Burns are pretty horrible, if you ask me, and also very interesting. I'm going to explain the classifications of burns and how to write them.
General Info
The first 48 hours after the burn is the most critical point, and has the most impact on patient outcome
You can use the "rule of nines" to determine the extent or total body surface area (TBSA) of the burn. This is important to assess damage and risks
Burns covering more than 20% of TBSA are pretty fucking bad, and you're gonna probably need some intensive support
This amazing inflammation system we have can lead to shock and the coagulation of the blood = very bad, possible death
A day or so later, the patient may develop acute respiratory syndrome due to inhalation of hot air (depending on the mechanism of injury)
Burn Classifications
Superficial Burns (1st degree)
These are painful, red areas that are not initially blistered
There is not significant worry about electrolyte loss or prognosis
May convert to deeper burns if there is treatment delay or infection
Partial Thickness (2nd degree)
These can be superficial or deep
Superficial 2nd degree burns are blistered, and will look pink and wet
Deep 2nd degree burns are blistered, and will look white and wet. They will also begin to bleed if you mess with them
2nd degree burns are very painful, as nervous structure is still maintained in the skin
Full-thickness Burns (3rd Degree and Up)
These result in a loss of skin structures, such as the hair follicles and sebaceous glands
They can look whitish-yellow or be black/charred
The skin will be hard and dry, and will not bleed if you start messing with it
These aren't as painful, as large areas of the injury will have lost nerve structures
4th degree and up cause damage to tendons, muscles, and bone. These are some of the worst injuries, in my opinion.
Treatment
Deep partial-thickness and full-thickness burns are probably gonna need debrided (removal of unsalvageable tissue). You may even need to cut out some bone if it was burned (otherwise you get necrosis - aka rot). Then some good skin will need to be grafted on top
Nonsteroidal anti-inflammatories (like ibuprofen) and opioids are used in pain management (depending on the severity of the burn). Or you can give ketamine or block nerves if it is really bad
Gonna want to get some fluids in severe burn patients
For full thickness burns, you may have to make escharotomy incisions. This means cutting large incisions in the skin to relieve the pressure made by the formation of eschar (a thick tissue that can constrict blood supply)
There's also fasciotomies, which are incisions in the fascia (connective tissue) of the muscles to allow them to expand and swell without damaging the soft tissue, nerves, and vessels of the arms and legs
A topical antibiotic may be useful, such as silver sulfadiazine. Silver nylon dressings are also a great choice. The burned areas should be cleaned daily, as well
Critical burn patients may need more intervention. They will have difficulty maintaining body temperature, so the room can be heated so they don't get too cold. Usually they can start eating (aka using the GI tract) about a day after injury. But you can start nutrition via IV immediately
Complications
Electrical injuries can cause burns to the deep tissues without significant findings on the skin. They can also cause cardiac arrhythmias
Pancreatitis and stress ulcers occur in severe burns
Abdominal compartment syndrome is a potentially lethal condition in severely burned patients, due to the buildup of pressure
Multiorgan system failure is a possibility
Most burn patients get an infection as some point in their recovery, and many have multiple bacterial infection episodes. If this is not fixed, they can develop sepsis
Writing Burns
Focus on what caused the burn. The mechanism of injury is very important. House fires (smoke inhalation), electrocution (arrhythmia), and chemical burns (leeching into the blood stream) all have different things we need to worry about
Figure out the thickness. The mechanism of injury is important here, as well. Touching a hot stove for a second doesn't give someone 3rd degree burns, but mustard gas can. Look up the specific situation you want and try to find information of that (like pictures, accounts, etc.), as every burn situation is a little different
Figure out what you want treatment to look like. If treatment is a bigger part of the story, give a more severe degree of burn, and throw in some complications. People love that stuff (well, certain people do)
For more severe burns (3rd degree and up), don't fall into the trap that they aren't painful. These injuries are insanely painful. Just because someone does not have sensation in the area that was fully burnt, does not mean the rest of their body is untouched. Burns radiate out into less thick areas. So the edges of the wound will be very painful. Their body is also in a really bad spot, leading to pain that isn't as acute or localized.
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my dad likes to call the stretches of time where youāre not creatingĀ ādreaming periodsā and says that theyāre meant to allow you to absorb all of the beauty, life, and inspiration from the things around you so that when youāre able to create again, you will have fanned your spark back into a flame. sometimes its hard to see those moments as anything but stagnation, but he always says that theyāre natural and healthy and neededāthings that should be embraced rather than feared.
