Tales From The E.R. #1: It Burns

The Emergency Department of any hospital lends itself to both funny and tragic incidents on a daily, sometimes hourly, basis. Medical staffs of the E.R. never know what will happen next and must be prepared for whatever will arrive.

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As an RN, and having spent 13 years in a Southern California Emergency Department, better known as the E.R., I treated an array of injuries: minor paper cuts, full trauma, stabbings, gun shot wounds – it’s a long list.

I stood in the Emergency Room lobby, it was morning and a preschool aged child was walking toward the front door of the emergency department with her parents. She had a dress on and as she approached I noticed her gait was abnormal. She waddled from side to side and it was apparent that walking caused her great discomfort. As soon as they reached the door, I picked the child up and, along with her parents, took her to be examined. As I lifted her dress to begin the assessment my eyes were immediately met with blistering burns to the lower portion of her abdomen and genital area. Some of the huge sagging blisters were still intact, while other areas of her skin had sloughed off. Upon questioning her parents, the medical staff was informed that this accident had occurred two days prior and that no medical care had been sought until this time. The culprit was a hot “Cup O’ Noodles” which this little one had tipped over and spilled onto her lap.

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Why did the parents not attend to their child immediately? Why were no First Aid measures taken to stop the burning damage to her skin? There is no logical answer. Even the slightest of burns hurts. So, if you can imagine blistering 2nd degree burns to your abdomen and genital area for two days you will appreciate the questioning of the E.R. staff towards the conduct of the parents. This child was immediately attended to and cool moist compresses were applied to the effected area. Arrangements were simultaneously made to have her transferred to a nearby hospital with a burn unit for further care. Needless to say, a CPS report was filed on behalf of this child and had she received immediate First Aid she may have escaped a trip to the burn unit. 

Immediate care of burns can significantly reduce further damage to skin. For minor burns, the following is recommended:

  • Cool the burn by running the effected area under cool (not cold) running water for approximately 10-15 minutes or place a clean, damp, cool compress to the area
  • Remove rings, bracelets, watches or other tight objects from the burned area
  • Keep all blisters intact as this will help prevent infection – just leave them alone!
  • Apply a topical burn gel or Aloe Vera gel
  • Take an over-the-counter pain reliever such as Ibuprofen or Tylenol

For major burns:

  • Call 911 or seek medical attention immediately
  • Protect the injured victim from further harm
  • Remove any restrictive items from around the burned area
  • Elevate the burned area
  • Cover the burned area with cool, moist, bandages
  • Begin CPR if needed

Remember: minor burns can and should be cared for at home while major burns should never be ignored. Skin is the body's largest organ and when damaged it can no longer function effectively to fight infection. Seek medical attention if you're unsure of how serious the injury is. Have a First Aid Kit on hand that is stocked with the ability to handle the unexpected until medical help arrives or you can make it to the hospital because you are always going to be your own Medic until then.

- JoLynn Udy, RN, Medical Director

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