WEBVTT - Ep 212 Burns Part 1: The first million or so years 0:00:00.240 --> 0:00:04.640 This episode features descriptions that some listeners might find upsetting. 0:00:04.760 --> 0:00:10.560 Please listen with discretion. Case one, a lady aged twenty 0:00:10.640 --> 0:00:14.360 years in feeble health was extensively burned by her mosquito 0:00:14.440 --> 0:00:17.680 curtains and calico bed cover being set on fire after 0:00:17.760 --> 0:00:21.440 she had fallen asleep. The flames enveloped her head, neck, 0:00:21.520 --> 0:00:24.840 and arms, and were not extinguished for twenty or thirty seconds. 0:00:25.200 --> 0:00:28.840 Ardent spirits were first applied, then flaxied oil, and lastly 0:00:28.920 --> 0:00:32.920 a calcareous soap of the same oil and lime water laudanum, 0:00:32.960 --> 0:00:36.120 was administered freely, both externally and internally. 0:00:37.200 --> 0:00:37.760 Case two. 0:00:38.080 --> 0:00:41.200 The editor, while rescuing the patient described in case one, 0:00:41.479 --> 0:00:44.880 was severely burnt on both hands from compressing the burning 0:00:44.920 --> 0:00:48.000 clothes with his bare hands until the flames were extinguished. 0:00:48.440 --> 0:00:51.760 The cuticle exfoliated from nearly the whole right hand, and 0:00:51.800 --> 0:00:55.360 the cutis vera sloughed in seven places. The left hand 0:00:55.440 --> 0:00:58.720 suffered much worse. The whole cuticle was separated and much 0:00:58.760 --> 0:01:01.360 of it was rolled up, especially that which covered the 0:01:01.360 --> 0:01:03.760 space between the wrist and hollow of the hand and 0:01:03.840 --> 0:01:06.039 extended up the inner side of the thumb as far 0:01:06.080 --> 0:01:09.000 as the middle of the second phalanx between these limits 0:01:09.000 --> 0:01:11.400 and the metacarpal bone of the little finger on one 0:01:11.480 --> 0:01:14.319 side and the corresponding bone of the thumb on the other. 0:01:14.560 --> 0:01:18.479 The true skin was killed and turned black. Immediately after 0:01:18.520 --> 0:01:21.679 the accident. He immersed both hands in whiskey, then in 0:01:21.720 --> 0:01:24.800 a liniment of flaxeied oil and lime water, after which 0:01:24.840 --> 0:01:27.240 the affected parts were wrapped in rags dipped in a 0:01:27.240 --> 0:01:30.199 painter's mixture of the same kind of oil and white lead, 0:01:30.480 --> 0:01:31.200 ground together. 0:01:31.800 --> 0:01:32.559 In three days. 0:01:32.600 --> 0:01:36.160 This was replaced by carrot poultices with yeast and peruvian bark, 0:01:36.560 --> 0:01:39.800 the deeply burnt parts being stimulated at different times with 0:01:39.880 --> 0:01:44.560 tincture of mir oil of turpentine, ammoniated alcohol, and other excitents. 0:01:44.959 --> 0:01:48.040 After a few days, separation was established and the dead 0:01:48.080 --> 0:01:51.320 skin sloughed off. Had the case presented nothing but what 0:01:51.400 --> 0:01:53.600 has been stated, a report of it would have been 0:01:53.680 --> 0:01:58.000 of little interest. There resulted, however, from this local injury, 0:01:58.200 --> 0:02:02.560 a great constitutional disturbs, And to this I beg leave 0:02:02.680 --> 0:02:06.040 to direct the attention of the reader. Several causes seem 0:02:06.120 --> 0:02:08.960 to have conspired to depress the energy and disorder the 0:02:09.000 --> 0:02:13.640 sensibilities of his nervous system. Number one, the acute sensibility 0:02:13.639 --> 0:02:17.000 of the parts injured. The pain for several hours after 0:02:17.040 --> 0:02:21.160 the accident was excruciating, notwithstanding the liberal use of laudanum. 