Burns and Sunscreen Flashcards
When doing a patient assessment for burns, what should be considered?
Burn depth
-Superficial (1st degree), superficial partial thickness or deep partial thickness (2nd degree), full thickness (3rd degree)
-Self treat or refer?
Location (face, ears, arms, hands, feet?)
Burn surface area (the larger the burn, the more severe is the fluid loss)
Causative agent
-Chemical? Electrical? Thermal? Radiation?
-The higher the temperature and the longer the exposure, the more damage to the skin
Pre-burn medical status (immunocompromised? diabetic?)
What are the different causes of burns?
Thermal (flames, flaming liquids, flammable liquids (gel candles), hot objects (irons), hot gases (steam)
Chemical (caustic, acids, phenols)
Radiation (sun, UV lamps, microwaves, lasers, radioactive)
Electrical (home appliances, lightning, work place)
Describe 1st degree burns
Affects the epidermis (outer layer)
Typically occurs with a sunburn
Appearance: dry, red blanches with pressure, pink/redness at burn site, pain that lasts from 48-72 hours, no blisters, mild skin peeling
Time to heal: 3 to 6 days
Describe 2nd degree burns
Superficial partial thickness: affects the epidermis and upper sections of the dermis
Appearance: moist weeping red blisters, blances with pressure, painful
Time to heal: 7 to 20 days
Deep partial thickness: affects the deeper dermis (damages hair follicles and granular tissue)
Appearance: wet or waxy, red patchy areas, larger blisters, pain with pressure
Time to heal: 21 days or more
Describe 3rd degree burns
Destroys the dermis and damages muscle, bone and subcutaneous tissue
Appearance: dry and leathery appearance to the skin, waxy white, gray or black or brown areas, some swelling to the burn area, painless to touch (nerve endings have been destroyed)
Time to heal
-Depends on the area, depth of the burn and severity of the burn area
-Never is over 2% of the total body surface area is affected
When should a patient be referred for a burn?
Burns where the skin is thinner (face, ears, eyelids, inner arm areas, groin)
Children under the age of 2 and adults over the age of 55 (thinner skin)
Chemical burns, electrical burns or inhalation burns
Burns with more than a few blisters/large blisters, large areas of blistering
Medical conditions that put patient at risk for infection (diabetes, immunocompromised, HIV)
How should thermal burns be treated?
Remove heat source (minimizes damage to skin)
Cool area up to 30 minutes with tepid water (prevents further damage to the skin)
Cover loosely with non-stick sterile gauze if area is open or damaged (decreases risk of infection)
Leave blisters intact (decreases risk of infection)
How should chemical burns be treated?
Cleaning or removing caustic agent
Remove clothing that has been exposed to agent
Irrigate with copious amounts of water (lukewarm or cool)
Refer ASAP
How should electrical burns be treated?
Remove from source of electricity (if safely possible)
Call 911 or transport ASAP
What is the general first aid of burns?
Cool area with cool water (not cold) for 10-30 minutes in cool water (compresses, irrigations, immersion)
Gently cleanse area with mild soap/water or sterile water (if necessary)
Apply dressing to promote moist wound healing and protect from further trauma (if necessary)
Pain relief (if necessary)
What is the UV index?
Predicts the strength of the sun’s daily UV rays (higher number = stronger the suns rays = increased risk of burning)
UV index of 3 or more is reported
UV index sun protection charge from Environment Canada
What are risk factors for sunburn?
Skin types (fair skin, red heads, freckles increase risk) Family history (melanoma is higher risk with history of blistering sunburns as a child) Medications (photosensitizing medications) Ozone depletion (increased UV radiation penetrating through ozone layer increases risk) Long term exposure to UV radiation (outdoor workers)
Describe phototoxicity
Incidence: common
Mechamism: not immunological, chemically induced reaction that occurs when a drug absorbs UV light
Onset: minutes to hours following exposure
Appearance: appears as an exaggerated sunburn, reaction is limited to sun-exposed skin, may or may not be itchy
Describe photoallergy
Incidence: rare
Mechanism: result of an immune response (UV light triggers reaction to the allergen)
Onset: 1-3 days after contact
Appearance: Inflammation of the skin in sun exposed areas that can spread to non-exposed areas (red and itchy reaction)
What is photoaging?
Premature aging of skin caused by continuous exposure to UV light
Appearance: pigmented spots resembling freckles, age spots or liver spots, wrinkles and fine lines around the eyes and mouth, a loss of skin tone/elasticity, leathery skin texture
Regular application of sunscreens and reducing exposure are the best ways to prevent photoaging
What should be taken into consideration when assessing a patient’s sunscreen needs
Patient requirements (outdoor worker, medical conditions, skin type, allergies) Age (under 6 months = physical protection only; over 6 months = physical and sunscreens)
How do you prevent sunburns in children under 6 months?
Avoid sun exposure when possible Protective coverings (wide brimmed hats/neck protector, long sleeves, shade covers over strollers, swim suits with long sleeves/covers child)
How do you prevent sunburns for children 6 months and older?
Avoid sun exposure when possible Protective coverings (hats, long sleeves) Physical sunblock (zinc) or sunscreen with SPF 30 or more
How do you prevent sunburns for pregnant women?
No studies have been done but it appears to be safe in pregnancy
Minimum of SPF 30 with broad spectrum agent
Use physical barriers (hats, long sleeves)
What are non-pharmacological prevention methods for sunburns?
Reduce exposure (particularly from 10am to 4 pm)
Stay in shade when possible
Wear clothing that covers legs, arms and head (cotton, linen, tightly woven fabrics)
Wear sunglasses (wrap around)
Wear a wide brimmed at (cover ears)
Protect children (long sleeves, hats, sunglasses, reduce exposure)
What is required for a sunscreen to be approved?
SPF clearly indicated (CDA suggests SPF of at least 30)
Broad spectrum (UVA/UVB protectant)
Non-irritating or hypoallergenic
Non-comedogenic (won’t block pores)
Water resistant/sweat resistant
A statement that the sun may cause sunburn, premature aging of the skin and skin cancer
CDA Logo
What are the different types of products available?
Physical block (zinc oxide)
Aminobenoic acids (PABA)
Benzophenones (oxybenzone)
Cinnamates (Parsol, cinoxate, octinoxate)
Salicylates (octyl salicylate, octisalate, homosalate)
Dibenzoylmethanes (avobenzone)
Mexoryl/tinosorb
What are the different formulations available?
Lotions/creams (most common vehicle for delivery)
Water-based gels (easily washed away by swimming or seat; preferred by patients with acne or oily skin)
Sticks (preferred for small areas, like lips or nose)
Sprays (convenient but may not be applied correctly)
Describe the general application of sunscreens
Apply liberally to the entire area that will be exposed to 15 to 30 minutes prior
Re-apply at least every 2 hours
Reapply after 40 to 80 minutes of swimming of excessive sweating
Reapply immediately after towel drying
Apply lip balms prior to exposure to sun to protect lips from burning
Wash hands after application to avoid rubbing sunscreen in the eyes
