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JoNightshade
07-08-2007, 12:19 AM
Hi... I'm working with a character at the moment who has deep second-degree burns over about a third or a half of his upper body and arms. I've done all the research about what this means medically, but now I need to know how it feels. I'm also wondering if my healing-timeline is right or not (should it be faster, slower, etc.)

Here's the situation: He was caught in an explosion and burned badly, but not badly enough to need any skin grafts. He's going to blister and then scar. So he has been in the hospital for about a week, drugged out of his mind. So he's escaped the worst of the initial pain. Now he's at the point where he's out of danger and slowly getting up and around.

So at this point, what would the burns feel like? I've had minor burns and I know that there is that inital searing agony, but then it fades. Would the burns still hurt, and if so, what kind of pain would it be? A throbbing? A burning? Would they itch? How long would it be before they would be "completely" healed, as in just scar tissue?

Ol' Fashioned Girl
07-08-2007, 12:27 AM
Another member, CBeasy, has just been through that - with grafts - but I'll bet he can help you with the rest of it.

Fenika
07-08-2007, 01:27 AM
This doesn't answer your question, but its an interesting fact- most (many?) burn victims die not from the damage, but from dehydration. The burns and complications from the burns reduce their water levels to critical. You might read up on this, as it would be a moderate complication early on for your character...

Cheers,
Christina

JanDarby
07-08-2007, 01:28 AM
So at this point, what would the burns feel like? I've had minor burns and I know that there is that inital searing agony, but then it fades. Would the burns still hurt, and if so, what kind of pain would it be? A throbbing? A burning? Would they itch? How long would it be before they would be "completely" healed, as in just scar tissue?


I had a large third-degree burn along my shin about ten years ago.

Warning: this is a little gross.

My burn actually didn't hurt more than a typical sunburn the first week, because the nerves had been damaged. During that week, it just acted like a sunburn, with a blister and raw skin. The pain was later, when I finally went to the doctor because the nerves had started to grow back, and the pain was simply unbearable. Especially at night, when there was nothing for distraction, and I was trying to fall asleep. Toe-curling pain, where all the surrounding muscles would tighten, almost to the point of a charley-horse. It was in the 2-3 weeks past the burn that was the worst, actually, and I was on narcotics for sleeping (and I am really sensitive to narcotics, so it takes a LOT before I'm willing to take them).

The pain itself is hard to explain. It's not a stabbing pain or even a burning pain, and after the initial heat (like a sunburn) fades, not much throbbing, but just pure, unremitting pain. The muscle-clenching aspect of it is what I most recall.

The other thing that the person might not notice at the time, and they don't tell you about, is that it's just exhausting. The body is sort of in shock and shutting down extraneous systems while it fixes the damage, and restful sleep is almost impossible, so I was tired all the time. And there's some swelling that lasts for weeks. I vaguely recall needing to keep the leg elevated a good portion of the day for a couple months afterwards.

I don't remember now exactly how long it took to grow new skin, but it was months before the entire wound was covered with pinkish, permanently altered skin. (My burn was 2-3" wide by about 6" long.) Until the scab was gone, there was itching, too, although I'd forgotten about that until just now. I remember the doc telling me that was good, b/c it was a sign of healing, although I didn't appreciate it at the time. Pretty much like any scab healing, in terms of the itching along the border. And the skin was hypersensitive for a LONG time after that. A year, maybe? Longer? I had a part-time day job that required me to wear business casual clothes, and even wearing light cotton pants was annoying, because when I moved, the fabric would brush against my shin and be mildly painful, like touching a sunburn.

PM me if you need more details.
JD

JoNightshade
07-08-2007, 01:35 AM
Jan, thanks for the great details! (And also Bahamuchild-- yeah, I was aware of the dehydration thing.) My question here is this... the guy does not have third-degree burns, which are classified as such by the fact that nerve endings are destroyed. So with a third-degree burn, not feeling pain initially is normal. But what if he wasn't burned that badly? Then I'm thinking it would hurt from the beginning. I'm also thinking that your long-term hypersensitivity would be a result of those burned-away nerves regenerating. Anyone know if this is correct?

JoniBGoode
07-08-2007, 05:05 AM
I had second degree burns with blisters on the front of each thigh many years ago, in a strip that was about 12” long x 6 “ wide. The blisters were 2” to 3” across. It was a cooking accident – a large pot of boiling water was spilt on me. Fortunately, I was wearing jeans, or it would have been worse.

