#erebus doctors sure know how to pic their executions methods

[ghostshipglamour]

So Your Chief Surgeon Set Fire To The Dance Floor: How Fucked Are You?

a badly done summary of current and historical care by me #notadoctor

Descriptions of burns under the cut (not very graphic), historical in italics

tldr:

I: Burns primer

Burns comes in superficial, partial thickness (either superficial or deep) and full thickness (reaching the fat) (Carter, 2022)- that correspond to the older first-second-third degree classification.

Superficial burns will not scar nor blister;

Partial thickness burns (both types) will blister, leak interstitial fluid and scar; the superficial partial type is often more painful than deeper burns because well. if the nerve ending isn't there anymore, it can't relay pain

Full thickness burns look dry, comes with a loss of sensation and form thicker scars (Carter, 2022)

It can takes a few hours to a day for the real depth of the burn to be revealed. The time it takes to heal will vary depending on the depth, location and affected structures (Carter, 2022).

From Dr Ashurtst in 1862: “ if half or even one third the body surface was involved in the burn it was almost assuredly fatal.” (Hattery et al., 2015), so if your cold boy had his clothes on fire he's probably not coming to the fun walking trip ahead.

The 1800’s conception of it was different, as stated in this excerpt from (Hattery et al., 2015) :

“In the 1800s, burn pathophysiology was thought to occur in three stages. The period of congestion occurred in the first 48 hours, followed by the period of inflammation from day 2 to 14, followed by the period of suppuration. Baron Dupuytren added a fourth period: exhaustion. He advocated that burns affect different skin areas differently—severe burns were less likely on the areas of the exposed skin, pointing to the thin epidermis of the areas habitually covered. He also suggested that there were six degrees of burns, the fifth being those involving structures such as fascia and muscle. The sixth degree was described as being a carbonized, easily breakable limb […].”

II: What Does kill You

Immediately, the more deadly aspects will be shock (hypovolemic shock), suffocation and, in our case, being trampled or stabbed. The smoke combined with the crowd crush is a special hell.

Then in the near future it’s going to be the infections that does you in- you have a great door open for bacteria and delicious dead tissues for it to snack on.

Other things that may kill you are metabolic imbalances (loss of proteins, magnesium, phosphate, potassium); and hypothermia (one that’s particularly interesting for the arctic) (Carter, 2022).

Since the skin is a barrier against infection and for thermoregulation, these things will keep being an issue even further in the healing process. The deeper the burn, the greater the infection risk (Jeschke et al., 2020).

III: What you should do : comparing historical burn management to current day wilderness options (it’s unfair to compare them to hospital care when they barely have a doctor)

Get it wet. Running water or wet bandages works. Ice or ice water have worse outcomes on the healing.  The goals are to clean the wound, limit the “spread” of the burn, and limit pain. Wet bandages are the one thing that will help pain: otherwise, you want no air nor friction on it (Bitter & Erickson, 2016).

Give fluids (re: hypovolemic shock if the burn is deep/large enough). If you don’t have IV’s, drinking will do in small sips (water+salts). If the mouth is not an option you can shove it up their ass, aka proctoclysis (Jeschke et al., 2020).

In the 1800s, physicians were aware of the dehydration issue: one physician recommend giving ice chips to melt slowly, or small amounts of carbonic acid water (Hattery et al., 2015).

Dress the wound with something that lessens bacteria and retains moisture. Honey has pretty good evidence going for it!

In the 1800s, they had different recipes depending on physician’s preference: olive oil and limewater, a liniment of turpentine, a saturated solution of the carbonate of soda… (Hattery et al., 2015). It’s unclear if a dressing was applied after the solutions .

Pain management: historical options are mostly brandy and opium (Hattery et al., 2015). Hot .

As needed, someone should perform debridement, AKA cutting off dead tissue to help the rest heal.

IV: Life Took The Lemons Away -add scurvy to the mix

A burn heals in 4 overlapping phases:

Haemostasis in the first 24 hours (blood vessels shrinks and clotting happens), Inflammation in the following week/month (removal of debris and release of growth stimulants), then proliferation (new connective tissue grows) and, finally, remodeling (Jeschke et al., 2020).

BUT. IF YOU HAPPEN TO HAVE SCURVY. You can’t synthesize collagen. There is no new connective tissue created (Maxfield et al, 2023). Your burn will stagnate in the first stage. Added to that, a vitamin D deficiency weakens your immune system (Maxfield et al, 2023), so the pre-established infection risk just got that much worse. Nice!

Sources:

Carter, D. W. (2022, november 3). Burns. Merck Manual Professional Edition. https://www.merckmanuals.com/en-ca/professional/injuries-poisoning/burns/burns?query=burns

Bitter, C. C., & Erickson, T. B. (2016). Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings. Wilderness & Environmental Medicine, 27(4), 519-525. https://doi.org/10.1016/j.wem.2016.09.001

Hattery, E., Nguyen, T., Baker, A., & Palmieri, T. (2015). Burn Care in the 1800s. Journal of Burn Care & Research, 36(1), 236-239. https://doi.org/10.1097/bcr.0000000000000112

Jeschke, M. G., van Baar, M. E., Choudhry, M. A., Chung, K. K., Gibran, N. S., & Logsetty, S. (2020). Burn injury. Nature Reviews Disease Primers, 6(1), 11. https://doi.org/10.1038/s41572-020-0145-5

Maxfield L, Daley SF, Crane JS. Vitamin C Deficiency. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493187/