irrka said:
Hmmm i dont know. I'm doing an elective at the burn unit now, and today a woman with 50% TBSA burn came in, most of it 3rd degree. She didnt need ANY pain meds while she was being moved to the hospital (like 2-3 hours!) and then only minimal pain meds while they were SCRUBBING the flesh off her! She said she was just itchy!
Burns can be all over the place as far as pain goes, but the burn injury model can be compared to that of ischemia, which itself is like a target. In the center of the full-thickness burn, or the infarcted area, it's gone. Whatever was there is dead, so there's no pain. In the "classic" full-thickness burn, beyond the full-thickness area, there will be partial thickness burn, just like the ischemic model of "injury" ringing the infarct. Beyond that, there will be the partial thickness burn that would have been called "first degree" in the past, and this parallels the "ischemic" ring that surrounds the injury in the ischemia model. Beyond that, in both models, there is no injury.
Where the parallel to the target analogy (and, likewise, the ischemia model) falls apart is in the special kinds of burns that can occur, such as electrical and focused light (such as laser) injuries. The interface between full-thickness injury and healthy tissue may be brightly distinguished, with minimal intermediate injury in between. In fact, this is the principle behind laser therapy in various medical environments (such as photocoagulation in eyes, vulvar wart therapy, and lithotripsy).
As in the case above, the partial-thickness injury may be very narrow, with the consequent apparent paucity of analgesia needed. Contrast that with a patient I had that had approx 1% TBSA on the dorsum of his non-dominant hand after burning grease splashed on it, leaving partial thickness burns, but requiring Dilaudid 1mg q15min for analgesia.
Reminds me of a story (what good is an internet post without a war story?) that a battalion (now division) chief in Buffalo told me - the recipe for "Buffalo Fire Department chicken wings": Put grease on stove. Heat grease. Put wings in. Fall asleep. When the fire department comes, the wings are done!