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theme: the reoccurring idea or subject in a work of art. Death, life, rebirth, change, love, what it means to be human, the definition of family, the effects of war, etc.
motif: a distinctive repeating feature or idea, such as the green light in The Great Gatsby. May overlap with tropes and is often used to further explore the theme.
if you support donald trump unfollow me. full stop. hopefully no trump supporters are dumb enough to think theyāre welcome here, but seriously. gtfo my page. block me while youāre at it.
āOne of the things I try to do: memorize the smallest, most mundane and ordinary, unprepossessing, and virtually invisible of physical moments: the look and feel of a certain wall at a certain time on a certain day. Those walls, those little shacks, those cats in the sun: all that is lacking in self-consciousness I seek to hold in vision, memory. (Simple composition, color tints, a wash of light, crumbled brick, cold shadow, stillness, rose-color dirt, a twitching whisker.) Not knowing why, but thinking I may want it later, I try to keep it and I never can.ā
ā Michelle Anderson-Binczak, section āChiaroscuro,ā in āThe Blue-Green Seas of Forever,ā FragLit (Fall 2007, no. 1)
Hello! Iām thinking of making an animation with this poem, so reply to this with any of your favorite techno moments/memories :) (and provide timestamp if itās possible)
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āFragrance has always been next to holiness to me, in different ways ā my casual visits to Churches and my hours in temples. I thought my nose was broken everywhere else: I couldnāt smell food, it held no memory, but I could divine the smell of Gods. They smelled to me like incense and still water.ā
ā Arabelle Sicardi, Perfume, Power, and GodĀ (via lesgardenias)
Easiest notes I've ever gotten I feel like I'm cheating it's like throwing a steak in a pit of lions it's like throwing bread in an overstocked koi pond
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Check out āBarry Lyndonā, a film whose period interiors were famously shot by period lamp-and-candle lighting (director Stanley Kubrick had to source special lenses with which to do it).
More recently, some scenes in āWolf Hallā were also shot with period live-flame lighting and IIRC until they got used to it, actors had to be careful how they moved across the sets. However, itās very atmospheric: thereās one scene where Cromwell is sitting by the fire, brooding about his association with Henry VIII while the candles in the room are put out around him. The effect is more than just visual.
As someone (I think it was Terry Pratchett) once said: āYou always need enough light to see how dark it is.ā
A demonstration of getting that out of balance happened in later seasons of āGame of Thronesā, most infamously in the complaint-heavy āBattle of Winterfellā episode, whose cinematographer claimed the poor visibility was because āa lot of people donāt know how to tune their TVs properlyā.
So it was nothing to do with him at all, oh dear me no. Wottapillock. Needing to retune a TV to watch one programme but not others shows where the fault lies, and itās not in the TV.
*****
We live in rural West Wicklow, Ireland, and itās 80% certain that when we have a storm, a branch or even an entire tree will fall onto a power line and our lights will go out.
Usually the engineers have things fixed in an hour or two, but that can be a long dark time in the evenings or nights of October through February, so we always know where the candles and matches are and the oil lamp is always full.
We also know from experience how much reading can be done by candle-light, and itās more than youād think, once thereās a candle right behind you with its light falling on the pages.
You get more light than youād expect from both candles and lamps, because for one thing, eyes adapt to dim light. @dduaneā says she can sometimes hear my irises dilating. Yeah, sureā¦
For another thing lamps can have accessories. Hereās an example: reflectors to direct light out from the wall into the room. Iāve tried this with a shiny foil pie-dish behind our own Very Modern Swedish Design oil lamp, and it works.
Smooth or parabolic reflectors concentrate their light (for a given value of concentrate, which is a pretty low value at that) while flatter fluted ones like these scatter the light over a wider area, though itās less bright as a result:
This candle-holder has both a reflector and a magnifying lens, almost certainly to illuminate close or even medical work of some sort rather than light a room.
And then thereās this, which a lot of people saw and didnāt recognise, because itās often described in tones of librarian horror as a beverage in the rare documents collection.
There IS a beverage, thatās in the beaker, but the spherical bottle is a light magnifier, and Gandalf would arrange a candle behind it for close study.
