours after

554
00:32:07,400 --> 00:32:10,840
Speaker 4: a burn, your body enters a new phase that's called

555
00:32:10,880 --> 00:32:15,200
Speaker 4: the hyper dynamic and hyper metabolic flow phase. And you

556
00:32:15,240 --> 00:32:17,520
Speaker 4: can kind of think of this as your body like

557
00:32:17,800 --> 00:32:22,240
Speaker 4: releasing all the stress hormones that it has so you're

558
00:32:22,360 --> 00:32:25,120
Speaker 4: still alive. Your body has kept you alive for this

559
00:32:25,360 --> 00:32:31,360
Speaker 4: first few days, and now it's recognizing that without a

560
00:32:31,480 --> 00:32:36,320
Speaker 4: portion of your largest organ being able to thermoregulate, being

561
00:32:36,360 --> 00:32:39,480
Speaker 4: able to regulate the water in your body, being able

562
00:32:39,520 --> 00:32:42,640
Speaker 4: to protect you from infection. Your body is going to

563
00:32:42,680 --> 00:32:47,120
Speaker 4: have to compensate in a huge, huge way. So what

564
00:32:47,200 --> 00:32:50,120
Speaker 4: we see our blood vessels actually clamping down, so a

565
00:32:50,160 --> 00:32:54,240
Speaker 4: real decrease in vascular permeability. We see your heart rate

566
00:32:54,320 --> 00:32:59,320
Speaker 4: going up. We see the small blood vessels or the

567
00:32:59,320 --> 00:33:02,800
Speaker 4: microvascular of the area around that wound starting to heal

568
00:33:02,880 --> 00:33:06,440
Speaker 4: and redistribute blood to these areas to actually promote healing

569
00:33:06,520 --> 00:33:08,920
Speaker 4: rather than just like kind of freaking out like they

570
00:33:08,920 --> 00:33:12,760
Speaker 4: were at first. Right. And then we also see huge

571
00:33:12,960 --> 00:33:17,560
Speaker 4: increases in our basal metabolic rate, so our body literally

572
00:33:17,600 --> 00:33:22,240
Speaker 4: starts burning way more energy than it has in the past.

573
00:33:23,360 --> 00:33:26,560
Speaker 4: And what is so wild about burns are that these

574
00:33:26,760 --> 00:33:30,000
Speaker 4: changes in metabolism and total body functioning, like changes in

575
00:33:30,040 --> 00:33:35,160
Speaker 4: cardiac output, changes in insulin and glucose regulation, changes in

576
00:33:35,280 --> 00:33:42,040
Speaker 4: heat production, last for years following a severe burn. Really, yes,

577
00:33:42,160 --> 00:33:45,160
Speaker 4: So if we see body surface area burns of twenty

578
00:33:45,200 --> 00:33:48,320
Speaker 4: percent or greater than these changes in metabolism can last

579
00:33:48,360 --> 00:33:51,000
Speaker 4: for two or more years.

580
00:33:52,520 --> 00:33:56,120
Speaker 1: Yeah, and this is okay, I have so many questions

581
00:33:56,200 --> 00:33:56,960
Speaker 1: about everything.

582
00:33:57,360 --> 00:34:00,440
Speaker 2: Yeah, And that's like at that.

583
00:34:00,400 --> 00:34:03,719
Speaker 1: Point, what does the burn like, what does the burned

584
00:34:03,800 --> 00:34:06,760
Speaker 1: skin or tissue look like, has it been healed?

585
00:34:06,840 --> 00:34:07,440
Speaker 2: Is it scar?

586
00:34:08,520 --> 00:34:11,320
Speaker 4: Yeah? It really So it's really really going to depend

587
00:34:11,320 --> 00:34:16,080
Speaker 4: on what kind of treatment you have access to. Okay, yeah, right.

588
00:34:16,520 --> 00:34:19,200
Speaker 4: If you don't have access to any treatment, especially if

589
00:34:19,239 --> 00:34:23,319
Speaker 4: this was a deep burn, then the tissue that has

590
00:34:23,400 --> 00:34:25,480
Speaker 4: died is going to form what's called an esh scar.

591
00:34:25,760 --> 00:34:28,280
Speaker 4: I think that's how you say it, and that's basically

592
00:34:28,280 --> 00:34:29,680
Speaker 4: like you can think of it as a really really

593
00:34:29,719 --> 00:34:33,680
Speaker 4: bad scab. So something that's completely black, completely necrotic, can

594
00:34:33,719 --> 00:34:38,000
Speaker 4: be very thick, and it will take a very long time,

595
00:34:38,680 --> 00:34:44,920
Speaker 4: if ever, for that wound to heal completely because again,

596
00:34:45,120 --> 00:34:48,480
Speaker 4: if the burn extends all the way through the dermis,

597
00:34:48,480 --> 00:34:52,560
Speaker 4: so a deep partial thickness burn, or a complete thickness

598
00:34:52,680 --> 00:34:55,680
Speaker 4: burn so a late second degree to be or a

599
00:34:55,719 --> 00:35:01,200
Speaker 4: third degree burn or greater, there aren't any like dermal

600
00:35:01,360 --> 00:35:06,560
Speaker 4: cells left to re epithelialize, and so that wound has

601
00:35:06,600 --> 00:35:09,960
Speaker 4: to heal like from the bottom up, and it's really

602
00:35:10,239 --> 00:35:13,480
Speaker 4: a slow process and in some cases it just never

603
00:35:13,640 --> 00:35:18,800
Speaker 4: completely makes new skin again without some kind of wound management,

604
00:35:18,840 --> 00:35:20,719
Speaker 4: So that wound might never heal and it might become

605
00:35:20,760 --> 00:35:24,440
Speaker 4: a chronic wound, okay if you don't have any access

606
00:35:24,520 --> 00:35:29,200
Speaker 4: to essentially surgical debreatment and then treatment for it. So

607
00:35:29,239 --> 00:35:32,799
Speaker 4: that's mostly burns and kind of how severe they can be,

608
00:35:33,160 --> 00:35:35,680
Speaker 4: what damage they can cause. There's obviously a lot of

609
00:35:35,680 --> 00:35:38,520
Speaker 4: complications that can arise during the treatment of these burns.