0:02:21.919 --> 0:02:25.560 Number two, the scene of concentrated horror under which the 0:02:25.639 --> 0:02:29.320 injury was inflicted contributed not a little to overthrow the 0:02:29.360 --> 0:02:33.000 powers of the nervous system. Number three. The immersion of 0:02:33.080 --> 0:02:36.800 both hands extensively denuded of cuticle in a liniment of 0:02:36.840 --> 0:02:39.680 oil and white lead, seems to me to have contributed 0:02:39.760 --> 0:02:42.240 largely to the same effect. Number four. 0:02:42.639 --> 0:02:42.839 Two. 0:02:43.160 --> 0:02:46.560 Three or four days after the accident, when febrile symptoms 0:02:46.600 --> 0:02:50.000 were developed, the patient, by his own advice, lost about 0:02:50.040 --> 0:02:53.400 ten ounces of blood. This was done under the apprehension 0:02:53.400 --> 0:02:56.280 that the fever and inflammation might run too high for 0:02:56.360 --> 0:03:01.080 healthy separation, but it manifestly did harm. It would be 0:03:01.120 --> 0:03:04.400 difficult to set forth the variety of physical and moral 0:03:04.440 --> 0:03:07.480 suffering which were attendant on the protracted state of nervous 0:03:07.600 --> 0:03:12.200 or constitutional irritation which these causes generated. A great variety 0:03:12.280 --> 0:03:15.800 of applications were advised and employed for this formidable affection, 0:03:16.080 --> 0:03:20.160 but with little good time only has been efficacious. But 0:03:20.320 --> 0:03:23.480 even a period of nearly two years has not entirely 0:03:23.560 --> 0:03:24.680 overcome the effect. 0:04:09.920 --> 0:04:12.400 I can't believe that they survived. 0:04:12.680 --> 0:04:17.000 Yeah, yes, I know, uh so that it is. 0:04:17.200 --> 0:04:17.520 It is. 0:04:18.839 --> 0:04:19.599 It's horrible. 0:04:19.920 --> 0:04:24.159 It's horrible, and it exhibits I think there are some 0:04:24.360 --> 0:04:26.800 it's There's an entire paper actually that I found this 0:04:26.920 --> 0:04:31.440 in that was like discussing, uh what this represents in 0:04:31.520 --> 0:04:34.440 terms of the history of burned treatment and where things stood. 0:04:34.520 --> 0:04:39.719 So the author of that was a medical doctor named 0:04:40.320 --> 0:04:44.080 Daniel Drake, who was actually one of like a famous 0:04:44.120 --> 0:04:47.880 doctor at the time, and he wrote this about his 0:04:47.880 --> 0:04:50.760 own experience, and he was the editor of a journal, 0:04:50.839 --> 0:04:53.040 and he was like, I need to tell everyone about this, 0:04:53.240 --> 0:04:55.839 like all of these and I think the realization that 0:04:55.880 --> 0:04:58.560 he came to was, like all of these treatments. We 0:04:58.600 --> 0:05:01.800 have so many different treatments and none seem to have 0:05:02.760 --> 0:05:04.960 a positive effect. 0:05:04.560 --> 0:05:07.960 Like, if anything, they might have made things worse. Yes. Yeah. 0:05:08.080 --> 0:05:10.960 The article, if you're interested, is titled History of two 0:05:11.040 --> 0:05:15.559 Cases of burn producing Serious Constitutional Irritations by Daniel Drake. 0:05:15.800 --> 0:05:18.840 It was published in eighteen thirty. And the paper that 0:05:19.000 --> 0:05:22.880 I found this in was called Daniel Drake's Account of 0:05:22.880 --> 0:05:27.040 his Own hand Burns by Eric Mooney that was published 0:05:27.040 --> 0:05:31.400 in like nineteen ninety eight. I think so yeah, truly 0:05:31.440 --> 0:05:35.960 awful stuff. But Hi, I'm erin Welsh. 0:05:35.360 --> 0:05:38.520 And I'm erin aman Upnike and this is this podcast 0:05:38.560 --> 0:05:39.080 will kill you. 0:05:39.880 --> 0:05:46.760 Welcome to Burns. Yeah, part one, Part one, two parts, 0:05:46.920 --> 0:05:49.800 because this is a big this is a big one. 0:05:50.040 --> 0:05:52.960 I mean each there are as I was working on 0:05:53.360 --> 0:05:56.880 the second episode and like the way that I split 0:05:56.960 --> 0:05:58.680 up the history for this is that I did, like 0:05:59.240 --> 0:06:03.640 most of history, most of history, stand right, most of everything, 0:06:03.880 --> 0:06:08.440 and then like the last eighty years basically, and like 0:06:09.279 --> 0:06:12.120 the various developments in the last eighty years, each one 0:06:12.120 --> 0:06:14.080 of those could be its own episode, not to mention 0:06:14.560 --> 0:06:19.080 burn Centers being its own episode, multidisciplinary like all these things. 