ER Stories 8: Burnt Skin

[Entry from my journal on Wednesday, February 6, 2013]

[Only the first picture is mine. All other pictures included in this post are ones I found on the internet from patients with similar cases.]

Patronato was really busy in the morning. I did a lot! Lots of patients, a few shots and a really interesting emergency:

Denise (coworker) and Chanmi (Global Citizen Year 2014) in the office/waiting room of Patronato

Denise and I exchanged a funny look when we heard odd squealing from outside. We thought it may have been an injured dog. A few seconds later, a very frantic set of parents rushed into the clinic, carrying the source of the squealing -- a little boy.

At the time, the doctor happened to be in the waiting room and all three of us sprang out of our seats and into action. Denise grabbed the instruments we would need. I directed the patient and family to our small emergency room. Doctor Chimbo rushed to his office to write a prescription for pain medication and cream. He then send the patient's father to hurry to the local pharmacy and pick up those necessary medications.

The five-year-old patient was very skinny. I would have thought he was three. He was still shrieking at the top of his lungs. He would not stand still. He was jumping and squirming out of everyone's reach.

The child had dark skin, so the pink splotches on his back and knee and face stood stood out clearly. Almost black, burnt skin surrounded each pink wound. There were a few bubbles of skin that hadn't been broken.

I tried to ask a simple "Como se llama?" to start filling out the chart, but in combination of shock, stress and my gringa accent, the mother must have misunderstood me. She went into a guilt-ridden story of how she was cooking something on the stove and her son innocently reached to see what it is was. He spilled the boiling soup all over himself.

The treatment was simple enough:  

1. Give the boy pain medication.

2. Clean the wounds.

3. Take off the black, burnt skin.

4. Pop the bubbles of skin that hadn't broken by themselves. (Clean the discharge.)

5. Put the medicated cream over the wounds.

6. Cover wounds with gauze (containing Vaseline for painless removal).

7. Bandage it all up.

Simple procedure does not mean painless procedure and this boy was not going to do it the easy way.

He never stopped his frantic fidgity movements or his desperate yells. The mother and Denis took turns holding him down while we treated his burns. I do not know how many times I heard us all say "¡No te muevas!" He was a fighter alright.

In the middle of everything, I remember the boy looking me right in the eyes. He shook his finger at me and commanded "¡No, no, no!"

Our small patient was still hopping up and down in pain when we were finished. Poor kid left the clinic with his entire chest, knee and small chunk of his face covered in bandages. 

Recognizing Burn Severity  (health.ucsd.edu)

Degree	How Much Damage	How It Looks & Feels	How It Heals	How It Might Happen
1st	Part of the 1st layer (epidermis)	Pink, red, dry and painful	Some peeling over a week; no scarring	Sunburn or steam
2nd	Some damage to second layer (dermis)	Blisters are present(should be removed); skin under blisters is weepy pink and painful	New epidermis grows in 1 to 3 weeks	Hot water, tea, coffee, flash fires, soups, hot foods
3rd	All of the skin is destroyed	Blisters may be present; color varies (red, pale pink, white or tan)	Needs skin grafting unless very small	Grease scalds, electricity, roofing tar, flames, hot coals

Next Wednesday, May 7th:ER Stories 7: My ER Story [STAPLES]
ER Stories 9: Suicidal Thoughts

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