11 - Burns Flashcards by Karlo Sison

Categorization of Burns

Tissue injuries caused by:
Thermal // Electrical // Chemical // Irradation
that results in:
Cell Death // Denaturing // Permeability // Vasodilation

American Burn Association:
Major // Moderate-Uncomplicated // Minor
determined by:
% BSA Affected + Burn Depth

“Rule of Nines”

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When to Consult a MD
for BURNS

If burn is:
Superficial Partial Thickness or GREATER
AND
Covers more than:
1% BSA

“rule of nines”

if it involves the:
Eyes / Face / Ears / Perineum

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Rule of 9’s

Legs = 9% Each

Back = 18%

Arms & Head = half of 9 = 4.5%

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Superficial Burn
Classification of Burn

Epidermis

*Local Pain**
no blisters or scars*

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Superficial Partial Thickness
Classification of Burn

Epidermis
& the most superficial portion of dermis

SEE MD

local pain / red
ELEVATED VESICLES

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Deep Partial Thickness
Classification of Burn

Entire Depth of Dermis & Epidermis

SEE MD

Extensive damage

Leathery Appearance
Infections / Scarring

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Full Thickness
Classification of Burn

SEE MD

ALL LAYERS OF SKIN + MUSCLE

Charred / Dry

Infections / Skin Grafting

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Thermal Burns

From Flame / heat / Sun / Scald

COOL TAP WATER
to prevent blister fromation
decreases EDEMA

OTC analgesic PRN

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Electrical Burns

Visible at Point of ENTRY & EXIT

Underlying tissue damage

SEE MD

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Chemical Burns

Remove Clothing
on or near Affected area

Wash area with WATER

Irrigate Eye(s)

CALL POISON CONTROL

DO NOT ATTEMP TO NEUTRALIZE THE BURN

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When to use Antibiotics for Burns?

Infections

Use ABx PROPHYLAXIS for:
Moderate –> Severe Burns

Use Systemic ABx in Rare Instances

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Cleansing Burns

Cleanse are with Water + Bland Soap

Non-adherant dressing may be applied
may use aSkin protectant / Lubricant

if a Weeping Burn:
Soak in Water SEVERAL Times daily

for superficial partial thickness burns:
Cleanse Daily

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Ideal Dressing

REMOVE excess exudate

Maintain a moist environment

permeable to Oxygen

Thermally insulate & Protect the wound

free of particulate & easily removalble

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Antimicrobial
Types of Wound Dressings

When wounds are Colonized / Infected

SILVER & IODINE

Acticoat / Actisorb / Iodoflex

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Nonadherent
Types of Wound Dressings

DO NOT stick to the wound bed
Affordable / Widely Available

Effective on FLAT wounds

Adaptic

Nexcare Pads

Release Dressings

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Primary
Types of Wound Dressings