0:06:19.120 --> 0:06:21.599 Anyway, I know, there's so there's so much and like 0:06:21.800 --> 0:06:25.760 even in the newer like the techniques and the newer 0:06:25.800 --> 0:06:28.000 technologies and things that we have, Like there's so much 0:06:28.080 --> 0:06:31.400 more detail that we listen. We've got a lot to 0:06:31.440 --> 0:06:35.239 cover though today and next week. Yes, today is Burns 0:06:35.480 --> 0:06:37.400 Part one. Should we tell people like kind of what 0:06:37.400 --> 0:06:40.320 we're covering today, what we're covering next week? Sure? Sure, 0:06:40.360 --> 0:06:43.960 let them know a little biting to I don't know, 0:06:44.000 --> 0:06:44.720 if you want to know. 0:06:45.040 --> 0:06:46.240 Here's a preview. 0:06:46.080 --> 0:06:48.640 Here's a preview. Today, we're going to talk about the 0:06:48.680 --> 0:06:53.440 biology of burns, what is happening in our bodies to 0:06:53.640 --> 0:06:56.880 our bodies when we suffer a burn, and then Aaron, 0:06:56.880 --> 0:06:59.000 you're going to walk us through, like you said, the 0:06:59.040 --> 0:07:03.600 most of humans's history with burns, and then next week 0:07:03.640 --> 0:07:07.080 we're going to pick up with more modern history and 0:07:07.400 --> 0:07:10.000 how we actually treat and deal with burns. Today. 0:07:10.720 --> 0:07:14.680 Yeah, yeah, there's a lot. There's a lot. There's a lot. 0:07:15.520 --> 0:07:17.520 And before we can do any. 0:07:17.320 --> 0:07:20.360 Of this, it is quarantine time any time. 0:07:20.440 --> 0:07:21.880 What are we drinking this week? 0:07:22.160 --> 0:07:27.080 We're drinking by degrees? By degrees it is technically still 0:07:27.120 --> 0:07:31.000 how we measure burns is ish okay, okay, ish, we'll 0:07:31.000 --> 0:07:33.600 get there, but kind of okay okay. It's still all 0:07:33.680 --> 0:07:34.560 over the literature. 0:07:35.280 --> 0:07:38.200 It is when when I was like, oh, degrees and 0:07:38.240 --> 0:07:39.920 you were like, no, we don't talk about that anymore, 0:07:40.400 --> 0:07:44.480 it's like it's fine, We're going to okay, okay, okay. Well, 0:07:44.480 --> 0:07:46.640 by degrees is the name of the quarantini, and the 0:07:46.720 --> 0:07:51.640 quarantini is a non alcoholic bee's knees basically, so some 0:07:51.800 --> 0:07:54.720 non alcoholic gin. Lots of different varieties out there, take 0:07:54.760 --> 0:07:56.600 your pick. Lemon juice honey. 0:07:57.800 --> 0:07:59.680 Yeah, just a great anti septic for. 0:08:00.360 --> 0:08:04.800 It is it is historically used as well as today. 0:08:04.560 --> 0:08:07.120 As well as today. Yep. Yeah, you can find the 0:08:07.120 --> 0:08:09.000 full recipe for that on our website. This podcast we 0:08:09.120 --> 0:08:12.080 kill You dot com and all of our socials This 0:08:12.120 --> 0:08:14.280 podcast will kill you most places. 0:08:14.560 --> 0:08:17.440 Just search this podcast kill you and you'll find us. 0:08:17.520 --> 0:08:20.520 You'll find us and if you if that searching lands 0:08:20.560 --> 0:08:24.920 you on our website. Other things that you can find include. 0:08:24.840 --> 0:08:29.920 Bookshop dot org, affiliate page, Goodreads list, links to music 0:08:29.960 --> 0:08:33.920 by Bloodmobile, a Furtian account, form of contact us form, 0:08:33.960 --> 0:08:39.160 links to merch Patreon, transcripts, et cetera. 0:08:39.600 --> 0:08:41.680 There's a lot there, isn't there a lot there? Yeah? 0:08:41.760 --> 0:08:44.800 This podcast will kill You dot com. Thank you for 0:08:45.000 --> 0:08:48.600 rating and reviewing and subscribing to this podcast on your 0:08:48.760 --> 0:08:52.880 favorite podcasterer and or on YouTube hello or on YouTube 0:08:53.000 --> 0:08:59.280 on YouTube satchers Yep. The end? Shall we have got 0:08:59.280 --> 0:09:01.160 a lot to cover? Yeah, let's get into it. 0:09:01.440 --> 0:09:16.040 Yeah, Okay. 0:09:16.120 --> 0:09:19.880 For today's episode, I wanted to take us through how 0:09:20.040 --> 0:09:26.240 exactly we classify burns in medicine and what this classification 0:09:26.480 --> 0:09:30.240 means for how our body responds to a burn injury. 