I didn't realize how sucky burns truly are

[crazylegs]

Oxygen is not something I'd want to carry; it's pressurized and highly flammable. And it is also a drug; for me to administer it without a doctor's order would be practicing medicine without a license. Good Samaritan laws would not cover me on that.

[Pedantry]
Oxygen isn't itself flammable - it merely massivly promotes fire...
[/Pedantry]

Luckily I can administer it without Drs orders (which is a bit odd as I'm a volunteer, but that's a whole other can of worms) but the cost is more than slightly prohibitive, plus I already carry enough stuff in the boot of my car as it is!

[dragon_wings]

Oxygen is not something I'd want to carry; it's pressurized and highly flammable. And it is also a drug; for me to administer it without a doctor's order would be practicing medicine without a license. Good Samaritan laws would not cover me on that.

I did not know that. Obviously that isn't a good thing. There is a chance I'm misremembering the story but

[Sapphire Silk]

My dad's an EMT and takes his kit with him *everywhere* He even took it with him hiking once and used the oxygen on someone that over exerted them self (there was other issues as well, perhaps dehydration).
When he came to visit me for thanksgiving he brought it and was able to give me some naproxen for my headache and sore knee.
*needs to look into first aid courses and at the very least a first aid book and kit*

Oxygen is not something I'd want to carry; it's pressurized and highly flammable. And it is also a drug; for me to administer it without a doctor's order would be practicing medicine without a license. Good Samaritan laws would not cover me on that.

[Pagan]

Fortunately, I had some codeine left from a previous surgery (I keep all my drugs, lol) and was able to sleep last night, but MAN does it hurt! I never realized how much a big burn could hurt....

Please, please, please, for the love of whatever deity(ies) you believe in, do not keep/use drugs past their expiration dates! It's not like food that can still be ok. Some drugs breakdown and just lose their effectiveness. Others can breakdown and become poisonous.

Nope, no pain meds. She doesn't believe that burns hurt that much, and pain meds are SOO overused, according to her. Fortunately, I called my doc and he gave me pain meds.

BTW, the reason that the doctor said no pain meds? I wasn't crying, or screaming, or whatever. I have a fairly high pain tolerance, but I told her that it was extreme pain and she said since I wasn't crying it couldn't be that bad, and that I was "Overstating" the pain. No, I wasn't. I didn't know that crying was an option...I was pounding the table though.

Ok, bitch. Let's burn your foot like that and see if just Tylenol does it for the pain.

Seriously, you spend 24/7/365 in your body (generally, barring any astral projection on your part). You know when something hurts, how much it hurts, or is wrong.

[kpzra]

We had a person in my Basic class that had no intention of working as an EMT but wanted more training than the first responder course. They could not get their license since the couldn't/wouldn't do the ambulance rides, but they got the classroom training.

My husband was a US Army Ranger, our first aid kit is actually a Pelican case.

[dragon_wings]

My dad's an EMT and takes his kit with him *everywhere* He even took it with him hiking once and used the oxygen on someone that over exerted them self (there was other issues as well, perhaps dehydration).
When he came to visit me for thanksgiving he brought it and was able to give me some naproxen for my headache and sore knee.
*needs to look into first aid courses and at the very least a first aid book and kit*

[Sapphire Silk]

Hmmm. That's a thought. If I can tolerate the workload, I might just do that. Govt is likely to fund it, too, since I'm on a pension and it's a 'work qualification'. Despite the fact that there's no way I could work in the field.

Some aspects of the job are physically intensive, like placing a patient on a backboard or lifting them onto a stretcher. And the gear is heavy to carry. So, you would probably have a hard time functioning as an actual EMT.

But you would know how and why to stablize an airway, apply a pressure dressing, and stabilize a bone until an ambulance arrived, and that's useful knowledge to have.

I keep an EMT kit in my car for emergencies. That way, I have some useful medical supplies on hand in case I pass by an accident and there are no first responders on scene (has happened a few times).

[crazylegs]

4. DO A FIRST AID COURSE.
The St Johns Ambulance Service had a bumper sticker campaign out, a while back, that listed just how many Australians died every year due to ignorance of first aid skills. Given our population, it was a staggering number. (I do forget what it was, but as a percentage of our population it was nasssty.)


