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Questions and Answers
What characterizes a superficial partial thickness burn?
What characterizes a superficial partial thickness burn?
Which factor does NOT fall under local factors that impair the healing process?
Which factor does NOT fall under local factors that impair the healing process?
Which type of wound is characterized by rubbing or friction to the epidermal layer?
Which type of wound is characterized by rubbing or friction to the epidermal layer?
What is the primary characteristic of a full thickness burn?
What is the primary characteristic of a full thickness burn?
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During which phase of wound healing does hemostasis occur?
During which phase of wound healing does hemostasis occur?
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What type of burn is caused by contact with flames or hot objects?
What type of burn is caused by contact with flames or hot objects?
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Which skin layer is responsible for temperature regulation and cushioning?
Which skin layer is responsible for temperature regulation and cushioning?
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What is the duration of the proliferative phase of wound healing?
What is the duration of the proliferative phase of wound healing?
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Which of the following is a situation that may require urgent medical attention?
Which of the following is a situation that may require urgent medical attention?
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What is a characteristic of chronic wounds compared to acute wounds?
What is a characteristic of chronic wounds compared to acute wounds?
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What is the hallmark symptom of superficial partial-thickness burns?
What is the hallmark symptom of superficial partial-thickness burns?
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Which burn type requires immediate emergency department attention due to potential complications?
Which burn type requires immediate emergency department attention due to potential complications?
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Under what circumstances should one call 911 for a burn injury?
Under what circumstances should one call 911 for a burn injury?
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What is the main goal of scar prevention methods post-wound healing?
What is the main goal of scar prevention methods post-wound healing?
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What constitutes a common exclusion for self-treatment of minor burns?
What constitutes a common exclusion for self-treatment of minor burns?
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Which of the following is a recommended initial step in wound response?
Which of the following is a recommended initial step in wound response?
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What characteristic is NOT typically associated with deep partial-thickness burns?
What characteristic is NOT typically associated with deep partial-thickness burns?
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When should a tetanus booster be considered for a breaking skin injury?
When should a tetanus booster be considered for a breaking skin injury?
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What is the main function of hydrocolloid dressings?
What is the main function of hydrocolloid dressings?
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Which of the following actions is NOT recommended for the treatment of sunburn?
Which of the following actions is NOT recommended for the treatment of sunburn?
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Study Notes
Minor Burns and Wounds
- Reading Assignment: This presentation summarizes the textbook chapter: Stelter N, Minor burns, wounds, and sunburn. In: The Handbook of Nonprescription Drugs
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Learning Objectives:
- Explain the layers of skin and differentiate injury based on depth of skin involvement
- Recognize the identification of minor injuries and the steps for management
- Determine situations that need urgent medical attention
- Recommend self-care when appropriate
- Differentiate common dressings
- Identify pharmacologic products used as skin protectants
- Explain basics of management for more serious chronic wounds
Types of Burns
- Sunburn: Overexposure to ultraviolet A (UVA) and B (UVB) from sun or tanning lights
- Thermal burn: Skin contact with flames, scalding liquids, hot objects
- Electrical burn: Entry point and flow to exit point with heat
- Chemical burn: Exposure to corrosive or reactive chemicals
Types of Wounds
- Abrasion: Rubbing or friction to the epidermal layer
- Laceration: Cut from a sharp-edged object
- Puncture wound: A piercing injury
Healing Process
- Inflammatory phase: Hemostasis (clotting) initiates, collagen formation and one layer of epithelial cells. Lasts 3-4 days
- Proliferative phase: New connective tissue, epithelium, capillaries, and inflammatory cells develop. Starts at 3 days, lasts approximately 3 weeks. Maturation (remodeling) occurs with continual collagen synthesis and breakdown. Peaks at 60 days
Impaired Healing
- Local factors: Inadequate tissue perfusion and oxygenation, inadequate moisture, foreign material in the wound, necrotic tissue, infection (e.g., Staphylococcus and Streptococcus)
- Systemic factors: Age over 60, stress, poor nutrition, diabetes, obesity, immune compromise (e.g., cancer, alcoholism, smoking). Medications that interfere with clotting formation, platelet function
Wound Classification
- Acute: Generally healed within 1 month
- Chronic: Greater than 1 month, requires referral
Depth of Burns/Wounds
- Superficial (superficial partial-thickness): Epidermis only. Painful area of erythema; no significant damage. Heals without scarring in 3–7 days
- Superficial partial-thickness: Epidermis and part of the dermis; patchy white to red area with some blistering, intense pain. Healing with minimal scarring in 10-14 days
- Deep partial-thickness: Epidermis and part of the dermis; edema, less blanching, minimal blistering, pain sensation may be altered. Burns need emergency department attention if of this depth. Healing typically takes 2-4 weeks with scarring.