0:09:31.320 --> 0:09:35.440 Because although a burn is a type of trauma to 0:09:35.520 --> 0:09:37.520 our skin. And there's a lot of other traumas that 0:09:37.559 --> 0:09:40.640 we could get to our skin right scrapes, cuts, et cetera. 0:09:41.480 --> 0:09:46.160 Our body's response to burn injuries is actually fairly unique. 0:09:46.240 --> 0:09:50.600 Even though it is still the same inflammatory response, it 0:09:50.640 --> 0:09:54.240 is also unique. It's kind of interesting, huh. Okay, And 0:09:54.280 --> 0:09:56.439 what I really think and what I took away from 0:09:56.760 --> 0:09:59.800 digging really deep into this is that what burns really 0:10:00.160 --> 0:10:06.280 show us is just how incredible and how important of 0:10:06.320 --> 0:10:11.120 an organ our skin is, true, and how severe damage 0:10:11.200 --> 0:10:17.599 to that skin has life threatening consequences and long lasting consequences. 0:10:18.600 --> 0:10:21.080 So I'm gonna walk us through the types of burns 0:10:21.160 --> 0:10:24.440 that we can see, burn severity and how we actually 0:10:24.480 --> 0:10:28.640 determine severe versus minor or major versus minor burns, and 0:10:28.760 --> 0:10:31.360 what is happening to our whole entire body as a 0:10:31.400 --> 0:10:34.640 result of a burn injury, and then save the like, 0:10:34.720 --> 0:10:37.800 what do we do about these burns for next week's episode? 0:10:37.880 --> 0:10:39.120 Okay, sounds good. 0:10:39.679 --> 0:10:42.000 So a lot of different things can actually cause the 0:10:42.040 --> 0:10:44.000 type of damage that we would refer to as a burn, 0:10:44.320 --> 0:10:47.080 and the source of a burn really does matter a 0:10:47.120 --> 0:10:50.199 lot because the pattern of injury that you see can 0:10:50.240 --> 0:10:53.880 be really different depending on the source of that burn. So, 0:10:54.000 --> 0:10:57.960 as an example, electrical burns, which we've talked about in 0:10:58.000 --> 0:11:00.480 our Lightning episode, we talked a lot about electric burns. 0:11:01.000 --> 0:11:04.840 They can cause really severe deep damage to our internal 0:11:04.880 --> 0:11:09.400 structures with very minimal visible surface injury. But those are 0:11:09.440 --> 0:11:12.720 still going to be burn injuries, but deeper. A burn 0:11:12.800 --> 0:11:16.760 from a chemical, like say a strong acid, might cause 0:11:17.040 --> 0:11:20.640 coagulation necrosis, so your blood vessels are all clotting and 0:11:20.679 --> 0:11:23.640 all your blood is clotting, while a burn from an 0:11:23.679 --> 0:11:29.560 alkaline chemical might actually liquefy your tissues completely. WHOA, Yeah, 0:11:29.840 --> 0:11:32.640 So burns from chemicals are going to act a little 0:11:32.679 --> 0:11:36.760 bit differently, and they might differ in how we need 0:11:36.800 --> 0:11:39.400 to treat them. You can think of frostbite as a 0:11:39.440 --> 0:11:43.120 type of cold burn, and those need to be rewarmed 0:11:43.280 --> 0:11:48.400 and watched. See our two episodes on cold and cold injuries. 0:11:48.920 --> 0:11:51.360 Hypotheth that what we call them, I think, So, yeah, 0:11:51.640 --> 0:11:54.640 I was like, what did we call this? Whereas a 0:11:54.760 --> 0:11:57.480 heat burn is going to be different, and so most 0:11:57.520 --> 0:11:59.840 of what I'm going to talk about, though it pro 0:12:00.000 --> 0:12:04.600 probaly applies to most all burns. They're really I'm talking 0:12:04.600 --> 0:12:07.440 mostly about thermal burns. So burns as a result of 0:12:07.480 --> 0:12:08.319 heat injury. 0:12:08.520 --> 0:12:10.280 Did you mention radiation burns? 