The initial pain was excruciating. Just to put this into perspective, I had done unmedicated childbirth about 5 years before and told my sister I would classify that as moderate discomfort. (My doctor says I have a high tolerance for pain.)

The only way I could stand the burn pain was because it was under ice. I sat down and we dumped a bag of ice in my lap. Even so, I was whimpering and moaning in the emergency room, to keep from screaming.

They gave me Tylenol with Codeine for the first 3 days, which made me irritable. (My mom, an RN, said that is a common side effect of Codeine.) After that there was some pain, but it was not nearly as bad, and I didn’t take anything for it. (Now I would probably take Tylenol or aspirin for a similar pain.)

As it began to heal, the pain went away and it did itch quite a bit, which was annoying.

BTW, they gave me silver nitrate cream to put on the burns, and I don’t have a scar. The only scar on my leg is from scratching a mosquito bite, not from the burns.

I think it took 6 to 8 weeks to heal completely, and yes, I slept a lot during that period. The skin felt new for a month or so, but I didn't have any hypersensitivity.

They probably have better treatments now, but it does hurt like a son of a gun.

Fern
07-08-2007, 07:33 PM
My daugher burned her feet (2nd degree burns) by stepping into a pile of ashes that had been there for 12 to 14 hours, but still had coals underneath.

We took her to the emergency room and they slathered her feet with silvadeen (sp?) and wrapped them in guaze and told us to take her to her pediatrician first thing Monday morning. We were also to give her Tylenol. I can't remember if they gave us a prescription or if it was regular Tylenol. This happened on a Saturday.

The Pediatrician was irritated that the hospital hadn't insisted on getting her to a Pediatrician on call because they had a new kind of treated guaze out that they could immediately place over burns like this. . .as the skin heals, the guaze turns loose and there isn't any of that painful peeling away of something stuck to the skin.

She was unable to walk on her feet for 6 weeks and they stayed bandaged all that time. I remember the itching being what she complained about most. We had to give her tylenol every 4 to 6 hours most of that time because of the intense itching. She ended up with one small scar on one foot.
---------

Another family member had 2nd degree burns on his legs from being out in a boat with no sunscreen. Trying to take care of it on his own, he left them uncovered, thinking that was best and he said the pain was horrible. Finally giving up to go to the doctor, he was told to wrap or keep the legs covered. Sitting bare legged under the ceiling fan in his living room had been causing him horrible pain because the fan was moving the hair on his legs, which in turn was keeping the burned areas highly irritated.

I don't recall how long it took for him, but I know he wore loose fitting clothing for a while afterward.

thethinker42
07-08-2007, 07:47 PM
I burned my entire hand once. Second degree burn from the wrist up to my finger tips (long story; I was holding something that caught on fire, and basically my whole hand was on fire for a few seconds). It BURNED badly for days...it was kind of weird, like an intermittant pain...it hurt constantly, but every 30 seconds or so, it would get REALLY intense, then back off....then really intense, then back off.

Holding it in cold water provided tremendous relief. I put aloe vera on it, but the mere act of rubbing it, however gently, onto the skin was excruciating. My mom eventually sprayed it with whatever spray they used to (and may still) use on sunburns...but anything that involved rubbing it on, hurt. I did not wrap or cover it, as I couldn't touch it with anything. The exception was any kind of cool, smooth surface -- metal, satin-like fabric, my desktop, etc. I went to school the same day I burned my hand, and found a great deal of relief by pressing my hand against the metal underside of my desk.

My fingers and hand had blisters in various places, and as the skin healed, the tips of my fingers actually peeled back, almost like a hood over the new layer of skin. It was pretty gross...but I was in second grade, so I used it to gross the other girls out.

Bending my fingers was out of the question for a few days. It was a week before I could make a fist, and even that was painful.

There was no scarring when it healed.

Hope that helps!!

Tsu Dho Nimh
07-08-2007, 08:53 PM
I used to go into burn units ... one man I remember was in the situation you describe from a gas tank explosion. He had flash burns and some spots of deeper burn where the flaming gasoline landed.

The critical part is the possibility of lung damage from hot gases showing up and killing him in the first day or two from pulmonary edema - we monitored his blood oxygen levels very closely at first.

Everybody in the unit was on pain killers - as much as they needed/wanted to keep their stress level down - which means they could be pretty loopy.

Burn units are hot and humid to minimize patient dehydration.

Debridement is a painful process - the patient gets soaked in a warm disinfectant bath to encourage the dead tissue to turn loose, then the nurses pull the loose bits off. :(

The guy had that zombie dead-peeling flesh look in patches, fresh baby-butt tender skin in others.