<snip>


(I know some people on this forum don't have that sort of spare money, but I feel very, VERY strongly about the wisdom of having first aid knowledge. It's one of MY soapboxes.)

This. A thousand times this

150,000 people die in the UK each and every year who could be treated by a first aider if there was one nearby. In a country where 60% of lay people can't find a pulse in a healthy person I'm suprised that it's that low.

St. John Ambulance run excellent courses (I'm an active volunteer so I would say that!) as do a lot of providers. Make sure you keep your skills current too so when the shit hits the fan it's an automatic movement.

If your funds are so low you can't afford the course then as an interim measure then buy the first aid textbook - it's about £10-£15. The only problem with a book is that it won't tell you if your technique is any good but it's better than nothing (only just though).

Remember this snippet too - a man with training but no kit is infinitely more useful than a man with kit but no training...

[Seshat]

So I took an EMT course. It was about 8 weeks, and I think I paid a small fee for the book and the instructor . . . but I got state certified and it was also an incredibly valuable course even though I never rode on the ambulance as one.

Hmmm. That's a thought. If I can tolerate the workload, I might just do that. Govt is likely to fund it, too, since I'm on a pension and it's a 'work qualification'. Despite the fact that there's no way I could work in the field.

OTOH, if there's one thing that's healthy for a populace, it's having a high percentage of its people as qualified First Responders.

I am getting better, and we are really keeping an eye on the burn, since I am diabetic and infections are easier to get (especially on the foot), so we change the dressing often, use the creams and have several people a day look at the foot (me, hubby, son, daughter-in-law all look at it when it's dressing change time to make sure we all see the same thing). This may be overkill, but I want to make sure it heals correctly.

Given that you're immune compromised, that's NOT overkill at all. Especially since you may have peripheral neuro.. <checks Panacea's post> neuropathy. Yeah. That.
(I knew what I meant, I didn't know the correct term.)

Pain is what the patient says it is.

Science journos are reporting that researchers are close to figuring out how to objectively assess pain.

I don't expect this to be in ERs and doctor's offices any time soon. (10 years, minimum, more likely 20+). But I'd LOVE to be able to say 'I'm a fibro patient with trigger points in most muscles' and doctors can look up the Objective Pain Chart and see that the pain research shows that that's level X class Y pain, and tends to respond to pain drugs foo, bar and baz. And THAT would be achievable even if the technology is confined to research labs.


That said, different people have different levels of pain tolerance as well. So the SUBJECTIVE experience of level X pain will vary from patient to patient.

[kansasgal]

Pain is what the patient says it is. The downside is it is easy to game the system that way. But when you've got a patient with a problem that you KNOW should cause severe pain, and they are not reacting as expected they 1) have a high pain tolerance, 2) have chronic pain and are used to enduring it (though acute pain will usually give you the same reaction as any other person), or 3) they have a neurological problem that needs to be investigated (unless they report a history of one), like peripheral neuropathy.

I have both a high pain tolerance AND chronic pain (which is probably why my pain tolerance is so high). When I had my second son (by C-Section) I was wandering around the hospital and dealing with him and the nurses kept coming in and asking if I wanted anything for pain..I had two meds ordered, and I was like "Nope, I'm fine!". Drove them crazy.

I get checked for peripheral neuropathy fairly frequently (like every 4 months) because of my diabetes, so I am very careful about my feet and legs and want to make sure any problems are seen and addressed NOW.

[Sapphire Silk]

BTW, the reason that the doctor said no pain meds? I wasn't crying, or screaming, or whatever. I have a fairly high pain tolerance, but I told her that it was extreme pain and she said since I wasn't crying it couldn't be that bad, and that I was "Overstating" the pain. No, I wasn't. I didn't know that crying was an option...I was pounding the table though.

It is still very painful, but I am dealing without pain meds most of the time. I do take them at bandage changing time, because it tends to hurt when we remove the dressing.

Pain is what the patient says it is. The downside is it is easy to game the system that way. But when you've got a patient with a problem that you KNOW should cause severe pain, and they are not reacting as expected they 1) have a high pain tolerance, 2) have chronic pain and are used to enduring it (though acute pain will usually give you the same reaction as any other person), or 3) they have a neurological problem that needs to be investigated (unless they report a history of one), like peripheral neuropathy.