0:12:10.640 --> 0:12:12.880 I didn't, But those are yet another type of ok 0:12:13.080 --> 0:12:14.959 that might be more like more similar to maybe a 0:12:15.040 --> 0:12:19.520 chemical burn, or or somewhere in between a little bit different. Okay, Yeah, 0:12:19.600 --> 0:12:21.600 So yeah, there's a lot of different kinds of burns, 0:12:21.800 --> 0:12:25.200 but so I'm focusing mostly on thermal burns. These are 0:12:25.240 --> 0:12:28.480 the most common types of burns worldwide. And these can 0:12:28.520 --> 0:12:32.320 be flame burns so from a fire, as well as 0:12:32.400 --> 0:12:35.600 skaled type burns, so think hot liquid and those sorts 0:12:35.600 --> 0:12:38.000 of things, and those are the two most common types 0:12:38.040 --> 0:12:42.240 of burns worldwide. Once we know what caused the burn, 0:12:42.880 --> 0:12:44.960 then the next thing that we need to know is 0:12:45.040 --> 0:12:48.640 the severity of that burn. And the severity is a 0:12:48.679 --> 0:12:52.400 combination of the body surface area that's affected, so how 0:12:52.440 --> 0:12:55.360 much of your body got burned and the depth of 0:12:55.400 --> 0:12:58.000 that burn. And then of course we also need to 0:12:58.000 --> 0:13:00.800 look for whether there was any additional injury or traumas, 0:13:00.920 --> 0:13:03.199 especially in the case of something like a flame burn, 0:13:03.600 --> 0:13:07.120 you might have inhalational injuries or a chemical burn, you 0:13:07.200 --> 0:13:10.760 might have other toxin exposures. You could even have like 0:13:10.840 --> 0:13:14.920 blunt trauma injuries, right, depending on how the burn was sustained. 0:13:15.920 --> 0:13:18.679 And then there's patient factors that might make someone more 0:13:18.760 --> 0:13:22.840 susceptible to severe outcomes from a less severe burn, like 0:13:22.960 --> 0:13:26.280 say a very young child or a very old person, 0:13:27.480 --> 0:13:27.959 et cetera. 0:13:28.280 --> 0:13:29.839 Underlying health issues. 0:13:29.520 --> 0:13:33.640 So exactly diabetes that might interfere with wound healing things 0:13:33.679 --> 0:13:36.920 like that. So let's go through how we kind of 0:13:36.960 --> 0:13:40.079 get to the severity we already mentioned. And a lot 0:13:40.120 --> 0:13:42.400 of us have heard of the idea of a first, second, 0:13:42.400 --> 0:13:45.480 and third degree burn, and that is like classically how 0:13:45.520 --> 0:13:49.400 we classify burns. And I say that we don't quite 0:13:49.520 --> 0:13:51.599 use it as much today because we now get a 0:13:51.640 --> 0:13:54.360 little bit more specific based on the thickness or the 0:13:54.400 --> 0:13:58.400 depth of the burn in our skin, but colloquially we 0:13:58.480 --> 0:14:00.640 still use for second, third degree. So we'll just go 0:14:00.679 --> 0:14:03.800 a little bit more detailed, Okay, And first I want 0:14:03.840 --> 0:14:05.960 to take us through our skin. And we've talked about 0:14:05.960 --> 0:14:08.760 our skin on a number of episodes before, including like 0:14:08.840 --> 0:14:13.760 our retinoid's episodes. Yes, but our skin is an incredibly 0:14:13.800 --> 0:14:17.840 important organ, and it's a layered organ, the largest organ 0:14:17.920 --> 0:14:20.320 in our whole entire body, and it's made up of 0:14:20.400 --> 0:14:23.320 several different layers. The top layer, the outside what you're 0:14:23.360 --> 0:14:26.560 touching and what you see, is called the epidermis. And 0:14:26.600 --> 0:14:31.280 this is very very thin layer, and it differs in 0:14:31.360 --> 0:14:33.680 thickness depending on where on your body. So it's a 0:14:33.680 --> 0:14:36.040 lot thicker in places like the soles of our feet 0:14:36.240 --> 0:14:39.400 and our back, and it's a lot thinner in places 0:14:39.400 --> 0:14:41.720 like say, your eyes or you know, the backs of 0:14:41.760 --> 0:14:45.680 your hands or things like that. Underneath the epidermis is 0:14:45.760 --> 0:14:49.200 the dermis, and this is the layer that has a 0:14:49.240 --> 0:14:52.080 lot of structure to it. It's a little bit thicker still, 0:14:52.120 --> 0:14:54.720 only on the order of millimeters, but the dermis is 0:14:54.760 --> 0:14:57.440 underneath that. And then underneath the dermis is a layer 0:14:57.520 --> 0:15:00.800 of subcutaneous