610
00:35:38,760 --> 00:35:41,959
Speaker 4: You're at very high risk of infection because your skin

611
00:35:42,040 --> 00:35:45,480
Speaker 4: is the main barrier from infection, and depending on what

612
00:35:45,680 --> 00:35:49,000
Speaker 4: caused the burn, you might have additional like inhalational injuries,

613
00:35:49,080 --> 00:35:52,239
Speaker 4: and smoke inhalation deserves its whole own episode because that

614
00:35:52,239 --> 00:35:55,799
Speaker 4: can cause really severe injury. It deserves its whole, entire

615
00:35:55,840 --> 00:35:59,920
Speaker 4: own episode. But that's kind of like the main how

616
00:36:00,080 --> 00:36:03,320
Speaker 4: we deal with burns in terms of how our body

617
00:36:03,360 --> 00:36:06,839
Speaker 4: is responding to that burn, and the management is going

618
00:36:06,840 --> 00:36:08,880
Speaker 4: to really vary depending on what you have access to

619
00:36:08,960 --> 00:36:11,279
Speaker 4: and depending on how severe that burn is. But Erin,

620
00:36:12,320 --> 00:36:16,240
Speaker 4: I have to assume that we've been subject to vulnerable

621
00:36:16,320 --> 00:36:20,200
Speaker 4: to burns ever since I don't know forever, since we

622
00:36:20,280 --> 00:36:24,400
Speaker 4: lost our fur, like furry animals can still burn, tell me.

623
00:36:26,560 --> 00:36:27,400
Speaker 2: I will get there.

624
00:36:27,480 --> 00:36:29,719
Speaker 1: I do have one other question for you, though, and

625
00:36:29,760 --> 00:36:32,360
Speaker 1: that's just sort of like in general, you know, so

626
00:36:32,440 --> 00:36:34,560
Speaker 1: much of what I encountered in the history of burns

627
00:36:34,719 --> 00:36:38,280
Speaker 1: is that burns were it could be very, very fatal,

628
00:36:38,440 --> 00:36:41,160
Speaker 1: and they're not as much now today if you have

629
00:36:41,280 --> 00:36:43,799
Speaker 1: access to all these top of the line treatments and

630
00:36:43,840 --> 00:36:50,160
Speaker 1: burn centers. But what is behind or driving that mortality.

631
00:36:50,280 --> 00:36:53,560
Speaker 4: It really depends. It depends on the total body surface area.

632
00:36:53,600 --> 00:36:56,560
Speaker 4: There's actually like a calculator that you can use based

633
00:36:56,560 --> 00:37:01,520
Speaker 4: on someone's age and their body surface area to predict

634
00:37:01,719 --> 00:37:04,799
Speaker 4: essentially whether someone is likely to die from it. In

635
00:37:04,840 --> 00:37:07,360
Speaker 4: the case of severe burns, then it's that first like

636
00:37:07,440 --> 00:37:09,719
Speaker 4: twenty four to forty eight hours that you really need

637
00:37:09,760 --> 00:37:12,719
Speaker 4: access to resuscitation or somebody could die from shock and

638
00:37:12,880 --> 00:37:15,960
Speaker 4: organ failure. And then after that it's more likely to

639
00:37:15,960 --> 00:37:19,400
Speaker 4: be infection or potentially other complications like if there was

640
00:37:19,400 --> 00:37:22,080
Speaker 4: an inhalation injury or something like that. At the same time,

641
00:37:22,560 --> 00:37:24,680
Speaker 4: gotcha o kyeah, Okay.

642
00:37:26,360 --> 00:37:29,040
Speaker 1: Yeah, it is hm Aron, it is grim, and I

643
00:37:29,440 --> 00:37:33,319
Speaker 1: will say that the history is for a large part

644
00:37:33,480 --> 00:37:37,399
Speaker 1: is quite grim as well. But this is why I'm

645
00:37:37,440 --> 00:37:40,520
Speaker 1: so glad that we're doing these two episodes, is because

646
00:37:40,600 --> 00:37:44,440
Speaker 1: it really does exemplify how far we have come in

647
00:37:44,480 --> 00:37:48,880
Speaker 1: our ability to treat and manage burns. It's pretty remarkable,

648
00:37:48,960 --> 00:37:51,000
Speaker 1: Like it really is. Medical revolutions.

649
00:37:51,080 --> 00:37:51,920
Speaker 4: It's incredible.

650
00:37:52,360 --> 00:38:14,520
Speaker 1: But let's see where things came from. Okay, do you

651
00:38:14,560 --> 00:38:16,840
Speaker 1: remember your first bad burn?

652
00:38:18,280 --> 00:38:21,920
Speaker 4: I remember some really really bad sunburns when I was

653
00:38:21,960 --> 00:38:25,560
Speaker 4: a kid, probably that came close to a second degree.

654
00:38:25,600 --> 00:38:28,040
Speaker 4: They were so bad. But that's it. That's what I

655
00:38:28,040 --> 00:38:29,920
Speaker 4: can remember, really bad sunburns.

656
00:38:30,560 --> 00:38:35,120
Speaker 1: Yeah, yeah, a sunburn's probably like hot stove when you

657
00:38:35,160 --> 00:38:36,120
Speaker 1: were a child.

