Monday, June 17, 2013

Series Post: Ask Dr. Dina - Burns

ETA - Regular reader and eviltry fan Robert Morris is offering a SHINY in the comments! Be sure you read them and see if you can spot the evil!

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance! 


FIRE FIRE FIRE! Yeah yeah! Huh huh heh heh huh huh….

In case you haven't figured it out by now, this post is going to be about burns.

Now, you don't necessarily need fire to burn yourself, but heat is generally the norm when it comes to searing your character. These are called "thermal" burns in medical speak.

Other ways your character can taste burn-y include chemical, radiation, and electrical. (I know, you'd think electrical burns are thermal burns, and technically you'd be right, but they do a different kind of damage than thermal burns, so get a category of their own. Different types of burns do different types of damage. Lemme 'splain.)

Here. Have a helpful chart. The post below is basically what that chart says, only more with the words and not so medicalish. Onward!

Thermal burns are what people think of most often when they hear "burn." Medical people complicate things (okay, differentiate) by sorting thermal burns by what caused it and what damage was done.

Thermal burns include:

Flash burns - literally just that. Done in a flash. An instant. BOOM. (BADA BOOM!) Explosions of any kind can cause them, such as natural gas, compressed gasses like propane, or other flammable liquids like gasoline and lighter fluid.  A lot of heat for a tiny window of time (that will seem like an eternity to the one experiencing it, OR they might not even notice they got burned, it was so fast). SOMETIMES clothing will protect you from flash burns, unless it catches on fire. Then you're going to notice the burning part. Ever singed your hair or eyebrows over a barbecue when you opened it to a giant ball of flame? Congratulations. You've experienced a flash burn.

Flame burns are what most people think of when you say "burn." Flame burns are you on the barbecue. It's fire, plain and simple, and how hot that fire burns depends on what it's got feeding it. Oil burning is a lot more dangerous than wood or paper because it's a liquid and water doesn't do anything but spread it around. You need to smother oil with powder, foam, or anything to wipe it away. House fires, charcoal grills that use lighter fluid, smoking around a can of hairspray, car wrecks, clothes or blankets catching fire from stoves or heaters…there are a LOT of ways to burn yourself the good old-fashioned way.

Scalds are caused by hot liquids. We've all burned our tongues on something hot that we've eaten or taken a sip of. That pot of coffee that just finished brewing? 180 degrees Fahrenheit, baby. 82.2 Celsius. Now, some people like it that way, others wait for that shit to cool off a little before they take a sip. (Personally I think coffee drinkers weird for drinking coffee in the first place. You want to play tough, drink tea like I do. Tea is brewed at anywhere from 176 F [80 C] to 212 F [100 C or boiling]. Just sayin'.) Water at 140 F (60 C) can cause a second degree burn in three seconds. That same water, heated to 156 F (68.8C) will cause the same injury in one second.

Not a whole lot of difference there. You've noticed, I'm sure, how much cooler (or warmer) your house feels when the temp changes either way by only a couple degrees. The same is true of burns. The intensity of the heat and length of exposure are crucial, and seconds can make the difference between a first and third degree burn. More about the degrees of burns in a minute.

We've all had what are called contact burns. These are what happen when you touch something hot – a Crockpot, stove-eye, the dashboard of your car or the leather seats when you sit on it in short shorts in the summer, bare feet on hot sand…. Again, millions of examples. Also again, the degree of the burn depends on how long the contact was and how hot the object was. Most people jerk their hand away from something hot they've touched almost instantly (there are some medical conditions that keep people from feeling temperature changes and pain, but we're not talking about those right now), so contact is usually minimal, but occasionally you can't move fast enough, are pinned against something, the heat welds your hand to the object…you get it.

Let's talk a little about degrees of burns. You hear it all the time on TV. Most people know that third degree burns are the bad ones. And yeah, they are, but really, ALL degrees of burns are bad. Just because something is first degree doesn't mean it won't scar or that it won't get infected (yes, burns are wounds, either open or closed, and they can get infected in a number of ways - more on that when we talk about infection).

First degree burns are the superficial ones. They only involve the outermost layer of skin - the epidermis. It's red, but there aren't any blisters. It hurts and takes a week or two to heal. Most sunburns are first degree burns.

Second degree burns are just what they say - they move into the second layer of skin. These usually have blisters, and blanch (turn from red to white/go bloodless) when you apply pressure to them. Sometimes they hurt, sometimes not, and usually take anywhere from two weeks to two months to properly heal, if they don't get infected. Some sunburns are second degree. (Blisters, it's second degree.)

Third degree burns go through all the layers of the skin. It's stiff and white and doesn't blanch at all. They generally don't hurt at all (because there aren't any nerves there to conduct pain) and will take months to heal, if ever. They require surgery and a vast amount of treatment.

You don't hear about it a lot, but there is a fourth degree of burn. These burns go all the way through the skin, muscle, and bone. They're black and charred and there's no fixing these. They don't hurt (there's nothing there to hurt), they don't bleed, and they always require surgery - usually amputation - if, and only if, the person burned this badly survives.