tissue, so this is like fa and things 0:15:00.840 --> 0:15:03.040 like that. And then below that is when we get 0:15:03.040 --> 0:15:07.920 to muscles and bones. Okay, So the degree of a 0:15:07.920 --> 0:15:12.480 burn depends on how far through that skin layers. Through 0:15:12.480 --> 0:15:15.920 those layers of skin, we actually get. A superficial burn, 0:15:16.000 --> 0:15:18.680 or a first degree burn, is one that burns only 0:15:18.920 --> 0:15:23.120 the uppermost layer, the epidermis. This you can think of 0:15:23.200 --> 0:15:28.280 as a bad sunburn, right, okay, blister, no, not a 0:15:28.280 --> 0:15:30.800 blister type of thing. Okay, So a bad sunburn. Your 0:15:30.800 --> 0:15:35.400 skin is red, angry, and it's painful, but beyond that, 0:15:35.720 --> 0:15:39.520 it's generally does not blister, okay, And it does not 0:15:40.120 --> 0:15:43.840 need any kind of specialized treatment, and you're not going 0:15:43.880 --> 0:15:47.160 to get a scar or any residual defects or anything. 0:15:47.640 --> 0:15:50.720 These type of superficial or first degree burns generally heal 0:15:50.760 --> 0:15:53.880 within a week or so, but no blistering. That is 0:15:53.880 --> 0:15:57.000 when we get into second degree burns, okay. And what 0:15:57.200 --> 0:15:59.520 used to be just lumped as second degree burns is 0:15:59.560 --> 0:16:04.040 now into two different types. So the first is a 0:16:04.080 --> 0:16:07.920 superficial partial thickness burn. This is the one erin that 0:16:07.960 --> 0:16:10.920 will blister, okay. And so this is a burn that 0:16:10.960 --> 0:16:14.800 burns completely through the epidermis and then into the first 0:16:14.840 --> 0:16:18.200 part of the dermis, but does not go like deeply 0:16:18.360 --> 0:16:21.440 into the dermis, okay. And so this is something that 0:16:21.480 --> 0:16:24.360 you might get if you burn yourself on a pan 0:16:24.600 --> 0:16:28.280 or the oven or like really hot you know, liquid 0:16:28.280 --> 0:16:31.320 that spills on you or something. These burns are very 0:16:31.440 --> 0:16:35.400 very painful. They might be red, they might be blistered, 0:16:35.480 --> 0:16:38.640 they might be very wet and kind of weep and 0:16:39.120 --> 0:16:42.680 you have to take care of these wounds. But you're 0:16:42.720 --> 0:16:46.280 not going to need surgery to fix these wounds. Ye, 0:16:46.480 --> 0:16:49.760 because the layer of the dermis has not been completely 0:16:49.760 --> 0:16:52.000 burned through, and so your skin is going to be 0:16:52.040 --> 0:16:54.720 able to it's called re epithelialize. It's going to be 0:16:54.760 --> 0:16:57.400 able to make new skin to cover up this wound 0:16:57.680 --> 0:17:01.560 without a lot of additional help. Most of the time, 0:17:01.600 --> 0:17:04.160 you're not going to get a scar from these types 0:17:04.200 --> 0:17:07.399 of burns. If you do, it might just be pigmentation 0:17:07.600 --> 0:17:11.320 changes because of losses of like the melanocytes that are 0:17:11.359 --> 0:17:16.320 in more of the epidermal layer. Okay, okay. Next is 0:17:16.480 --> 0:17:19.800 again within this considered second degree burn is called a 0:17:19.920 --> 0:17:25.400 deep partial thickness burn, and the deep partial thickness burns 0:17:25.440 --> 0:17:27.960 actually tend to hurt a little bit less than the 0:17:28.000 --> 0:17:31.639 first two, and that's because they burn deeply enough that 0:17:31.680 --> 0:17:37.200 they're actually destroying our pain receptors in our skin. These 0:17:37.240 --> 0:17:40.560 burns tend to be a lot drier than a superficial 0:17:40.600 --> 0:17:44.320 partial thickness burn, so you don't necessarily have blisters, or 0:17:44.320 --> 0:17:46.960 if you do, they're just not quite as wet as 0:17:46.960 --> 0:17:51.639 a superficial burn. They often look either very dark pink 0:17:51.960 --> 0:17:55.520 or sometimes almost white, where they just look like it 0:17:55.560 --> 0:17:57.480 doesn't really look like there's anything there. It's just like 0:17:57.520 --> 0:18:01.959 completely white, regardless of your skin color. And they're almost 0:18:02.000 --> 0:18:05.960 kind of pearly looking, rather like or like waxy looking 0:18:06.000 --> 0:18:11.000 a little bit. These generally do need surgery very often. 