658
00:38:36,200 --> 00:38:37,879
Speaker 2: I'm sure that kind of thing.

659
00:38:38,000 --> 00:38:42,480
Speaker 1: Yeah, I am sure that I burned myself earlier than this,

660
00:38:42,800 --> 00:38:46,840
Speaker 1: But seared into my memory is the summer of nineteen

661
00:38:46,880 --> 00:38:51,440
Speaker 1: ninety seven. I was running around my friend's yard, Kathleen.

662
00:38:51,560 --> 00:38:54,759
Speaker 1: She lived down the street from us in Kentucky, and

663
00:38:54,840 --> 00:38:55,959
Speaker 1: we had a bonfire going.

664
00:38:56,040 --> 00:38:56,920
Speaker 2: You know, it was classic.

665
00:38:57,000 --> 00:38:59,759
Speaker 1: Got a bunch of neighbors there, hot dogs, some'mores, the

666
00:38:59,760 --> 00:39:04,680
Speaker 1: whole the whole nine yards, and I see a marshmallow

667
00:39:04,800 --> 00:39:08,040
Speaker 1: on the ground near the fire. Never wanting a marshmallow

668
00:39:08,080 --> 00:39:10,920
Speaker 1: to go to waste, I'd pick it up. And it

669
00:39:10,960 --> 00:39:12,759
Speaker 1: takes a few seconds to register that what I was

670
00:39:12,800 --> 00:39:15,719
Speaker 1: holding was not, in fact a delicious marshmallow, but it

671
00:39:15,800 --> 00:39:18,520
Speaker 1: was a white, hot ember that had shot out of

672
00:39:18,520 --> 00:39:19,880
Speaker 1: the fire and into the grass.

673
00:39:19,880 --> 00:39:21,600
Speaker 2: It was looked just like a marshmallow.

674
00:39:22,880 --> 00:39:25,760
Speaker 1: And I had a rough time for a few days,

675
00:39:25,760 --> 00:39:28,920
Speaker 1: but ultimately it was a very minor burn, Like very minor, right.

676
00:39:28,960 --> 00:39:31,480
Speaker 1: I iced my fingers, I covered them an aloe, I

677
00:39:31,520 --> 00:39:36,560
Speaker 1: soaked them in water, cold water overnight, and I was fine.

678
00:39:36,600 --> 00:39:39,359
Speaker 1: This story is not unique, and I'm sure everyone has

679
00:39:39,360 --> 00:39:42,240
Speaker 1: a story just like this, or one much much more severe,

680
00:39:42,520 --> 00:39:47,120
Speaker 1: because I was extremely lucky. Hundreds of millions of people

681
00:39:47,160 --> 00:39:50,160
Speaker 1: are burned every year, which is I would guess a

682
00:39:50,200 --> 00:39:54,960
Speaker 1: conservative estimate, and nearly two hundred thousand lose their lives

683
00:39:55,000 --> 00:39:59,400
Speaker 1: around the globe every year due to burn injuries. Burns

684
00:39:59,520 --> 00:40:03,160
Speaker 1: are a routine feature of our lives as human beings,

685
00:40:03,840 --> 00:40:06,880
Speaker 1: and that's been the case for a very long time.

686
00:40:07,680 --> 00:40:10,319
Speaker 1: My story of picking up a white hot ember, not

687
00:40:10,400 --> 00:40:13,200
Speaker 1: only is that a common story today, it's been a

688
00:40:13,239 --> 00:40:17,399
Speaker 1: common story for hundreds of thousands of years.

689
00:40:17,400 --> 00:40:20,320
Speaker 2: At least at least Okay.

690
00:40:20,480 --> 00:40:23,360
Speaker 1: Many a paper that describes the history of burn treatments

691
00:40:23,440 --> 00:40:27,560
Speaker 1: starts off with some variation of ever since man discovered fire,

692
00:40:27,719 --> 00:40:31,359
Speaker 1: he's had to deal with burns. Yeah, So many of

693
00:40:31,360 --> 00:40:32,440
Speaker 1: them start just like that.

694
00:40:33,120 --> 00:40:35,479
Speaker 2: And it's the truth. It is absolutely the truth.

695
00:40:35,520 --> 00:40:38,120
Speaker 1: I mean, sure, there may have been some hot springs,

696
00:40:38,160 --> 00:40:43,799
Speaker 1: accidents or severe sunburns, lightning strikes, wildfires, maybe that caught

697
00:40:43,880 --> 00:40:47,920
Speaker 1: up with early humans. And in this we're no different

698
00:40:48,000 --> 00:40:50,480
Speaker 1: than the other animals that have suffered the same fate

699
00:40:50,640 --> 00:40:53,799
Speaker 1: for the four hundred million years that fire has been

700
00:40:53,920 --> 00:40:58,200
Speaker 1: possible on this planet. Whoa, it wasn't possible before then,

701
00:40:58,400 --> 00:41:01,640
Speaker 1: it was only one no oxygen or why oxygen and

702
00:41:01,840 --> 00:41:02,800
Speaker 1: land plants?

703
00:41:03,080 --> 00:41:06,239
Speaker 4: Okay, okay, yeah, fascinating and really fascinating.

704
00:41:06,320 --> 00:41:10,680
Speaker 1: Yeah, but it's the domestication of fire that sets us apart.

705
00:41:11,520 --> 00:41:16,239
Speaker 1: Controlling and creating fire making fire gave us warmth, It

706
00:41:16,320 --> 00:41:20,080
Speaker 1: protected us from predators. It provided a means of cooking,

707
00:41:20,280 --> 00:41:23,960
Speaker 1: giving us access to higher quality and more easily digestible foods,

708
00:41:24,200 --> 00:41:27,040
Speaker 1: which provided the energy needed to fuel bigger brains. It

709
00:41:27,120 --> 00:41:31,840
Speaker 1: helped us to make tools, weapons, and ceramics. Fire is

710
00:41:31,880 --> 00:41:36,560
Speaker 1: a fundamental essential step in hominine evolution, second in importance

711
00:41:36,680 --> 00:41:39,879
Speaker 1: only to language, which may have been encouraged by fire.