Honestly, I wish more ER nurses would do this. We'd get asked why we didn't give certain meds (didn't carry them), why we didn't do this or that when it was outside our scope of practice or we were pressed for time. 90% of being a Paramedic is being a good EMT-B. We can also be creative in what we do with the tools we have.

[kpzra]

I would certainly encourage anyone to take a basic course in first aid. I took a 16 week, college credit course in First Aid (it was only 1 credit hour IIRC) my first semester in college and it was one of the most USEFUL classes I have ever taken. Even as a nurse, it was incredibly useful.

When I first started working as an ER nurse (was still an LPN at the time), I had a roommate who was in paramedic school, and who later worked out of the same ER I did. He often complained ER nurses had no idea what paramedics had to deal with in the field.

So I took an EMT course. It was about 8 weeks, and I think I paid a small fee for the book and the instructor . . . but I got state certified and it was also an incredibly valuable course even though I never rode on the ambulance as one.

Honestly, I wish more ER nurses would do this. We'd get asked why we didn't give certain meds (didn't carry them), why we didn't do this or that when it was outside our scope of practice or we were pressed for time. 90% of being a Paramedic is being a good EMT-B. We can also be creative in what we do with the tools we have.

[kansasgal]

Thanks Sheshat, I will take the course (I took a course years ago, but in my old age the information went the same way that other information I have learned went..to the old age home, lol)

Yes, the wound had to be debrided, there is skin that had to be removed and yes, it is PAINFUL. Thankfully, it was just a small amount, but still.

I have gotten a second opinion from my doc, and he is keeping an eye on it. As to being paid, in Kansas you don't get paid for the first week, regardless of injury, as you are expected to use sick leave/vacation. Since I don't have sick leave or vacation, I am simply not getting paid.

I am getting better, and we are really keeping an eye on the burn, since I am diabetic and infections are easier to get (especially on the foot), so we change the dressing often, use the creams and have several people a day look at the foot (me, hubby, son, daughter-in-law all look at it when it's dressing change time to make sure we all see the same thing). This may be overkill, but I want to make sure it heals correctly.

Because of where the burn is, I still can't wear a shoe and probably won't be able to for another couple of days, if not for a week or more. I don't want to come back to work too early and end up breaking the blisters/causing an infection, so I'm just living with it.

BTW, the reason that the doctor said no pain meds? I wasn't crying, or screaming, or whatever. I have a fairly high pain tolerance, but I told her that it was extreme pain and she said since I wasn't crying it couldn't be that bad, and that I was "Overstating" the pain. No, I wasn't. I didn't know that crying was an option...I was pounding the table though.

It is still very painful, but I am dealing without pain meds most of the time. I do take them at bandage changing time, because it tends to hurt when we remove the dressing.

[Sapphire Silk]

I would certainly encourage anyone to take a basic course in first aid. I took a 16 week, college credit course in First Aid (it was only 1 credit hour IIRC) my first semester in college and it was one of the most USEFUL classes I have ever taken. Even as a nurse, it was incredibly useful.

When I first started working as an ER nurse (was still an LPN at the time), I had a roommate who was in paramedic school, and who later worked out of the same ER I did. He often complained ER nurses had no idea what paramedics had to deal with in the field.

So I took an EMT course. It was about 8 weeks, and I think I paid a small fee for the book and the instructor . . . but I got state certified and it was also an incredibly valuable course even though I never rode on the ambulance as one.

[Seshat]

Take a first aid course.

Now.

If you're working with things-that-might-burn-you, or things-that-might-cut-you, or otherwise anything at all dangerous (like a kitchen, or a workshop, or ... ); you need the correct first-response drilled into you so hard it's nearly instinct.

I've said this before, but my father was an ambulance driver for a time, my Girl Guides (Girl Scouts equiv) leader a hospital matron. She also taught the Brownies (little kids) first aid. Between the two of them, I had responses drilled into me.

I get a burn? IMMEDIATE response, remove the danger, then turn to stick the burn under running water. If there's a second person around, I instruct them to remove the danger. It's so deeply ingrained that I don't think about it until after I'm moving.

