BURNED

[Doc Dutch]

You are out in the desert at a first aid station at a recreation center when a 22 year old male stumbles up to you and nearly collapses as he gets to the shade of your tent. He has been in the desert on a hiking trail and got lost. He denies alcohol or drug ingestion. He denies a trauma history on his hike. He did not take enough water with him and he lay down for a minute behind a rock because he got tired and tried to escape the heat. He lost track of time and now on the left side and posterior side of his body, legs and arms he is burned.

On initial examination he has about 4.5 percent burns on his left upper extremity (forearm and brachium), 7 percent on his left thigh plus his legs added together. These burn wounds are pink and shiny and moist with obvious skin sloughing. The rest of his exposed skin of his upper and lower extremities are sunburned. His shirt is "stuck" to his left torso (what I am suggesting is that if you remove the shirt, so will you remove skin and he cries out in pain as you try to remove it). His oral mucosa is dry and sticky. His face is starting to develop fine blisters. He complains of being "dizzy" and he feels hot to the touch. There is some minimal sweat on his skin. He tries to cry but cannot form tears. He cannot urinate any fluid.

Now what? I will tell you at this first aid station you have everything a paramedic/EMT needs but you are definitely "out in the field" and not a level one trauma or burn center. The nearest medical center is an hour and thrirty minutes by ambulance. You can call for air but by the time you call and the med-evac bird fires up and makes it to you, you may as well have placed him in the ambulance and sent him once you decide he needs to be transferred. It is about 120 degrees out there today and no good shade unless you are in-doors or under a tent and even still, sunblock is an imperative as is frequent hydration.

Thoughts?

Dutch Matthews, MD