Forever Seared Into My Memory

This week's guest columnist is Dr. Aaron Foster, a Family Practice resident at the University Hospital and Clinics here in Lafayette. Forever seared into my memory is the image of my friend, running down the dock at summer camp, his body engulfed in flames.  Behind him trailed burning footprints, lighting his path in the night.  All boys are fascinated by fire, and at age 14 we discovered that aerosol bug spray was flammable, and would briefly burn on your skin without causing injury.  This led to the scene of my friend, doused in flaming insect repellent, running down the dock to jump in the lake.  Luckily he survived the ordeal unharmed, minus some hairs on his head and eyebrows. Many children, though not as foolish as we were, are not as lucky either.  According to National Institutes of Health (NIH) statistics, a quarter of all burns treated in the U.S. involve kids under age 16.  While teenage foolishness may be unavoidable, burns are largely preventable.  The incidence of burns, and most importantly severe burns, has decreased in recent decades.  This is due to improved building codes, education in schools about fire escape planning, and smoke detectors.  Yet burns do still occur, and fortunately most of these are minor. As a medical student I spent time on a burn ward, and saw many different types and severities of burns.  One thing that stood out for me was the disproportionate number of young children admitted for burns.  According to the NIH, most pediatric burns happen to kids under age 5.  Most of these are scald injuries, and occur in the kitchen.  And given that we adults are in charge of the kitchen, these are avoidable. Preventing burns includes common sense things like keeping small children out of the kitchen while cooking.  Don't carry children and hot food at the same time.  Advice that might seem less obvious: turn the pot handles on the stove inward, so they don't stick out where kids can grab them.  Make sure appliance cords don't hang over counters either, for the same reason- curious children grab stuff, and if that stuff is hot toasters or pots full of boiling soup, disaster can ensue. Several times in the past in this blog, Dr. Hamilton has mentioned that most of the burns he sees are when little kids take hot bowls of noodles out of microwaves.  Someone else happens along, bumps that big, in-the-way microwave door, and the bowl spills on the child.  In my time as a medical student on the burn ward, I also saw a lot of kids burned when they pulled on a tablecloth that had a container of hot liquid on top. As we mentioned above, kitchen burns can be prevented with a little extra care.  Small children should be kept out of the kitchen while hot food is being prepared, and should never operate microwave ovens without an adult hovering.  Pot handles and electric cords should be out of reach. After age 5, burns happen more with open flames.  This includes campfires and bonfires, and fireworks.  Open fires should be contained within fire pits, with no flammables (extra wood, long dry grasses) close by.  Kids shouldn't wear loose flowing clothing near fire, or clothes that easily catch fire with a spark (synthetics).  And though it seems obvious (to the sober), don't throw lighter fluid or gasoline on open flames.  We see too many kids who get engulfed when those fluids become an exploding cloud. Though we do our best to prevent children from harming themselves, burns happen. Fortunately the vast majority do not require seeing a doctor.  Small burns can be managed at home by remembering the 5 C's.  Clothing- immediately remove any clothing involved, so that the hot liquid or flaming clothes don't continue to burn. Cooling- cool water stops the burning process, and feels good too!  Cleaning- soap and water is sufficient, to minimize infection if the skin barrier is compromised.  Cover- put on antibiotic ointment generously and cover with gauze.  This also soothes, and prevents infection. Comfort- pain relief with Tylenol or ibuprofen. When should kids see a doctor for burns?  Burns that blister, or are larger than the area of the patient's hand, or involve faces or joints, should get seen.  Kids should have up-to-date tetanus vaccines, since burns increase the risk of tetanus infection.