712
00:41:41,440 --> 00:41:45,120
Speaker 1: Without fire, we would not have developed into the humans

713
00:41:45,120 --> 00:41:46,480
Speaker 1: that we are today.

714
00:41:46,760 --> 00:41:47,160
Speaker 4: Wow.

715
00:41:47,320 --> 00:41:47,719
Speaker 2: At all.

716
00:41:48,200 --> 00:41:50,960
Speaker 1: Burns are a consequence of fire domestication.

717
00:41:52,120 --> 00:41:58,560
Speaker 4: For the large lot Prometheus. Just kidding, sorry, deep cut,

718
00:41:58,719 --> 00:41:59,439
Speaker 4: I like it.

719
00:42:02,360 --> 00:42:05,680
Speaker 1: But as as our homin and ancestors learned to use

720
00:42:05,719 --> 00:42:09,880
Speaker 1: fire first by controlling wildfires, then making fires from scratch,

721
00:42:10,440 --> 00:42:14,080
Speaker 1: they were sure to suffer burns. Just last year, a

722
00:42:14,080 --> 00:42:16,920
Speaker 1: paper came out that pushed back the estimate of fire

723
00:42:17,080 --> 00:42:21,520
Speaker 1: making to like actually originating fire to four hundred thousand years.

724
00:42:22,080 --> 00:42:22,719
Speaker 4: Wow.

725
00:42:22,800 --> 00:42:27,440
Speaker 1: Wow, So researchers found compelling evidence of fire making in

726
00:42:27,480 --> 00:42:31,600
Speaker 1: eastern England in Neanderthal sites. Before this, the earliest evidence

727
00:42:31,680 --> 00:42:34,680
Speaker 1: was like fifty thousand years, which didn't mean that people

728
00:42:34,760 --> 00:42:36,759
Speaker 1: thought it wasn't older, but like this was like.

729
00:42:36,760 --> 00:42:40,279
Speaker 4: That was the evidence they had. Yeakay wow.

730
00:42:40,640 --> 00:42:44,200
Speaker 2: But it's likely that our Haminin relatives had been controlling.

731
00:42:43,719 --> 00:42:46,759
Speaker 1: Fire for much longer than that, perhaps as far back

732
00:42:46,760 --> 00:42:49,319
Speaker 1: as like one and a half million years. They would

733
00:42:49,360 --> 00:42:51,520
Speaker 1: have had to in order to migrate to regions with

734
00:42:51,640 --> 00:42:53,320
Speaker 1: colder climates in the first place.

735
00:42:53,680 --> 00:42:55,560
Speaker 2: Okay, all this is to say.

736
00:42:55,400 --> 00:42:58,520
Speaker 1: This is my long, my long winded way of saying,

737
00:42:58,840 --> 00:43:01,960
Speaker 1: ever since man discovered fire, that he's had to deal

738
00:43:02,000 --> 00:43:05,200
Speaker 1: with burns. Right, We've been dealing with burns for hundreds

739
00:43:05,200 --> 00:43:07,719
Speaker 1: of thousands of years. In the quest to harness fire.

740
00:43:08,040 --> 00:43:09,719
Speaker 4: Okay, And throughout all.

741
00:43:09,640 --> 00:43:13,440
Speaker 1: That time, humans have attempted to treat the burns that

742
00:43:13,480 --> 00:43:16,000
Speaker 1: they experienced, and of course we can only guess that

743
00:43:16,080 --> 00:43:19,040
Speaker 1: the variety of remedies used before the invention of writing,

744
00:43:19,160 --> 00:43:21,360
Speaker 1: but it's likely they were plant based. Like there is

745
00:43:21,440 --> 00:43:25,120
Speaker 1: some evidence for that, including a ghost citation I couldn't

746
00:43:25,120 --> 00:43:27,239
Speaker 1: track down, so I'm not going to even reference it.

747
00:43:27,320 --> 00:43:31,600
Speaker 1: But our earliest confirmed insight into the treatment of burns

748
00:43:31,640 --> 00:43:35,000
Speaker 1: comes from the medical texts from ancient civilizations that were

749
00:43:35,080 --> 00:43:38,560
Speaker 1: used to encountering, you know, the Ebers Papyrus, the Hippocratic texts,

750
00:43:38,920 --> 00:43:42,319
Speaker 1: medical treatises from China, writings by Shushruda, and so on.

751
00:43:43,040 --> 00:43:46,000
Speaker 1: The majority of these treatments for burns were centered on

752
00:43:46,239 --> 00:43:48,960
Speaker 1: the application of like a goo or an ointment or

753
00:43:49,000 --> 00:43:52,360
Speaker 1: a cream to the burn itself, to the actual location

754
00:43:52,440 --> 00:43:55,000
Speaker 1: of the burn, with a little bit on pain relief

755
00:43:55,040 --> 00:43:58,680
Speaker 1: and maybe early like debreedment type of approaches.

756
00:43:59,160 --> 00:43:59,399
Speaker 4: Okay.

757
00:44:00,400 --> 00:44:03,840
Speaker 1: Ancient Egyptian physicians seem to favor recipes that included resin

758
00:44:03,920 --> 00:44:08,239
Speaker 1: and honey or oil soaked linen wraps, but milk also.

759
00:44:07,960 --> 00:44:10,800
Speaker 2: Made an appearance, specifically.

