JRA and with burns, what pain control can be done?

[ghurty]

A family friend asked me about this the other day, and I did not know what to tell him:

He has a kid that suffers from JRA(Juvenile Rheumatoid Arthritis), and the kid received 2nd degree burns (not extensive).

But the problem is as follows: being that he has JRA, he cannot tolerate cool water, even the slightest amount caused extreme pain. Also he could not take any over the counter pain medications because they would interfere with his JRA drug treatment.

So I have two questions:

In the field, if I were to be called to such a situation, what can I do to help relieve the pain (beyond DSD)

Two: In this case, what could have the family done?

Any one have any experience with JRA?

THanks

[Scaramedic]

1. Depending on his pain level, MS.

2. At minimum take him to see his Pediatrician, let him make the decisions for care.

What's DSD?

[Dustdevil]

What's DSD?

Dry sterile dressings, which I would avoid because they would aggravate the pain and not really serve any function in the emergent period.

Back in the day, we used non-menthol shaving cream to cover burns. It provides a barrier between the burn and the environment, relieving some pain (probably not much, but better than nothing), preventing some fluid loss by evaporation, and it comes off very easily. I haven't seen anybody recommending that in nearly thirty years, but given this particular scenario, I can see a potential benefit to it.

Of course, could you not use water that was not cool? Nine months out of the year, all fluids in Texas ambulances are warm, to say the least. Although, once applied, they become cool through convection.

[firedoc5]

Dry sterile dressings, which I would avoid because they would aggravate the pain and not really serve any function in the emergent period.

Back in the day, we used non-menthol shaving cream to cover burns. It provides a barrier between the burn and the environment, relieving some pain (probably not much, but better than nothing), preventing some fluid loss by evaporation, and it comes off very easily. I haven't seen anybody recommending that in nearly thirty years, but given this particular scenario, I can see a potential benefit to it.

Of course, could you not use water that was not cool? Nine months out of the year, all fluids in Texas ambulances are warm, to say the least. Although, once applied, they become cool through convection.

"Back-in-the day". Geesh that makes me feel older....We were instructed to use that about 25 yrs. ago. One argument one of the other older ER docs was that was it worse to use "cooler" sterile water and lessen chance of infection and even though cause more immediate pain (even when when MS was given) or to have less pain at the time and chance an infection days or weeks down the road?

Different docs, different school's of thought, etc...?

[NYAEMT-I]

There are many different classes of JRA. My Daughter was diagnosed with polyarticular JRA at age 2.5. We did the complete drug regimen starting with the Motrin every 4-6 hours to control it, culminating in Enbrel 50mg injections once a week. There are different drug classes that are usedd to control this in kids. The first step they normally take is just simple anti-inflammatory drugs such as Naprosyn.The second step is called a Disease Modifying Anti-Rhemaitc Drug (DMARD) such as methotrexate. The third step for us was a Biologic Drug that depletes the immune system such as Enbrel, Humira and there is one other I think. When she was on Methotrexate she was unable to have acetaminophen due to the over stressing of the liver (excuse me if I am off a little on this she is now almost 9 and has been in remission for over 3 years). Then when she was on the Naproxen she couldn't have the ibuprofen due to it being processed in the same area of the body. There were certain anti-biotics that she couldn't have at this time either. Bactrum was a big one. I can't remember why though. Enbrel made her really susceptible to Pneumonia and all kinds of infections. As far as dealing wth JRA in the field, I would consult Medical Control to see what they want you do for the pain control part of it. There are a lot of drug interactions that these kids can have depending on what medication they are on to control the JRA. The parents should have a number for the childs rheumatologist so that the doctors can call and confer over what they think needs to be done. My daughters pedi also never hestitated to call the Rheumy to confer about care when they thought it was neccessary. If you have any other questions about JRA feel free to pm me.

Take Care

Em

[zippyRN]

the obvious answers are opiates and /or nitrous

as well as careful cooling then clingfilm on the burns

[Richard B the EMT]

Non menthol shaving cream?

I'm doing EMS at BLS level for 34 years, and have to admit, for any purpose, THAT was a first.

And again, I ask the unanswerable questions of, Why would anybody put butter on a burn, as 1) won't there be pain on trying to remove the butter, and 2) why would one want to sautee a burn?