Burns

Lecturer: Snow Gryphon, Dunvegan Physician
January, 2015
Basic Course, no prerequisites

Burns

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At Physician’s Academy we make no effort to train you for any real life medical situations. We offer general information on medical topics, by the book and others, designed to better prepare you to role play as a Second Life Gorean physician. I make no claim to authoritative interpretation of the books by John Norman; nor am I trained in medicine in real life.  These lectures are offered as a resource to role play only.
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In today’s lecture we will discuss Burns, what they are and causes, classifications and treatments.  Then we will have a short demo RP.

I gratefully acknowledge the assistance of my FC Lady El Macleod and kisu, our first girl, in the development and presentation of this lecture and demo.

Let us begin.

1.    What is a Burn?  (a Gorean Context)

1.1.    A burn is an injury to flesh or skin caused by the sun, heat, cold, chemicals, or friction.  Contact with any source of heat can cause a burn or scald injury. On Earth, burns can also include electrical and radiation burns.

1.2.     Heat burns are caused by fire, steam, hot objects, or hot liquids. Scald burns from hot liquids are the most common burns to children and older adults.

1.3.     Cold temperature burns are caused by skin exposure to wet, windy, or cold conditions.  They are treated somewhat differently and will not be addressed further today.

1.4.     Chemical burns are caused by contact with chemicals in a liquid, solid, or gas form. Natural foods such as chili peppers can cause a burning sensation.

1.5.     Friction burns are caused by contact with any hard surface such as roads, carpets, or floor surfaces.

1.6.    Breathing in hot air or gases can injure your lungs, throat and nasal passages.

2.    Question: What are Some Examples of Burns on Gor?

2.1.    A friction burn on a slave's butt from being dragged across a rough floor by her hair, or by some bindings.

2.2.    A scald can result from spilling a pot of boiling bosk stew on your hands.

2.3.    Burns are a particular hazard for blacksmiths as they can easily burn their hands and arms and inhale hot air and toxic gases.

3.    Classification of Burns & Their Symptoms

3.1.    Burns injure the skin layers and can also injure other parts of the body, such as muscles, blood vessels, nerves, lungs, and eyes. Burns are classified as first, second, third, or fourth degree, depending on how many layers of skin and tissue are burned. The deeper the burn and the larger the burned area, the more serious is the burn.

I will be presenting photos of burns.  Please avert your eyes if you are feeling nauseous looking at them.

    [photo 1: skin layers]
   
3.2.    A first degree burn is a reddish burn of the top layer of skin (epidermis), such as mild sunburn. The burned skin may hurt and be slightly swollen, and it may make a person feel slightly feverish.  A first degree burns usually heals on its own. They do not usually cause blisters or scars.

      [photo 2: first degree burn]
     
3.3.    There are two types of second degree burns, defined by their depth: Superficial partial-thickness burns injure the first and second layers of skin and are often caused by hot water or hot objects. The skin around the burn turns white when pressed, and returns to red when released. The burn is moist and painful with blistering and swelling.   

 Deep partial-thickness burns injure deeper skin layers and are often caused by contact with hot oil, grease, or soup. The skin looks spotted, remains white when pressed, may appear waxy in some areas, and is dry or slightly moist. Infection is possible with these burns. Treatment varies somewhat for a second degree burn depending on its size, depth, and a person's age and overall health.

   [photo 3: second degree burn]
  
3.4.    Third degree burns (full-thickness burns), injure all the layers of the skin as well as the fatty tissue beneath them.  A third degree burn can cause severe pain. But if nerve endings are damaged, the burn may not hurt right away. Third degree burns may look white, red, or black, and they do not change color when you press on them. Although blisters may develop, the burn is mostly dry, hard, and leathery-looking. Common causes of third degree burns are steam, hot oil, grease, chemicals, and hot liquids. Infection is a major concern with third degree burns. These burns always require care from a physician, and large burns may require skin grafts and surgery.

   [photo 4: Third Degree Burn]
  
3.5.    Fourth degree burns extend through the skin to injure muscle, ligaments, tendons, nerves, blood vessels, and bones. These burns may often be fatal in Gor.  I decline to present a photo of a fourth degree burn.  They can be gruesome in the extreme.

3.6.    Burns also can be classified according to the extent of the burn.  The greater the extent of the burn, the more serious it is.  It is possible to estimate the Total Body Surface Area (TBSA) affected.  A Minor burn in an adult is considered to be when less than 10% TBSA is affected.  A Moderate burn when 10-20% TBSA is affected and a Major burn when >20% TBSA is affected.  A TBSA of >20% is life-threatening.

    [photo 5: Extent]
   
3.7.    Any Questions or comments?

3.8    Question: You have two patients that have come in as the result of a house fire.  One has third degree burns on her foot, the other has second degree burns on her torso with a TBSA > 20%.  Who do you treat first, and why?

4.    Treating Burns

4.1.    Burns should be treated quickly.  A rapid assessment of the classification and severity of the burn is essential before treatment.  Also, burns often are accompanied by shock. 

4.2.    Question: What are the symptoms of shock? 

4.2.1.    Answer: They can include rapid heart rate, cool clammy skin, rapid, shallow breathing, and low blood pressure. 

4.3.    Question: How do we treat shock? 

4.3.1.    Treat by laying the patient down, raising their legs and keeping the patient warm.   They also may need intravenous fluids.