760
00:44:10,200 --> 00:44:13,520
Speaker 1: Goat milk or milk from women who had given birth

761
00:44:13,560 --> 00:44:17,440
Speaker 1: to a son. I don't know if that means like

762
00:44:17,520 --> 00:44:19,320
Speaker 1: specific right, only sons?

763
00:44:19,520 --> 00:44:22,080
Speaker 2: Only just one son? Is okay? Do you have sons?

764
00:44:22,120 --> 00:44:26,000
Speaker 2: And you know, I don't know other.

765
00:44:25,400 --> 00:44:27,560
Speaker 4: Remedies like you had a son before, but now you

766
00:44:27,640 --> 00:44:30,560
Speaker 4: just had a daughter, Like does that is that okay?

767
00:44:30,719 --> 00:44:32,319
Speaker 2: I don't Yeah, you'll have to ask.

768
00:44:32,440 --> 00:44:33,360
Speaker 4: We need detail.

769
00:44:33,880 --> 00:44:38,000
Speaker 1: The author of the texts, yeah, whose might not be reachable.

770
00:44:38,520 --> 00:44:41,520
Speaker 1: But the other other remedies called for a sequence of

771
00:44:41,520 --> 00:44:45,120
Speaker 1: different ointments to be applied, so like day one black mud,

772
00:44:45,200 --> 00:44:47,800
Speaker 1: day two, boiled cow dung, so on, and so forth.

773
00:44:48,440 --> 00:44:51,520
Speaker 1: Animal products feature prominently in many of the recipes from

774
00:44:51,560 --> 00:44:54,960
Speaker 1: ancient Egypt, Greece, Rome, and India, not just milk, like,

775
00:44:55,040 --> 00:44:59,600
Speaker 1: for instance, bowls fat boiled with papyrus is one treatment.

776
00:45:00,120 --> 00:45:03,720
Speaker 1: The Hippocratic texts recommend that for a burn, you should

777
00:45:03,840 --> 00:45:06,920
Speaker 1: quote take melted fat of old pigs, mix it with

778
00:45:07,000 --> 00:45:10,160
Speaker 1: resin and bitumen, spread it out over a cloth, warm

779
00:45:10,200 --> 00:45:12,080
Speaker 1: it at the fire, and apply it as a plaster

780
00:45:12,800 --> 00:45:13,280
Speaker 1: end quote.

781
00:45:13,320 --> 00:45:13,560
Speaker 4: Okay.

782
00:45:14,239 --> 00:45:18,640
Speaker 1: Dung was also a popular choice, specifically hare's dung, and

783
00:45:18,719 --> 00:45:19,760
Speaker 1: she goat dung.

784
00:45:20,400 --> 00:45:24,680
Speaker 4: She goat, she goat, she goat, she goat, she okay,

785
00:45:25,040 --> 00:45:26,560
Speaker 4: she goat, she goat. Okay.

786
00:45:27,840 --> 00:45:30,440
Speaker 1: Eggs here and there we're mentioned, you know, hard boiled

787
00:45:30,520 --> 00:45:34,040
Speaker 1: yolks mixed with rose oil as an example. There were

788
00:45:34,040 --> 00:45:36,840
Speaker 1: also many plant based remedies as well, So an ancient

789
00:45:36,920 --> 00:45:40,600
Speaker 1: China tea leaf extract was applied to burns. In ancient India,

790
00:45:40,640 --> 00:45:43,319
Speaker 1: you might get an ointment made from butter mixed with

791
00:45:43,360 --> 00:45:46,400
Speaker 1: the bark of a fig tree. To quote from a

792
00:45:46,480 --> 00:45:49,480
Speaker 1: nineteen seventy seven paper by Thompson on the history of

793
00:45:49,480 --> 00:45:53,040
Speaker 1: burn treatment, quote it would be tedious and not a

794
00:45:53,080 --> 00:45:56,440
Speaker 1: little revolting to detail all the hundreds of variations on

795
00:45:56,480 --> 00:46:02,399
Speaker 1: this theme and quote fair enough enough, But hopefully I've

796
00:46:02,400 --> 00:46:05,800
Speaker 1: given you a small taste of the variations on the theme.

797
00:46:06,320 --> 00:46:08,600
Speaker 1: And I think that there are two main takeaways with

798
00:46:08,840 --> 00:46:12,560
Speaker 1: this foray into ancient burned treatment. First, there are a

799
00:46:12,600 --> 00:46:15,880
Speaker 1: lot of treatments, which suggests, of course, that this was

800
00:46:15,880 --> 00:46:19,560
Speaker 1: a problem encountered frequently enough to keep trying new things.

801
00:46:19,480 --> 00:46:23,360
Speaker 4: Right and everywhere, So everyone's got their own version of etrans.

802
00:46:22,960 --> 00:46:23,720
Speaker 2: Got their own version.

803
00:46:23,880 --> 00:46:28,800
Speaker 1: And because there was no clearly single reliable remedy, people

804
00:46:28,800 --> 00:46:33,600
Speaker 1: were constantly inventing new recipes. And second, by and large

805
00:46:33,640 --> 00:46:38,160
Speaker 1: treatments were topical aimed at promoting healing and providing relief,

806
00:46:39,080 --> 00:46:42,319
Speaker 1: and when you think of these in comparison to the

807
00:46:42,360 --> 00:46:46,120
Speaker 1: full scale, multi specialty approach that we use today, it's

808
00:46:46,160 --> 00:46:48,239
Speaker 1: barely a drop in the bucket. I mean, they were

809
00:46:48,239 --> 00:46:50,040
Speaker 1: doing the best that they could with the knowledge that

810
00:46:50,080 --> 00:46:53,839
Speaker 1: they had, and as that knowledge grew, so did their approaches,

