He seems to be in good spirits, that's good.
'Oh wow, I never knew it was just that easy to get burned through all that equipment.' I say legitimately astonished, 'Forgive me though, I'm completely ignorant to how most of the protective equipment works and what the weaknesses are. Eitherway...I'm sorry this happened, I'm sure the last thing you wanted to do today was be here today.'
'Anyway, lets take a look at this thing.' I say as I get up from the stool.
*I see a loose cover over the right upper arm.*
That must be it.
'Is it your right side?' I ask as I move to the right arm. He confirms.
*I put on a pair of gloves and carefully start removing the cover over the burn area.*
'What's your pain level like?' I ask. 'On a scale from 0 to 10? 10 being unbearable.'
The cover comes off, revealing the burn. The whole thing is about 6cm in diameter, probably a little bigger than the palm of a hand. The core of the burn, which is the worst part is pale and almost waxy looking, with dark spots intermingled with it. It measures about 2-3cm. Around the central part of the burn is a larger area of red, raw looking flesh with curled thin peices of singed skin scattered about. It looks like they're starting to form tiny dew-drop like blisters.
How is he not in pain? He's probably still running on endorphins or adrenaline. The central part is definitely looking like a mix of deep dermal and full thickness, while the outer edges are partial thickness (2nd degree) fading out to superficial (1st degree) burns. He must be still running on either adrenaline or endorphins. While the full thickness burns typically don't hurt, the surrounding second and first degrees typically do. He's a tough guy, but I'm sure being exposed to open air right now isn't good feeling.
'Well....you got yourself pretty good here.' I say.
'Is this the first time you've ever gotten injured on the fire ground?' I ask trying to distract him a bit.
*I press on the inner portion of the burn. The central area does not blanch, it stays the same color. The outer area does blanch a little. He flinches.*
'Sorry about that.' I say as I continue.
Central portion is more than likely full thickness, outer edges are not. Lucky for him this is mostly 2nd and 1st degree
'You were wearing you full protective equipment? Your BA?' I ask.
'So you got burned, and were able to get out of the structure on your own?' I ask trying to make sure I understand the whole situation.
'You didn't get hit with debris, ot get knocked out or anything?'
*I begin checking his pulse in the burned arm and the uninjured for comparison.*
Good strong pulse. No vascular compromise. That's good.
*I grab a cotton swap out of on of the drawers in the room*
'Okay, close your eyes for me.' I say. 'Now I'm going to lightly touch you at different spots on your arm. Just tell me where i'm touching when you feel it.'
*With his eyes closed I begin touching the middle aspect (unburned) of the burned arm, then his outer and inner forearm and the palm and dorsum of his hand. I conclude with an unburned portion of the outer upper arm just below the burn injury. He is able to correctly and immediately identify each spot I lightly rub with the cotton tipped applicator swab.*
Good, neuro is intact.
*I place two of my fingers into the palms of both of his hands.*
'Okay now squeeze my fingers' I say
*I flex his lower arm to 90 degrees and have him pull towards him and push away. Both appear to be at least a little painful, probably because of the tension the contracting muscles are putting on the burnt skin.*
Good motor strength. I'm not worried about a compartment syndrome. Things are not looking too bad.
'Are you breathing okay? No coughing? You didn't inhale any smoke or get any fire or extreme heat in your face did you?' I ask as I reach for my stethoscope.
*I have him take some deep breaths as I listen to his lungs*
*I listen to heart sounds.*
Regular rate and rhythm.