0:18:11.160 --> 0:18:13.720 These are deep enough that the skin is not going 0:18:13.720 --> 0:18:16.080 to be able to completely heal over this without some 0:18:16.240 --> 0:18:18.639 kind of surgical intervention, and that means that they're at 0:18:18.720 --> 0:18:22.800 much higher risk of some kind of scar formation. There's 0:18:22.840 --> 0:18:26.640 not a huge leap then, from a deep partial thickness 0:18:26.760 --> 0:18:29.760 to a full thickness burn or a third degree burn, 0:18:30.440 --> 0:18:33.639 and this is one that extends completely through the dermis, 0:18:33.680 --> 0:18:37.399 so the epidermal layer and the dermis are completely burned 0:18:37.440 --> 0:18:42.199 through all the way down into that subcutaneous tissue. In 0:18:42.280 --> 0:18:44.840 some cases it a burn can extend all the way 0:18:44.880 --> 0:18:46.960 down into our deeper tissues, which is sometimes called a 0:18:47.000 --> 0:18:49.560 fourth degree burn, or sometimes it's just lumped under this 0:18:49.600 --> 0:18:51.960 third degree, and that means that there's damage to the 0:18:52.040 --> 0:18:54.440 muscles or the bones, depending on how deep it goes. 0:18:55.720 --> 0:18:59.720 These full thickness burns are not painful because all of 0:18:59.760 --> 0:19:03.960 our nerve endings have been destroyed. And I asked risk 0:19:04.040 --> 0:19:08.560 that erin, Yeah, because that just means that at the 0:19:08.600 --> 0:19:12.760 time of the injury, that specific area that sustained a 0:19:12.800 --> 0:19:15.480 full thickness burn, if you touch it, you will not 0:19:15.600 --> 0:19:18.080 feel that the way that if you touch a burn blister, 0:19:18.160 --> 0:19:21.159 it really hurts. But that doesn't mean that they're not 0:19:21.240 --> 0:19:23.560 painful in the long run, or. 0:19:24.000 --> 0:19:28.639 That you only have a third degree burn and that 0:19:28.720 --> 0:19:31.439 other parts of your body are not experiencing first and 0:19:31.520 --> 0:19:32.159 second degrees. 0:19:32.280 --> 0:19:36.639 Yeah, exactly, exactly, very very often, almost always, if someone 0:19:36.720 --> 0:19:40.840 has severe burns, not every part of the burn is 0:19:40.960 --> 0:19:43.960 the same degree. Right, You have a mix of burns 0:19:44.000 --> 0:19:47.720 of varying degrees or varying thicknesses on different parts of 0:19:47.720 --> 0:19:49.919 that burn, which means, yes, things are likely going to 0:19:49.960 --> 0:19:52.359 be very painful, even if parts of those burns have 0:19:52.680 --> 0:19:54.760 completely destroyed the nerve endings and everything. 0:19:55.240 --> 0:19:58.359 Okay, So I have a question about like surface area 0:19:58.480 --> 0:20:02.320 and degrees. Yeah, because it's a big like we just 0:20:02.359 --> 0:20:06.520 talked about, there's a mixture of, yes, different degrees or 0:20:06.560 --> 0:20:09.600 severities of the burn in different parts of your body. 0:20:09.640 --> 0:20:12.200 So how is that calculated? How does that get incorporated 0:20:12.200 --> 0:20:13.760 into total body surface area? 0:20:13.920 --> 0:20:16.080 That's a great question. So total body surface area is 0:20:16.119 --> 0:20:18.040 the next thing that we have to look at. So 0:20:18.119 --> 0:20:20.600 once we know, and I say it as if these 0:20:20.600 --> 0:20:23.280 are separate things, they're really not. Like we're looking at 0:20:23.320 --> 0:20:25.080 all of this at the same time. If someone comes 0:20:25.119 --> 0:20:28.200 into a hospital with a burn, but total body surface 0:20:28.240 --> 0:20:31.680 area is how much of your body surface is covered 0:20:31.680 --> 0:20:34.520 by this burn, regardless of the degree, So you don't 0:20:34.560 --> 0:20:36.760 need to separate it by oh, you know this much 0:20:36.800 --> 0:20:39.400 surface area was a first degree versus second versus third. 