Burns cause a lot of damage, not just to the part that was burned. Which leads us into the types of non-thermal burns.

Chemical burns are a complete bitch. These are caused by strong acids or alkali. These are a bitch because even after you get the chemical off or out of you, they continue to cause damage until whatever's doing the damage is rendered inert. Alkali substances usually cause more severe injury since they react with the natural oils in your skin and don't wash off with water. They literally seep into your pores. Examples are battery acid, bleach, ammonia, toilet bowl cleaner…basically any fucking chemical you can think of. You ever heard of a MSDS form? Most places that use chemicals are required to have one on file for EVERY SINGLE CHEMICAL THEY HAVE ON THE PREMISES. Even shit like hydrogen peroxide. Sure, basically harmless, but still. You get that shit in your eye, you're not gonna like it, and a MSDS sheet says everything about what that chemical does and how to deal with it if anything happens involving it.

Electrical burns are exactly what they sound like. It's contact with electricity. Remember when I said they were also thermal burns? They are, only they're from very high heat. Electricity burns a lot hotter than fire in a lot of cases and does a lot more damage. Sources of electricity range from the AC power in your house to DC power found in solar cell panels. (Hint – DC [direct current] is lower voltage than AC [alternating current]. This little bit of info is what pissed Thomas Edison off and led to the invention of the electric chair. I shit you not.)

Now, electric current isn't picky. That shit goes wherever it's easiest to go, and hurts like motherfucker. The contact/entry site/stingy part is the LEAST of your problems. Electric shock can stop your heart, (what did I just say about the electric chair? This is also why they use electricity to start it again, called "defibrillation." Pacemakers also use tiny electric shocks to "shock your heart back into rhythm."), fuck up your brain, screw with your motor function…anything to do with your body's own electrical system (yes, you have one, after a fashion) can take a hit. You can't tell by looking how badly you're hurt when you've taken a literal shock to your system, so you get shocked, you get your bitch-ass to a hospital NOW so they can check you out. Now, I'm not talking about little static discharge shocks like when you scuff your feet across a carpet and touch a doorknob. Everyone does that, and yeah, it's annoying and uncomfortable, but that's not going to hurt you. It will just piss you off enough to take the maintenance man's drill to the doorknob like a gangsta. (Beating up the printer is another issue.) I'm talking high voltage, which is more than 1,000 volts.  You wouldn't think of a lightning strike as being low voltage, but in reality, yeah, they are. Most lightning strikes are under 1000 volts. Also, it's the speed of lightning strikes that's the key issue, not the voltage. Lightning strikes are fortunately rare, and while the aftereffects of them can be highly intense and very interesting, none have been known to convey actual real-life superpowers. To date, anyway.

Now we'll move on to the last type of burn.

A lot of writers get into trouble when they use radiation for things, because of comic books and movies. Radiological burns are caused by…you guessed it…radiation. All kinds. Alpha, beta, gamma…all of them will burn you. Most of them require decontamination to cope with before they stop burning, then there's radiation sickness to deal with. Now, like anything, radiation can be used for good or for evil. The place in the hospital where you get your MRI, CT scan, ultrasound, or X-ray? Radiology. (Many people confuse nuclear medicine with radiology, when actually the two are in the same area. Nuclear medicine is a division of radiology, not separate from it.)

High doses of radiation can, quite literally, melt your face off. But that's an extreme example, and you kind of have to be in the middle of a nuclear fallout in order for that to happen.

Most of us have had radiation burns before. We just call them something else – sunburn. Yep…the sun delivers ultraviolet (NOT "ultra violent") radiation in varying dosages in different parts of the world, and if you're not careful/are exposed too long, you'll get a sunburn. (Or tanning booth burn.) Welding can also deliver this type of burn. Cancer patients sometimes go through external radiation therapy, and radiation burns are sometimes a side effect.

Radiation burns need to be kept in mind most frequently for writers, because they're so easy to get. Have a character baking in the sun? Give that bitch a sunburn and some aloe vera. (Hint: people of all skin pigmentation can get sunburn. It's just more noticeable on those with fair complexions. It hurts everyone equally.) Have a character working as a welder? Sparks fly. Literally. And they hurt on bare skin. Next time you meet someone who welds, look at their arms. You'll see a series of little round scars – these are burn scars from sparks.

And there you have it. Lots of ways to torment your poor character via burns. Maybe they get in a hurry and burn their tongue on a hot cup of tea. Maybe they stay out in the sun too long. Maybe they have cancer and need radiation therapy.

If you have your character run into a burning building for whatever reason you've got them doing that, they may get burned in addition to smoke inhalation, falling debris, chemical exposure...