Hereās one being used - with a lightbulb - by a woodblock carver.
And hereās the effect it produces.
Hereās a four-sphere version used with a candle (all the fittings can be screwed up and down to get the candle and magnifiers properly lined up) and another one in use by a lacemaker.
Finally, hereās something I tried last night in our own kitchen, using a water-filled decanter. Itās not perfectly spherical so didnāt create the full effect, but it certainly impressed me, especially since Iād locked the camera so its automatic settings didnāt change to match light levels.
This is the effect with candles placed ānormallyā.
But when one candle is behind the sphere, this happens.
Ā It also threw a long teardrop of concentrated light across the worktop; the photos of the woodcarver show that much better.
Poor-people lighting involved things like rushlights or tallow dips. They were awkward things, because they didnāt last long, needed constant adjustment, didnāt give much light and were smelly. But they were cheap, and thatās what mattered most.
Theyāre often mentioned in historical and fantasy fiction but seldom explained: a rushlight is a length of spongy pith from inside a rush plant, dried then dipped in tallow (or lard, or mutton-fat), hence both its names.
We wade into a blackened pond to save
the dying water.
The water isnāt dying
āwe know, we knowāitās the fish and frogs
starving, pushed out
by subsurface growth.
Still, thatās how they put it to us,
our new neighbors
whoāve come to watch
their new neighbors
cope with a stagnant, weedy,
quarter-acre runoff swamp.
They say, let it go, by which they mean
(this from Scott, cut
like a side of beef,
six-pack belted like a holster to his pants)
itās Godās will, or natureās, and besides
itās too much work,
to which his father John, bigger, beer-
gutted, bald scorch of a face, plops
on our dock and says You
got that right. At first we tried sprinkling
chemicals around
the darkening perimeterāto wit,
copper sulfate penta-
hydrate (CuSo4ā5H2O),
used variously as
a micronized fungicide in pellets,
a crystalline pesticide ānoted
for acute toxicity in bees,ā
and here, a powdery āpowerhouse algaecide"ā
or in other words (this
from John), fancy sun-block
for the water. For weeks the bottom-
black surface glowed
eerily aquamarine,
yet all that died were two fat grass carp,
lazy from the slime
they ate, who floated up
like scaly logs to petrify. Thatās why
Iām waist-deep
where my neighbors watch, rowing
with a rake through a sludge of leaves,
stirring algae in
a cooking pot, dragging it
through the muddy pool. Each time I pull a gob
of slime and glop, dark
as organs, toward shore,
John yells out, encouraging, thatās a good one,
and I shove it on to Ann
to rake up the bank
where weāll haul it off some day.
Donāt just sit there
in the willow shade,
I ought to shout. Come on. Help us out.
Or (this from Virgil,
via Corydon), why not at least
go about some needful task? But thereās
so much trouble
in the world these days
Iāve been content to work in peace
beside my wife, my lifeās
surprising love,
to keep the cardinals throbbing in our close cattails
and frogs at home
in a splash of breathable water.
Each step stirs a slick
of spreading ooze
that follows
orbital in my wake, a little nebula of oil
and algae stars. And look,
overhead the first real star
has answered back: Thereās darkness
on the way. We drag one more
sloppy mass up the bank
and see its dimming possibilitiesā
tadpoles and minnows, shiny as coins, egg-
clusters of sun perch, bluegill roeā
throbbing in the grass,
twisting to be loose, aglow
against the color of the coming night. And there go
John and Scott, down
on their knees in the grass,
untangling as many as they can to slip back
to the black pond, before the sky
turns black as well.
Thereās smoke you can see from the neighborsā chimney,
and the shadows of the hills
are lengthening as they fall.
I read one of this guyās books for my poetry class last year and got to chat with him for a bit; I think I and only one other student showed up to speak with him so we talked for a good bit. One of the things he said about meter permanently stuck itself in my headāand this is a broad paraphrase: song and poetry is often metered, and meter comes naturally to us because those regular rhythms are naturally occurring in the world around us. Two-syllable metrical āfeetā (iamb and trochee) are the footsteps of someone walking, or maybe a heartbeat. A dactyl or anapestic āfootā (three syllables) is the canter of a horse. It felt like an epiphany at the time. I think it is something to do with how such structures are considered to be āformal,ā almost contrived, but actually, they weave themselves into the concrete reality of living as easily as a heartbeat.
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