JoniBGoode
07-08-2007, 09:58 PM
One more thing that I remembered... I shrieked when it happened. I'm not a screamer, but this was totally involuntary, and loud. It was obviously the reaction of someone in extreme pain. My brother-in-law later described it as "blood-curdling."

Also, they tell you to try not to pop the blisters or tear the blistered skin. That's becasue the blisters form a natural, sterile covering over the wound. If the blisters do open up during the healing process, exposing raw skin, it's more painful and you're more likely to get scarring.

tjwriter
07-08-2007, 10:31 PM
I burned my right palm twice in the same place on the same item, which was a kerosene heater. It would seem that I didn't learn.

I would have been somewhere between 4-7 at the time, but I don't remember much. I think I may have blocked it.

I had to but cream on it (probably silver nitrate) and I had to go to physical therapy for a few weeks.

I could ask my mom about it, but the only thing I really remember is one of the times when my hand landed on the top. Of course, I'm the child that after cracking my head open to the skull, asked my mom for a paper towel because I was making a mess.

WriterInChains
07-08-2007, 10:33 PM
In my early 20s I had a full bowl of soup splashed on me (by accident) only seconds after scooping it out of the huge pot, so it was just below boiling. I had 2nd degree burns covering the bottom half of my face, my neck, & a palm-sized spot on my stomach from where the soup went down my shirt. They gave me Demerol - a whole cc in my arm, which at the time hurt more than the burn but my boss said later I told them I wouldn't drop my drawers for it. The burn only throbbed and felt a little hot for the first few days, then when the blisters got bad my skin felt tight, like it was too small for me. When the blisters broke it really hurt and itched, but it wasn't a throbbing or burning -- my whole body hurt and felt like someone had systematically beaten me with a two-by-four a few days before. It's hard to describe, & maybe had something to do with my constant fear of scarring during that time, but I couldn't sit still & was too tired to move - around the clock.

I went back to work before I was supposed to (couldn't stand to sit at home anymore, even though I wasn't so hot on being seen either), and being near heat wasn't pleasant but I'm not sure if that was physical or emotional. This was about 20 years ago now. I was VERY lucky & don't have one scar from it.

If you want more info, plz feel free to PM.
Break a leg w/your story! :)
~C

JoNightshade
07-08-2007, 11:41 PM
Oh man you guys, all of this info is super great. Thank you SOOOO much!!! This helps a ton.

Now another question: I wanted my guy to have some scarring, which is why I said "deep" second degree burns, which are between 2nd and 3rd degree. Quite a few of you said you had no scarring after you recovered from 2nd degree burns, even what sounds like pretty extensive injuries. So would it be better to classify his burns as third degree? Or would that necessitate skin grafts?

The way my novel is organized, I move directly from the accident (an explosion) to two weeks later, at which point I am assuming he is able to get up and around and is out of life-threatening medical danger.

Mary Star Church
07-09-2007, 02:16 AM
My dad was burned on 60 percent of his body - 2nd and 3rd degree burns in 1974 in an explosion. Many of the treatments that are now available weren't back then, but some things are the same.

Burn victims are routinely bathed in antiseptic solutions and are scrubbed with stiff brushes to remove scar tissue. This is a very painful procedure.

Dad talks about air beds in his treatment. The patient is laid on a bed that has constantly moving air current - he talks about how cold it was and how he would try to drift off somewhere in his mind to avoid the reality of the situation.

Now, there is a growth hormone that doctors can use to grow skin for grafting. Back in those days, pig skin was laid on the burned tissue to keep down infection risk. Skin was taken from unburned parts of the body and moved (grafted) to cover burned areas. This leaves other areas that were not burned in pretty much the same condition as burned areas - skinless.

As far as time frame for healing, Dad was in the hospital for six months before coming home the first time. He had frequent surgeries after that to help him with mobility. His neck was so badly burned that he couldn't lift his head at first. The doctors took skin grafts from his back and made it so that he could lift his head and look side to side. Burned tissue has almost no elasticity - and it contracts. Fingers and toes are curled into a constant bent position.

Many of his internal organs are now fused together because of scar tissue due to the heat of the fire. When he has surgery, we can usually expect it to take 3 or 4 times longer than we are told simply because of the delicate nature of avoiding organ tissue.

I hope the information helps. I would be happy to answer any other questions or consult Dad for you about anything specific you need to know.