811
00:46:54,280 --> 00:46:58,080
Speaker 1: but not necessarily with success, just sort of there were

812
00:46:58,120 --> 00:47:03,759
Speaker 1: limitations for thousands of years. By the Middle Ages, the

813
00:47:03,840 --> 00:47:07,239
Speaker 1: list of options for treating a burn had grown tremendously,

814
00:47:07,520 --> 00:47:09,919
Speaker 1: so sure, still plenty of people were opting for raw

815
00:47:09,920 --> 00:47:14,120
Speaker 1: onion slices, which remained popular for long, like a really

816
00:47:14,160 --> 00:47:18,040
Speaker 1: long time actually, with Ambrose Paree employing onions and salt

817
00:47:18,040 --> 00:47:22,439
Speaker 1: allegedly effectively in the sixteenth century. But there was one

818
00:47:22,560 --> 00:47:25,400
Speaker 1: sizeable shift in focus over that time, and that was

819
00:47:25,400 --> 00:47:30,960
Speaker 1: sort of towards temperature. Physicians found that topical treatments that

820
00:47:31,040 --> 00:47:35,600
Speaker 1: invoked a cooling sensation or were themselves cooling like melted snow,

821
00:47:36,120 --> 00:47:39,680
Speaker 1: provided relief to those with burns, especially with superficial burns.

822
00:47:40,160 --> 00:47:43,760
Speaker 1: Others suggested that treating like with like, so applying heat

823
00:47:43,800 --> 00:47:47,200
Speaker 1: to the burn would yield more positive results, especially for

824
00:47:47,239 --> 00:47:48,360
Speaker 1: those with deep wounds.

825
00:47:49,280 --> 00:47:49,640
Speaker 4: Okay.

826
00:47:50,000 --> 00:47:51,520
Speaker 2: Yeah.

827
00:47:51,560 --> 00:47:56,120
Speaker 1: The first book dedicated to burns des Combustion of Us

828
00:47:56,440 --> 00:48:00,000
Speaker 1: was written by Fabricious hild in Us in sixteen o seven,

829
00:48:00,080 --> 00:48:02,879
Speaker 1: and it warned that if cooling were applied to burn skin,

830
00:48:03,040 --> 00:48:05,560
Speaker 1: it would quote harden like fat when it is cooled,

831
00:48:05,600 --> 00:48:07,280
Speaker 1: and thus shut in the moisture.

832
00:48:07,920 --> 00:48:08,960
Speaker 4: How fascinating.

833
00:48:09,120 --> 00:48:12,319
Speaker 1: Okay, keep things warm, keep things more flowing is kind

834
00:48:12,320 --> 00:48:15,920
Speaker 1: of like their idea. But this book also was among

835
00:48:15,960 --> 00:48:21,000
Speaker 1: the first to propose treatments for contractors. Okay, but which

836
00:48:21,200 --> 00:48:21,480
Speaker 1: did you?

837
00:48:21,600 --> 00:48:22,880
Speaker 2: Did we talk about contractors?

838
00:48:23,040 --> 00:48:24,879
Speaker 4: No, but I'll talk more about it next week.

839
00:48:24,960 --> 00:48:28,000
Speaker 1: Okay, Okay, so we'll get there. Stay tuned for explanation

840
00:48:28,040 --> 00:48:32,439
Speaker 1: on contractors. But this idea of treating burns with heat,

841
00:48:32,880 --> 00:48:35,080
Speaker 1: it was kind of like to keep things flowing, prevent

842
00:48:35,280 --> 00:48:41,040
Speaker 1: fluid accumulation and encouraging this like, yeah, just free flow, freelow.

843
00:48:41,320 --> 00:48:41,600
Speaker 4: Okay.

844
00:48:42,480 --> 00:48:45,799
Speaker 1: Shakespeare even makes a reference to heat treatments in King

845
00:48:45,880 --> 00:48:51,000
Speaker 1: John and Falsehood Falsehood cures as fire cools fire within

846
00:48:51,080 --> 00:48:54,439
Speaker 1: the scorched veins of one new burned. I'm really great

847
00:48:54,440 --> 00:48:54,880
Speaker 1: at reading.

848
00:48:54,880 --> 00:48:57,799
Speaker 4: Shakespeare nailed it erin.

849
00:48:57,960 --> 00:48:58,840
Speaker 2: I remember for.

850
00:48:58,760 --> 00:49:01,600
Speaker 1: A really long time we had to do iambic pentameter

851
00:49:02,000 --> 00:49:06,000
Speaker 1: or speak an iamic pentameter in like tenth grade English.

852
00:49:06,040 --> 00:49:08,839
Speaker 1: And I was just like, I don't get it, and

853
00:49:09,320 --> 00:49:11,080
Speaker 1: it's been a block for me ever since.

854
00:49:11,200 --> 00:49:12,480
Speaker 2: So there you go.

855
00:49:13,320 --> 00:49:15,880
Speaker 1: But this debate cold versus heat, it went on for

856
00:49:16,040 --> 00:49:19,120
Speaker 1: hundreds of years, and it wasn't the only debate. There

857
00:49:19,200 --> 00:49:22,800
Speaker 1: was an argument over whether open air exposure or covering

858
00:49:22,880 --> 00:49:25,680
Speaker 1: a burn and dressing soaked with various substances was the

859
00:49:25,680 --> 00:49:26,400
Speaker 1: better approach.

860
00:49:26,880 --> 00:49:28,240
Speaker 2: Then there was a discussion over.