Note: if the patient is SO badly burned their skin is peeling off, do NOT stick the burn under running water. Call emergency, tell them the severity of the burn, and obey their instructions. If there's a pharmacist or a doctor in the same building, call them and tell them it's a skin-peeling-off level burn. They'll grab the appropriate supplies and come running. With this level of injury, you worry about paying for it until AFTER the injury is treated. Yes, I'm serious.

Oh: and burns are one of the THE most severe pain levels possible. If someone has experienced burn debridement, that's their 'level 10 pain' on the pain scale. Debridement nurses are among the nurses I most respect, because their very job is to inflict one of the most severe pains it's humanly possible to feel. It's absolutely essential to do it, otherwise the patient loses mobility in the healing skin and therefore in the affected body part. But I strongly suspect that the turnover for burns nurses is one of the highest in the profession, just from sheer emotional damage done to the nurses.

Since yours doesn't need debridement, you're probably "only" (HA!) in level 7 to 9 pain. Being told to suffer/endure it and offered just tylenol? I'd be tempted, very strongly tempted, to get my own doctor to write a report on the level of injury you have, take photographs of the wounds, and attach those to a complaint letter to whichever board is responsible for ensuring that doctors are practicing proper medicine. I don't want to throw the word 'malpractice' around because it has a proper, formal definition and I don't know if this fits; but it certainly doesn't come under MY expectation of proper medicine.

As Panacea said, burns can't be faked. And anyone trained medically should know how severe burns pain is. The question should be 'which pain treatment?', not 'do I give this patient pain treatment?'


Anyway...


1. Have your own doc look at it, and write you the necessary authorisations and forms to get paid for your time off, get paid for treatment costs, and get proper pain medication. If necessary (and your doc or his reception/secretarial staff should know if it is), have your doc refer you to a trusted peer for a formal 'second opinion'.

2. Keep a doctor, preferably your own doc, in the loop on the progress of the burn. Also, consistently see the same pharmacy technicians/pharmacist when collecting treatment stuff. A pharmacist is likely to have watched burns heal before, and can help you monitor whether the healing is normal or not. If there's a nurse or other qualified person associated with the pharmacy, ask to make a weekly (or so) appointment to have her check on the burn's healing. The pharmacist will be able to tell if they can do that.

3. If the pain bothers you despite painkillers, play 'fool the nerve' games. Google a nerve diagram of the human body, find out which path(s) the nerve(s) to the affected part(s) of your foot/leg take. Above the pain area, but still where the nerve is, put hot packs or cold packs or one of those 'post sports' heat creams. Or massage the muscle, slap the skin, or tickle the skin, or scratch the skin (not enough to injure it!). Basically, experiment with sensations.

Nerves can only transmit X amount of information to the brain. You want to make the nerve transmit 'hey, I'm hot/cold/slapped/tickled/scratched/rubbed' rather than 'aaaaah! paaaainnn!'

If it wasn't damaged skin, I'd be saying to do these things at the pain site. But in this case? Nuh-uh. Especially the scratching or the cream, because they might damage the already-damaged skin (& underlying tissues).

Experiment with sensations, experiment with locations 'upstream' of the burn. You'll probably find that several different sensations work, and also that you need to switch around a bit. Nerves can 'tire' of transmitting a particular signal. (It's actually more complicated than that, but that's close-enough for government work. :P )


4. DO A FIRST AID COURSE.
The St Johns Ambulance Service had a bumper sticker campaign out, a while back, that listed just how many Australians died every year due to ignorance of first aid skills. Given our population, it was a staggering number. (I do forget what it was, but as a percentage of our population it was nasssty.)


The following plea is to everyone, not just the OP:

Please, please, for your sake and the sake of everyone around you, do a first aid course. Your doctor or your pharmacist should be able to tell you who to contact. There may also be subsidised courses available if cost is keeping you from it.
Think of it as an investment in your and your family/friends' wellbeing. If you have even enough spare money to buy a latte a week, save that instead until you've paid for a course.
(I know some people on this forum don't have that sort of spare money, but I feel very, VERY strongly about the wisdom of having first aid knowledge. It's one of MY soapboxes.)