Post created by Rachelle
My mom and I have been watching the show ER on Hulu. The show follows fictional doctors and nurses at County Hospital as they care for patients with all kinds of ailments and emergencies. One of the cases that recently stuck with me was a woman who tried to commit suicide by lighting herself on fire in the Emergency Room parking lot. She was completely consumed in the flames for about a minute before the doctors and EMT’s nearby were able to pull her out and put out the flames. The woman’s skin looked black and leathery, almost like the leftover ashes of a newspaper. The doctors brought her into the trauma room and began treatment immediately. This was horrifying to watch, but also intrigued me because it seemed crazy that the doctors would even try to treat this woman after she was literally on fire for what seemed like long enough to kill her. It seemed especially interesting now that we are talking about the integumentary system. So, I decided to do a little research to figure out how emergency room staff go about treating something like that.
According to the doctors, the woman suffered third degree, or full thickness burns over 90% of her body. Third degree burns that destroy both the Epidermis and the Dermis of the skin, even reaching far enough to affect the nerve endings. Often the person does not experience any pain with these burns because the nerve endings are destroyed and therefore not able to send signals to the brain. In order to determine the amount of body tissue affected, the doctors use what is called the “rule of nines”. This rule splits the body into different sections, each with a corresponding percentage for how much of the overall tissue it represents. For example, the anterior of one leg represents 9% of the body, the anterior of the torso represents 18%, and so on. The greater the percentage, the greater the risk of death or permanent life-changing damage.
The first thing the doctors did to treat the woman’s burns was to put sterile dressings on them.
Burns start out sterile and must be kept that way to protect the body from infection, and they must be kept moist in order for the body to heal well. While the doctors on the show did not explain what kind of dressings they used, I found one that was interesting that I will share here. Nanocrystalline silver dressings slowly release silver, which is toxic to the infectious bacteria, into the burned skin. This helps keep infection at bay for a longer period of time, which is important when the burns are so sensitive and cannot handle as many dressing changes. It is best to put a wet dressing over the top of the Nanocrystalline to keep the area moist. This top bandage can be remoistened as needed to keep the skin from drying out. After about 48 hours, the burn is reassessed as a lot of change happens in that time, and further dressings and bandages will be applied as deemed necessary. Third-degree burns take close to a month to heal (or longer) and often leave deep, hypertrophic scarring behind as well as affect the range of motion depending on where the burn occurred.
Going back to the woman on the show, one of the doctors felt it was unnecessary to continue to treat her because she wanted to die and because the extent of her burns would most likely cause her body to get septic, ultimately leading to her death. Sepsis occurs when the body overreacts to an infection with an overwhelming inflammatory response. This can come on suddenly and cause life-threatening problems internally. The biggest issues are blood clots and leaking blood vessels, which can lead to septic shock that causes cardiovascular issues and ultimately death. Sepsis works fast, often taking only 24 hours to destroy the body beyond repair. Making things worse for the woman, she had burned her throat, which meant that she could not breathe well on her own. The doctors tried to put a tube in her throat that would ultimately be hooked up to a ventilator that would breathe for her until she healed, but she refused because she wanted to be able to say goodbye to her son, which she could not do with the tube.
While the doctors do say, and my research confirmed, that the woman had about a ten percent chance of survival due to recent medical advancements, the likelihood of her getting through the first stages of healing without getting septic were very small. If she had accepted treatment and survived, she might have come through after a long journey of skin grafts and other treatments to patch her skin back together. In the end, she did not accept treatment and most likely died from her inability to breathe well on her own, though they did not show her death. The last we saw her she asked a nurse to write a note to her son for her before she died.
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