...but that's a post for another time.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)


  1. See! I am telling you she is beyond evil. Dina James is to be feared. Why?

    Look, it's simple. She's scary, her blogs are scary, 'Cuts and Punctures', 'Burns'. We all know somewhere at her place there's a pig carcass hanging in a well lit soundproof shed that was used to practice for the blog, like on Mythbusters. Except with her, you are not quite sure it was a carcass when it was hung up, I mean you just know she's also researching blood splatter. And the latest 'Burns'? Just imagine the smell. And you just hope it was a pig, but with her love of animals ...?

    Look at her book covers for 'Time Heals' and 'All Wounds'. Simple straight forward, no images to mislead, just a plain cover that has an inquisitive 'Open this book and read me' feel. Yet, there's that slasher movie whisper in your ear, 'Don't open this book.' I mean you could end of up with your eyes ripped out, your throat slashed.

    Given her depth of eviltry it could be a high level spell jammed in your brain forcing you to wander the armpits of odd geometric worlds sustained by reptiles and pachyderms, or find yourself with some sort of alien down the gullet laying a future regurgitating embryo, or a magog egg shoved up a nasal orifice or something crawls in your ear and your her minion forever or at least until the next sequel without Ricardo Montalban.

    So nope, not reading her books, too scary. I don't think I can afford the nightmares. For Satan's sake the woman admits to knitting possessed caps for kids! Her friends kids.! They put them on can't take them off! Just read her Blog and Tweets. You can feel the Evil riding the photons right into your eyes, like you are a geeky ensign in a bad episode. I'll buy the books as a sort of offering to her realm, but read them? No way.

    For fun identify all the 5 SF&F genre references (Book Series, Movie, TV Show...), First one to post correctly gets a free Dina James book via Amazon courtesy of me. #shewhomustnotbenamed picks the possessed book for you to receive. #shewhomustnotbenamed may chose to add or modify this offer at her whim.

    1. Blood spatter expertise - Dexter
      Don't open book - Evil Dead
      Future regurgitationg embryo- Alien Trilogy
      Magog - Andromeda
      Ear bug- Star Trek Wrath of Khan
      Ricardo Montalban reference -Star Trek Darkness Rising
      Geeky ensign reference - Original series Star Trek
      Geometric Worlds--could be a loose reference to the Douglas Adams Hitchhiker Books

      (Guess you are a Trekkie)

    2. This comment has been removed by the author.

    3. Shannon wins!!! 10 days 3 out of 5 responses and bonus is close enough for me.

      Here are the full references.


      Beavis & Butthead - (that one is obvious)
      Simpsons - "It tastes burny!"
      Princess Bride - "Lemme 'splain."
      Fifth Element - "BADA BOOM!"
      Office Space - carpet static/removing doorknob/smashing the printer
      X-Files - superpowers endowed by lightning


      high level spell jammed in your brain forcing you to wander the armpits of odd geometric worlds sustained by reptiles and pachyderms - Discworld,

      Future regurgitationg embryo- Alien Trilogy

      Magog - Andromeda

      Ear bug- Star Trek Wrath of Khan

      photons right into your eyes, like you are a geeky ensign in a bad episode - STNG (Crusher video game..)

      and last shewhomustnotbenamed H Potter

      Shannon contact me at to collect if you have a preference on which of Dina's books let me know. She might go with it.

  2. Please note, #shewhomustnotbenamed has added a few cultural references of her own. 3 SF/F and 3 other cryptically included her blog above. (Because she is evil, remember)

    You have to get all of mine and at last three of her's too, but now shipping (even international) is included.

    (Okay I hope by now someone spots the extra reference I tossed in as a bonus)

  3. I'm not gonna enter, because I HAVE read all her books. Just putting in my two cents worth to say you NEED to read Dina's books, because they are AMAZING. So go for the shiny people, it's better than getting stabbed with a knitting needle.

  4. Electric burns are nasty, nasty things. Treated a cat that was climbing power poles - he came in initially with burns in the pads of 2 feet 1 front, 1 back) after being out overnight.

    Over the next 72 hours, his entire front leg went stiff and cold, and the skin in a big patch over his thigh went leathery and dry.

    In the 48 hours after that, the skin of his thigh sloughed off, revealing cooked muscle underneath (yes, as a matter of fact, cooked cat DOES smell a bit like pork, and the meat is white). The tendons of the front leg contracted, so his front leg became a stiffly curled, cold, dead chunk.

    At that point his owners opted for euthanasia because of the probability of the hind leg dying entire also, and what do you do with a cat with no legs on one side?

    Pretty dramatic changes from initial apparently superficial "wonder what he stepped on" injury to full development of changes due electric current through tissue. Given the extent of the changes, I'm sure that the cat would have hit the ground dead instead of burned had the contact been front leg to front leg (and thus across the heart and vagal nerve) instead of front leg to back leg.

  5. Hey - I'm sure you have a list of topics a mile long, but what are the chances you'll be doing a Dr. Dina on the b.s. of "instant anesthesia"? :D

    1. I hadn't planned on that one, but I'll add it to the list! Your comments are so helpful, thank you!


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