I have provided notecard in the folder with symptoms and treatments for Shock and Concussions.  Every physician should know this very well.

4.4.    First degree burns can be cooled in cool water for 10-15 ehn (minutes) to reduce pain and prevent further damage.  Pat the burn area dry and treat for pain (with Lavender, Ginger, Cayenne and Nutmeg, in a tea with one teaspoon of the herb and two tablespoons of honey – formula provided by Lady El MacLeod), if necessary.

[photo 6: of cooling hand]

4.5.    For second degree burns, rinse burned skin with cool water until the pain stops.  Alternately, apply cool compresses to burns on the face or body. Do not use ice or ice water, which can cause tissue damage. Take off any jewelry, rings, or restrictive clothing. Do not break the blisters. Clean the burn area with mild soap and water. Some of the burned skin might come off with washing. Rinse with sterile water and pat the area dry with a clean sterile rep cloth. 

[photo 7: of applying honey]

You may use on antibiotic salve formulated for burns or honey.  If the burned skin or blisters have not broken open, a bandage may not be needed. If the burned skin or unbroken blisters are likely to become dirty or irritated by clothing, apply a bandage.  Wrap the burn loosely to avoid putting pressure on the burned skin.  If the burn is on a leg or an arm, keep the limb raised as much as possible for the first 24 to 48 ahn (hours) to decrease swelling. Move a burned leg or arm normally to keep the burned skin from healing too tightly, which can limit movement.

[photo 8: bandaging a hand]

4.6.    Third degree burns are treated in a way similar to second degree burns except:  Do not remove burned clothing stuck to the skin, at least initially.  It must be removed carefully by the Physician using a scalpel, tweezers and scissors.  Do not immerse large areas of burned skin in cold water.  It may lead to a drop in body temperature and shock.   But do elevate the burned parts of the body to promote circulation, and use a moistened sterile rep cloth to cover the burned area.

4.7.    If a patient presents with a major fourth degree burn, I am not sure I would RP it with them, since it likely is not survivable.  Realistically, in Gor a minor fourth degree burn could be handled by perhaps a combination of surgery and skin grafts, but they are beyond the scope of this lecture.

4.8   Questions and Comments?

4.9   Question: My mother taught me to put butter on a burn.  Did she give me good advice? Why or why not?

5.    Role Playing Treating a Burn

5.1.    A burn is often an emergency to treat, so bring the patient into the infirmary and quickly assess the classification and severity of the burn, and look for symptoms of shock.  Ask the patient in IM about the burn and about any preferred outcomes.

5.2.    Try to get approval from the slave owner before treating a slave.  However if the burn is second degree or worse and looks like it is the result of misadventure rather than punishment, go ahead and treat, even without approval, and be prepared to deal with any fallout later.

5.3.    Meanwhile, wash your hands and have your infirmary slave, if you have one, prepare the following: a basin of bath of cool water, a bowl of soapy water, clean towels, sterile rep cloth bandages, scissors, scalpel, tweezers, light tube, antiseptic salve or honey, a cool water compress if the burn is on the head.  Most or all of this should have been prepared ahead and available on demand.

5.4.    As you are RPing your treatment, open your city’s treatment form, and gradually gather the required info.   For example, ask the name and caste of the Free, if you don’t already know.   Also ask about how the patient received the burn.  This can break-up the treatment in a natural way and lead to some interesting RP.  You also may ask if this is the only complaint.  There may other problems you can address later.

5.5.    At the end of the treatment determine if a further appointment is necessary and book it.  Then finish filling out the form and sign, seal and deliver it.  Next time you see the patient, be sure to ask about their health and how well their burn is healing.

5.6.    Questions and Comments?

5.7    Question: A warrior comes in with burned hands and doesn’t remember how it happened.  While you are treating his hands, what else should you do?

Answer: Often a patient will come in with multiple problems, and it is your job to treat the most important problems first, while not ignoring the others.  So while you are treating his burned hands, ask questions to try to find out why his memory is impaired.

6.    A Demonstration of a Burn Treatment RP

6.1.    RP can be done in an infinite number of ways, but try to use approved, not overly technical techniques and stay BtB.   Always remember, this is Role Play, not Real Life.  Treat your patients with respect, listen to them and use a turn-based approach. And, of course, have fun!

6.2.    Today, the setup is that the patient (Lady El) comes running in to the infirmary after burning her foot while trying to stomp out a fire in the lab.   Her foot is smoldering and she is in considerable pain and is very annoyed with me for having left that bota of paga opened.

 i am assisted by kisu, our First Girl and infirmary slave.  We will be doing this perhaps more quickly than you would at home due to time constraints.

In your folder you will find a notecard called Burns: Step by Step.  You can use this to follow along and see how I'm doing...smiles.  I will also be using this NC as a guide.  It is useful to have NCs like this available when a patient comes in.  It will help you stay on track and free you to focus on the more creative parts of the RP.

Ah one thing before we start: I am going to make one, or maybe more than one mistake.  See if you can spot it (them).

Let’s begin the RP.

6.3.    Questions and Comments? 

6.4.    That concludes today’s class.   Safe paths everyone.