0:20:39.680 --> 0:20:41.880 Here we're just looking at how much of your skin 0:20:41.960 --> 0:20:46.160 got burned. And this is actually the most important part 0:20:46.560 --> 0:20:51.479 in looking at mortality is surface area. So how we 0:20:51.520 --> 0:20:54.879 classify something as a so called minor burn, This is 0:20:54.920 --> 0:20:57.960 actually a lot more. I won't even say contentious in 0:20:58.000 --> 0:20:59.720 the literature because I don't think anyone's fighting over it. 0:20:59.760 --> 0:21:03.480 But it really depends on the situation whether something is 0:21:03.520 --> 0:21:08.040 considered a severe or a minor burn. In general, most 0:21:08.080 --> 0:21:11.760 people don't require hospitalization for burns that cover less than 0:21:11.760 --> 0:21:14.320 ten percent of their body surface. But that's a huge 0:21:14.359 --> 0:21:17.399 generalization because a burn on the face, a burn on 0:21:17.400 --> 0:21:20.280 the groin, a burn on the hands, even if it's 0:21:20.320 --> 0:21:24.399 significantly less than ten percent, might still require hospitalization as 0:21:24.480 --> 0:21:26.919 well as depending on the thickness or the degree of 0:21:26.920 --> 0:21:27.399 that burn. 0:21:27.960 --> 0:21:30.240 Or other injuries sustained or types of exact type of 0:21:30.320 --> 0:21:31.160 burn that it is. 0:21:31.200 --> 0:21:35.440 Yeah, exactly, So that is really an over generalization. Most 0:21:35.480 --> 0:21:37.960 of the time, if we're thinking about what is going 0:21:38.000 --> 0:21:42.760 to cause more likely to cause systemic symptoms, then we're 0:21:42.800 --> 0:21:45.480 looking at burns that are maybe more than fifteen or 0:21:45.520 --> 0:21:49.800 twenty percent of your body surface area, depending on the 0:21:49.840 --> 0:21:52.520 person and their age and like how big they are, right, 0:21:52.520 --> 0:21:55.080 Like a kid might have a less body surface area 0:21:55.119 --> 0:21:58.119 to cause severe effects. But all of that is really 0:21:58.200 --> 0:22:01.200 like it so depends on the person, right, So there's 0:22:01.240 --> 0:22:03.240 not like a clear cut definition of like this is 0:22:03.520 --> 0:22:06.359 a major burn versus a minor burn, or a severe 0:22:06.400 --> 0:22:09.919 burn versus a non severe burn. But calculating that body 0:22:09.920 --> 0:22:13.960 surface area is a really important part of the care 0:22:14.119 --> 0:22:17.479 of a person and understanding how severe their outcomes are 0:22:17.480 --> 0:22:19.479 going to be. And the way that we do that 0:22:19.880 --> 0:22:21.760 is there's a couple different ways. There's a fast and 0:22:21.800 --> 0:22:24.560 ready way kind of that is called the rule of nines, 0:22:25.359 --> 0:22:27.520 and that is that we just split up an adult 0:22:27.640 --> 0:22:31.320 body area into areas that are about nine percent. So 0:22:31.359 --> 0:22:33.760 our head is about nine percent of our body surface. 0:22:34.440 --> 0:22:36.760 Our chest, the front side of our chest, and the 0:22:36.760 --> 0:22:39.439 front side of our abdomen are each nine percent, and 0:22:39.480 --> 0:22:42.120 same thing with the back, so that's like eighteen and eighteen, 0:22:42.920 --> 0:22:44.960 and then the front of our legs are nine percent, 0:22:45.000 --> 0:22:46.560 the back of our legs are nine percent, on our 0:22:46.560 --> 0:22:48.760 two arms put together are nine percent, and then an 0:22:48.800 --> 0:22:50.400 extra one percent for the genitals. 0:22:50.760 --> 0:22:51.119 Okay. 0:22:51.720 --> 0:22:54.399 The other way that you can do it though, because 0:22:54.400 --> 0:22:58.480 that calculation does not hold true for children because children 0:22:58.560 --> 0:23:03.080 their head is a magnificantly larger body surface than especially 0:23:03.160 --> 0:23:06.399 for babies, So there's different calculations that we use for 0:23:06.560 --> 0:23:10.800