861
00:49:28,120 --> 00:49:31,359
Speaker 1: Which substances and which dressings, you know, whiskey, linseed oil,

862
00:49:31,400 --> 00:49:34,960
Speaker 1: olive oil, alkaline, water, leads, silver, linen, wool, cotton. Then

863
00:49:35,000 --> 00:49:37,680
Speaker 1: you could argue over whether you should feed your patient

864
00:49:37,719 --> 00:49:40,480
Speaker 1: and provide plenty of fluids or do some blood letting

865
00:49:40,480 --> 00:49:41,080
Speaker 1: and purging.

866
00:49:41,440 --> 00:49:41,560
Speaker 4: Oo.

867
00:49:42,239 --> 00:49:45,920
Speaker 1: Everyone had their favorite approach, backed up by an anecdote,

868
00:49:45,960 --> 00:49:48,040
Speaker 1: a gut feeling, professional pride.

869
00:49:48,280 --> 00:49:48,879
Speaker 4: Take your pick.

870
00:49:50,000 --> 00:49:52,840
Speaker 1: This lack of consensus on how to best manage burns

871
00:49:53,040 --> 00:49:56,360
Speaker 1: it plagued doctors throughout the Renaissance and into the seventeen

872
00:49:56,440 --> 00:50:01,120
Speaker 1: hundreds and eighteen hundreds. Wars, industrial as accidents and train

873
00:50:01,239 --> 00:50:05,120
Speaker 1: crashes served as a painful reminder that in fact, medicine

874
00:50:05,280 --> 00:50:08,960
Speaker 1: had not substantially advanced since the time of Galen and Hippocrates.

875
00:50:09,040 --> 00:50:13,160
Speaker 1: When it came to burns, what was needed to make

876
00:50:13,239 --> 00:50:18,359
Speaker 1: any type of progress was consensus, first and foremost on

877
00:50:18,440 --> 00:50:20,839
Speaker 1: how to measure the severity of burns and the rate

878
00:50:20,920 --> 00:50:24,719
Speaker 1: of healing, because only then could you compare treatments or approaches.

879
00:50:24,920 --> 00:50:28,439
Speaker 1: Only then could you pick lead ointment versus whiskey, ice

880
00:50:28,520 --> 00:50:31,480
Speaker 1: water versus warming cloths. Only then could you have a

881
00:50:31,520 --> 00:50:35,120
Speaker 1: hope of saving someone's life. How do you get consensus,

882
00:50:35,960 --> 00:50:40,040
Speaker 1: You gather data. In the early nineteenth century, Guillam Duputrin

883
00:50:40,200 --> 00:50:43,600
Speaker 1: reviewed fifty cases of burn patients and followed their treatments

884
00:50:43,600 --> 00:50:46,440
Speaker 1: and outcomes, and with this information he put together a

885
00:50:46,480 --> 00:50:50,600
Speaker 1: classification system for burns organized by depth, similar to the

886
00:50:50,600 --> 00:50:53,360
Speaker 1: degree system that many people are familiar with today that

887
00:50:53,400 --> 00:50:56,600
Speaker 1: we just went through. His was not the first burn

888
00:50:56,719 --> 00:50:59,960
Speaker 1: grading system overall, but it was the first to relate

889
00:51:00,160 --> 00:51:06,200
Speaker 1: burned severity, depth, and total area with mortality. With this system,

890
00:51:06,400 --> 00:51:09,600
Speaker 1: doctors were not just treating burns, they were measuring them.

891
00:51:10,600 --> 00:51:14,239
Speaker 1: Establishing this baseline was super important to compare different approaches.

892
00:51:14,320 --> 00:51:17,200
Speaker 1: You know, again, turpentine versus lindseed oil might look the

893
00:51:17,239 --> 00:51:20,479
Speaker 1: same in a severely burned individual, but if you tried

894
00:51:20,520 --> 00:51:23,680
Speaker 1: them out on a more moderate or minor burn, you

895
00:51:23,800 --> 00:51:27,279
Speaker 1: might see a difference in healing, right. And it also

896
00:51:27,320 --> 00:51:29,960
Speaker 1: opened the door to other kinds of treatments entirely, not

897
00:51:30,120 --> 00:51:33,759
Speaker 1: just those based on topical ointments, such as surgical approaches

898
00:51:33,880 --> 00:51:37,799
Speaker 1: you know, skin debreaedment and skin grafts, supportive therapies in

899
00:51:37,840 --> 00:51:41,400
Speaker 1: the form of fluid replenishment pain relief. By the end

900
00:51:41,440 --> 00:51:44,719
Speaker 1: of the nineteenth century, many, though not all, of the

901
00:51:44,760 --> 00:51:48,640
Speaker 1: pieces were there to revolutionize burn care. They were just

902
00:51:48,640 --> 00:51:52,239
Speaker 1: sort of scattered all over the place waiting for someone

903
00:51:52,320 --> 00:51:56,120
Speaker 1: to put them together. Up to this point, so around

904
00:51:56,640 --> 00:52:00,680
Speaker 1: I'm going to say early nineteen hundreds, much all of

905
00:52:00,760 --> 00:52:05,120
Speaker 1: human history, burns had remained out of reach for physicians,

906
00:52:05,200 --> 00:52:08,120
Speaker 1: who could at most hope for the body's innate wound

907
00:52:08,160 --> 00:52:12,120
Speaker 1: healing methods to kick in as they the doctors provided

908
00:52:12,160 --> 00:52:16,799
Speaker 1: some modicum of pain relief. Frankly speaking, medicine had made

909
00:52:16,840 --> 00:52:20,440
Speaker 1: no progress in increasing survival or healing in brace.

910
00:52:20,920 --> 00:52:23,560
Speaker 4: That's so wild, even into the nineteen hundreds.