JJ Cooper
07-09-2007, 04:36 PM
Hi Jo,

About six years ago my brother developed Stevens Johnsons Syndrome (http://sjsupport.org/) which is an allegic reaction to prescribed medication and is like being badly burnt inside and out. He got it fairly bad and still has treatment. Anyway, his scarring is like being burnt, the physical difference with him is that now maybe he looks about ten years older than he is, has no hair over the affected parts of his body (most of it unfortunately) and has to avoid the sun where he can. Like a true Aussie lad though he remains very active. It is mainly the ageing affect, the precautions with the elements and a very lengthy recovery that has greatly changed in his life. Hope this helps.

JJ

Tsu Dho Nimh
07-11-2007, 07:47 PM
Now another question: I wanted my guy to have some scarring, which is why I said "deep" second degree burns, which are between 2nd and 3rd degree. Quite a few of you said you had no scarring after you recovered from 2nd degree burns, even what sounds like pretty extensive injuries. So would it be better to classify his burns as third degree? Or would that necessitate skin grafts?

The way my novel is organized, I move directly from the accident (an explosion) to two weeks later, at which point I am assuming he is able to get up and around and is out of life-threatening medical danger.

http://www.burn-recovery.org/injuries.htm gives the modern classification methods and treatment

2 weeks later, he is still healing and is still at risk of infection if he has areas that aren't fully regrown. He'll be red and raw-looking, still peeling in patches. You need "full thickness burns" in at least some places, or else an infected partial thickness burn, for scarring. He may or may not be out of the hospital ... a small severe burn is more manageable as an outpatient than wide-spread less severe ones (fluid loss from the partial layer's blistering and oozing can be life-threatening).

Depending on many factors, including how promptly the burn was treated at the scene, and the extent of the deep burn, even a full thickness burn might not leave scars. Aside from a jog in the hairline, I have no scars from one I got on the forehead ... my dad promptly applied a handful of snow and then anti-infection stuff. Same with one on my hand from not seeing a gas stove's flame ... it was mostly partial thickness with one seriously charred spot where there was no dermis left.

They healed over.

Kadea
07-11-2007, 10:43 PM
Hopefully this helps you out about the scarring...

About 15 years ago I was in one of those skid cars racing around a track. I turned around to point something out to my dad behind me and set my arm on the engine grate by accident. It hurt really really badly and bubbled within a couple hours. My dad never too me to the hospital (we were on vacation and I guess he didn't want to track down a hospital). I was miserable and we iced it. For years I had a scar that looked like a partical grate (or a chinese symbol to some people!). It has almost completely faded with time, but if I really look closely I can still faintly see the mark (like a very faint huge odd shaped freckle), but it's not very visible anymore 15 years later.

If you want me to go more in to detail... just let me know... :)

Goodluck!

kenzie45230
07-13-2007, 12:45 AM
You asked, "Quite a few of you said you had no scarring after you recovered from 2nd degree burns, even what sounds like pretty extensive injuries. So would it be better to classify his burns as third degree? Or would that necessitate skin grafts?"

I had 2nd and 3rd degree burns on my left arm from fingertips to elbow twice within 4 years. The last time was 23 years ago, and since the burn was in the exact same place they were concerned about scars.

My fingers had to be bandaged separately so that the skin wouldn't grow together. Because of the 3rd degree burning, they made me go to the hospital every day to have the dressings changed. They peeled my skin and reapplied the "silvadeen" every day for about 10 days. They also told me that if I had tried to do this at home or if I used anything other than the "miracle" burn cream (which was really expensive back then), that I would have certainly scarred. So maybe your character isn't so apt to make the trip to the hospital or doc every day?

The pains were horrible, much worse than anything I've ever experienced - which have been childbirth, back injury and knee injury. Because of the 3rd degree burns, I was on pain medications for almost a month.

At the beginning the pain was so bad that I just wanted to die. The second time, I actually drove myself to the hospital with my arm in a bucket of ice and cold water. I guess that helped keep the scarring down too.

The first pains were a combination of burning and throbbing. For about a month, I would wake up with my arm throbbing. Even then, I would not have minded dying. Pain meds didn't do much except make me sleep, which was okay, except that I went back to work after about 5 days. I don't think I drove for about a month.