Placed DIRECTLY on the wound surface

ABSORB Exudates

Provide Protection + Support

Telfa

Comfeel Plus

Aquacel

Secondary
Types of Wound Dressings

Provide Additional:
Absorption / Protection / Compression

can secure primary dressings to wound

Kerlix / Kling / Confrom

Specialty
Types of Wound Dressings

Absorb Moisture
Kaltostat / Repel / Melpilex / Actisorb

Maintain Moisture
Exuderm / Suresite

Provide Moisture
AzuaSite / FlexiGel

Adhesive Bandages
Types of Wound Dressings

Beneficial for SUPERFICIAL Wounds
PREFERRED by patients

Waterproof + Antimicrobial properties

Liquid Adhesive Bandages = Liquiderm

Surgical Tape
Types of Wound Dressings

Holds Bandages in place

Should be easy to remove

Clear / Paper / Cloth
Types

Dressing Burns
Types of Wound Dressings

Sterile + NON-Adherent Gauze Dressings
for Small Burns

Self-Adhesive + Waterproof
Dressings

CHANGE DRESSING DAILY

When pain subsides & healing begins –> D/C DRESSINGS

Protectants
for BURNS

Makes wound area less painful / systomatic relief

Choose a product that:
Prevents DRYNESS & provides LIBRUCATION

Alantoin / Cocoa Butter
Shark Liver Oil / Petrolatum

AAA PRN** for up to **<7 days

Systemic Analgesics
for BURNS

Aspirin / Ibuprofen / Naproxen
NSAIDS

DECREASE Erythema & Edema
especially in the first 24 hours

APAP will NOT decrease inflammation

Topical Anesthetics
for BURNS

Benzocaine & Lidocaine
MOST COMMON
benzocaine hypersensitivity in 1% of people

HIGH Conc. –> Intact Skin

low conc –> broken skin

AAA 4xDay

**Concentrations for Topical Analgesics**

**HIGHER CONC.** for **INTACT SKIN** Use ***_LOWER CONC._*** for ***_BROKEN SKIN_***

**First Aid Antiseptics**

*DECREASES the* **Infection Rate** Used to **DISINFECT only INTACT skin** **surrounding the wound** * *AFTER** * *removal of all other matter** Types: **Hydrogen Peroxide 3% // Ethyl Alcohol Isopropyl Alcohol // Iodine + Povidone Camphorated Phenol**

**Hydrogen Peroxide** Types of First Aid Antiseptics

Hydrogen Peroxide **3% Topical Solution** **Effervescent / Mechanical cleansing** action *DO NOT apply _bandage_* until **area dries** ***_little benefit over soapy water_***

**Ethyl Alcohol** Types of First Aid Antiseptics

Good **BacteriCIDAL Activity** Can cause **tissue irritation** **1-3 times a day** *do NOT apply a _bandage_ until* **area dries**

**Isopropyl Alcohol 70%** Types of First Aid Antiseptics

**70%** Used for **cleansing** + **antiseptic** effects on **INTACT skin** **Strong Astringent** **STRONGER BacteriCIDAL activity**

**Iodine 2%-2.5%** Types of First Aid Antiseptics

**Antiseptic** for **superficial wounds** *avoid _bandaging_* wound **after application** **STAIN** the skin

**Povidone / Iodine** Types of First Aid Antiseptics

* *9-12% Iodine** * *BETADINE** Skin cleanser liquid = Povidone/Iodine 7/5% ***_NON-Irritating_*** to **skin** **Absorbed SYSTEMICALLY** *DO NOT USE on **_Severe Burns / Large Wounds_***

**Camphorated Phenol** Types of First Aid Antiseptics

**Phenol 4% Campho-Phenique Gel/Liquid** = Camphor 10.8% / Phenol 4.7% **Unguentine Ointment** = Phenol 1% Apply only to **Dry + Intact Skin** *AVOID _bandaging_* wound after application

**Topical Steroids for BURNS**

**Hydrocortisone 1%** cream/ointment for **_Minor Burns_** covering a **small area** ***CAUTION IF _SKIN IS BROKEN_*** = **INFECTIOUS**

**Topical Antimicrobials for BURNS**

* *CRUCIAL TO _MAJOR BURN THERAPY_** * if skin is _INTACT,_ of LIMITED use* **BACITRACIN / NEOMYCIN / POLYMIXIN B** * *RX** topical ABx for MAJOR burns: * *Silver Sulfadiazine (SSD)** * questionable efficacy / MAY DELAY wound healing*

**Vitamins for BURNS**

Commonly used for **severe burns C-A-B /// *E is bad*** **C** = **Collagen Synthesis** **A** = **Enhances Healing** **B = Promote Wound Healing** ***_E = may DELAY wound healing_***

**Self-Treatment GOALS of Minor Superficial Burns**

**Relieve PAIN** associated w/ burn ***_AVOID Maceration_*** of **tissue** ***_Prevent_*** **DRYNESS** Provide a **favorable environment** for **HEALING** *that MINIMIZES the chances of* **INFECTION & SCARRING**

**Self-Treatment Recommendation for BURNS**

for **Minor Superficial Thickness Burns _\< 1% BSA_** *DO NOT* **cover extensive area** * DO NOT INVOLVE:* * *Eyes / Ears / Face / Perineum**