911
00:52:23,560 --> 00:52:26,799
Speaker 1: Into the nineteen hundreds, And if this story so far

912
00:52:27,000 --> 00:52:32,520
Speaker 1: feels unsatisfying or incomplete, then I've succeeded. That's what that

913
00:52:32,640 --> 00:52:35,000
Speaker 1: was my aim here, Like I wanted to spend this

914
00:52:35,080 --> 00:52:38,040
Speaker 1: episode with this, my part of this episode taking us

915
00:52:38,080 --> 00:52:42,800
Speaker 1: through the desperate centuries and millennia in which medicine remained

916
00:52:43,000 --> 00:52:46,040
Speaker 1: completely in the dark, so that next week when we

917
00:52:46,160 --> 00:52:48,560
Speaker 1: get to share the story of how that changed, when

918
00:52:48,600 --> 00:52:50,759
Speaker 1: we get to really take stock of how far we've

919
00:52:50,800 --> 00:52:54,560
Speaker 1: come and stand a little bit in awe of scientific progress,

920
00:52:54,840 --> 00:52:57,799
Speaker 1: what funding for research has helped us to achieve, and

921
00:52:57,960 --> 00:53:01,560
Speaker 1: how working across disciplines can make a huge difference, so

922
00:53:01,600 --> 00:53:04,319
Speaker 1: that when we get there we get to go, oh

923
00:53:04,360 --> 00:53:06,600
Speaker 1: my god, Oh my gosh.

924
00:53:06,600 --> 00:53:08,040
Speaker 4: We've actually come so far.

925
00:53:08,239 --> 00:53:09,200
Speaker 2: We actually have.

926
00:53:10,400 --> 00:53:12,000
Speaker 1: But that's where I'm gonna stop it here, so I

927
00:53:12,160 --> 00:53:14,480
Speaker 1: learn it there. For now we can fill you in

928
00:53:14,560 --> 00:53:15,880
Speaker 1: on where you can read more.

929
00:53:16,280 --> 00:53:17,000
Speaker 4: There's a lot.

930
00:53:17,320 --> 00:53:19,480
Speaker 2: There is a lot. There is a lot.

931
00:53:20,360 --> 00:53:23,239
Speaker 1: So I'm going to shout out just three sources in particular,

932
00:53:23,520 --> 00:53:27,080
Speaker 1: there's nineteen eighty six History of burn Care by Pinnagar

933
00:53:27,160 --> 00:53:31,160
Speaker 1: and Pinnagar, then nineteen seventy seven Thompson Historical Landmarks and

934
00:53:31,200 --> 00:53:33,640
Speaker 1: the Treatment of Burns, and then by van He from

935
00:53:33,640 --> 00:53:36,239
Speaker 1: two thousand and seven from Fat of Old pigs to

936
00:53:36,400 --> 00:53:40,440
Speaker 1: fenestrated skin grafts. Oh, I have lots more, lots more.

937
00:53:40,440 --> 00:53:45,239
Speaker 4: I can't wait. My absolute favorite paper that I read

938
00:53:45,280 --> 00:53:49,040
Speaker 4: for this and next week's episode is by Jeshki. I'm

939
00:53:49,040 --> 00:53:50,799
Speaker 4: so sorry if I said that wrong at all, from

940
00:53:50,840 --> 00:53:53,600
Speaker 4: Nature Reviews. Disease primers love it when there's one of

941
00:53:53,600 --> 00:53:56,799
Speaker 4: these from twenty twenty called burn injury and it was.

942
00:53:57,080 --> 00:53:59,600
Speaker 4: I mean, it's so good, it's so comprehensive. It has everything,

943
00:53:59,760 --> 00:54:01,680
Speaker 4: but you know that there's also more. So if you

944
00:54:01,760 --> 00:54:06,680
Speaker 4: want way more in depth information about the response and

945
00:54:06,800 --> 00:54:10,000
Speaker 4: the path of physiology and all of this biology, don't

946
00:54:10,040 --> 00:54:12,200
Speaker 4: you worry because we have the list of all of

947
00:54:12,239 --> 00:54:15,120
Speaker 4: our sources on our website this podcast will kill You

948
00:54:15,400 --> 00:54:17,240
Speaker 4: dot com under the episode STAB.

949
00:54:17,480 --> 00:54:17,879
Speaker 2: We do.

950
00:54:18,719 --> 00:54:21,440
Speaker 1: Thank you to Bloodmobile for providing the music for this

951
00:54:21,520 --> 00:54:23,200
Speaker 1: episode and all of our episodes.

952
00:54:23,520 --> 00:54:27,440
Speaker 4: Thank you to Leanna and Tom and Mark and Pete

953
00:54:27,520 --> 00:54:29,600
Speaker 4: and everyone at exactly right.

954
00:54:31,480 --> 00:54:33,640
Speaker 2: Yes, thank you, probly everyone.

955
00:54:33,880 --> 00:54:37,000
Speaker 1: Thank you to everyone, and thank you to you listeners

956
00:54:37,640 --> 00:54:41,759
Speaker 1: and watchers, anyone who participates in this podcast in some way.

957
00:54:41,800 --> 00:54:44,640
Speaker 1: We really do appreciate you tuning in and telling us

958
00:54:44,640 --> 00:54:48,760
Speaker 1: what you think and just sharing this. I don't know everything,

959
00:54:49,000 --> 00:54:51,160
Speaker 1: Thank you for being you you, and.

960
00:54:51,200 --> 00:54:53,600
Speaker 4: A special shout out as always to our patrons. Thank

961
00:54:53,640 --> 00:54:56,759
Speaker 4: you so much for your support over on Patreon. It

962
00:54:56,920 --> 00:54:59,640
Speaker 4: really does mean so much to us, truly, truly.

963
00:55:00,600 --> 00:55:03,840
Speaker 2: Until next time, wash your hands you feel the animals.

964
00:55:08,800 --> 00:55:23,760
Speaker 1: Um um