I think my last bandage came off at about 10 weeks, and even then my skin was sensitive.

writerdude
07-13-2007, 02:51 AM
I'd be happy to answer questions to the best of my ability, but my burns occurred 36 years ago, and treatment today probably is far different. I had a mix of first to third degree burns covering about 40% of my body, primarily my back and right arm but also large sections of my left arm and part of my face. I remember little of my first three weeks (of nine) of my initial hospital stay, I suspect because I was so badly injured that my mind blocked the experience and that I was on heavy pain medication. I was 9 years old, and not a lot was explained to me directly. I would be happy to discuss the feelings that I remember from that time and what I feel about it now; I don't know exactly what you're going for or if a child's experiences would be useful to you. Contact me at writerdude@yahoo.com; I don't check these forums often--this is only my 2nd or 3rd visit in several years. Good luck with your project!

JoniBGoode
07-13-2007, 06:57 AM
[quote=

Now another question: I wanted my guy to have some scarring, which is why I said "deep" second degree burns, which are between 2nd and 3rd degree. Quite a few of you said you had no scarring after you recovered from 2nd degree burns, even what sounds like pretty extensive injuries. So would it be better to classify his burns as third degree? Or would that necessitate skin grafts?
[/quote]

I can't speak to skin grafts, but scaring can definitely occur with second degree burns...it just depends. My doctor was THRILLED that my burns healed without scars. He had warned me ahead of time that I might have significant scarring.

I think it also depends on how the healing process progresses. For example, I think a burn that gets infected is more likely to form a scar. Or, if it's in a spot where the scab is repeatedly torn, that will scar.

JoNightshade
07-13-2007, 09:00 AM
I can't speak to skin grafts, but scaring can definitely occur with second degree burns...it just depends. My doctor was THRILLED that my burns healed without scars. He had warned me ahead of time that I might have significant scarring.

I think it also depends on how the healing process progresses. For example, I think a burn that gets infected is more likely to form a scar. Or, if it's in a spot where the scab is repeatedly torn, that will scar.

Hm, infections. Good idea. This guy gets caught in an explosion and drops, on fire, into a bunch of grass and gravel and stuff. Also I think you're right... different people heal differently anyway so maybe even with 2nd degree (and some third) I can probably get away with it.

Thank you to everyone again. I am now 90% finished with my WIP and this is getting me through. :)

Dominic
07-13-2007, 05:23 PM
Jo,

I've never had a severe burn, but I was the safety manager at a plastics plant for several years. Our biggest fear was a major plastics exposure which can do plenty of nasty things to a person, but what applies here is the burn information.

You have a lot of great feedback already, but one thing that I didn't notice is a warning that when the upper body is involved and, more specifically, the head, there are special concerns. The eyes, mouth, nose, and ears all are susceptible to burning on a deeper level and with more dramatic effects. I have a friend who is a doctor and, for all of her competence, this is the one thing she fears treating the most.

If your character has any burns near his head, you might want to map out how the explosion strikes him. Second degree elsewhere could easily be enough for third degree on the head.

As for the scarring, if this is an explosion, there is a simpler solution for the scarring. Explosions typically propel material around them. It is more likely that he would be struck by something than not. This could cause anything from scratches and bruising to severing body parts. The additional part of this is that any puncture of the skin enables the heat to get further past the skin. So second degree all around a cut could see the skin down to the bottom of the cut burned, thus causing a spot where third degree burns are prevalent.

The difficulty is that third degree burns over more than 10% of the body typically means a longer recovery time. I know two guys who are recovering from third degree burns and are still in treatment four months later. Both work every day at their jobs, but spend a day every week at a burn unit.

As for the deep second, these are typically handled like third degree burns. This is primarily because of the similarity.

Based on your description, I get the impression that this character has about 10% to 15% of his skin burned. That size area with second degree burns, whether deep or not, would be responded to as if it were third degree. This would mean that time in the hospital would not be out of the question.

Hope this helps.

Dominic

CBeasy
07-23-2007, 06:17 AM
Jan, thanks for the great details! (And also Bahamuchild-- yeah, I was aware of the dehydration thing.) My question here is this... the guy does not have third-degree burns, which are classified as such by the fact that nerve endings are destroyed. So with a third-degree burn, not feeling pain initially is normal. But what if he wasn't burned that badly? Then I'm thinking it would hurt from the beginning. I'm also thinking that your long-term hypersensitivity would be a result of those burned-away nerves regenerating. Anyone know if this is correct?
Hey, I haven't been around due to lack of internet, but I can answer any questions you have tomarrow night around 10 pm. Contact me via AIM, or meet me here at AW. BTW, my nerves did come back, and the feeling is not hypersensitive, it basically normal, though I do have a lingering tingleing sensation if a few of my fingers.