- Full-thickness: Destruction of both dermis and epidermis; dry, leathery, painless. Severe burns require hospital treatment
- Subdermal: Deepest degree, requiring hospital treatment
% of BSA
- Rule of 9s: Estimates the percentage of body surface area (BSA) affected. Know the percentages on the image.
- Alternate Method: The size of the patient's hand including the palm and fingers is approximately 1%.
Exclusions for Self-Treatment (Burns)
- Large areas of blistering
- Fever over 103°F
- Extreme pain
- Headache or confusion
- Lightheadedness or vision changes
- Dehydration
- Severe swelling
- Signs of infection (red streaking, areas of redness spreading away from open blisters, pus draining from open blisters)
Sunburn Response Steps
- Apply analgesics (ibuprofen, acetaminophen) or topical gel
- Cool the skin with cool water
- Use a moisturizer, lotion, or gel
- Aloe vera or calamine lotion; Hydrocortisone 1% three times a day for 3 days.
- Avoid alcohol in products
- Drink additional water
- Avoid additional sun exposure
- Do not use ice or ice-cold water when cooling burns.
Burn Response Steps (General)
- Identify cause, timing, depth, and size of injury
- Irrigate burns with cool water for 20 minutes if occurred within 3 hours
- Remove rings or constricting items
- Apply a skin protectant and appropriate dressing
- Treat pain with NSAID or acetaminophen
- Assess need for tetanus immunization if skin is broken (booster every 10 years; repeat if >5 years since last vaccine).
- If burns worsen after 24-48 hours, refer to primary care provider
- Recommend scar prevention, sun protection, skin protectant
Call 911 for Burns If...
- Depth involving all skin layers
- Skin appears dry and leathery, charred appearance with patches of white, brown, or black
- Larger than 3 inches in diameter
- Covers hands, feet, face, groin, buttocks, or major joint
- Smoke inhalation occurred
- Rapid development of swelling
Wound Response Steps
- Identify cause, timing, depth, size of injury
- Stop bleeding with gentle pressure and elevation
- Clean the injury with tap water
- Use tweezers cleaned with alcohol to remove debris
- Apply a skin protectant and dressing
- Treat pain with NSAID or acetaminophen
- If skin is broken, assess need for tetanus immunization (booster every 10 years, repeat if >5 years since last vaccine)
- If injury does not heal within 7 days, refer to primary care provider.
- Watch for signs of infection (redness, drainage, swelling, warmth, pain; darker skin infections may appear purple-gray or darkening).
- Recommend scar prevention, sun protection, skin protectant
Seek Prompt Medical Care If...
- Keeps bleeding after a few minutes of direct pressure
- Animal or human bite; determine rabies vaccination of pets; rabies considerations for wild animals.
- Deep and dirty wounds; wounds caused by metal objects
- Wounds located on the head, neck, scrotum, chest or abdomen or wounds that are over a joint
Exclusions for Self-Treatment (Minor Burns & Wounds)
- Chemical, electrical, inhalation burns
- Wound from animal or human bite
- Deep partial-thickness or deeper burns
- Any injury suspected as non-accidental
- Signs of infection
- Circumferential burns
- Preexisting medical disorders that may impair recovery
- Wounds with foreign matter
- Chronic wounds (>1 month)
- Injuiries located on the face, hands, feet, major joints, genitals, perineum
- Injury larger than 3 inches
- Worsening or not improving after 7 days
Treatment Goals
- Relieve symptoms
- Promote healing
- Minimize scarring
Burn Cooling
- Continuously cool burns with running water for 20 minutes.
- As soon as possible, with benefit up to 3 hours
- Avoid ice or ice-cold water (numbness and excessive vasoconstriction)
- Gentle irrigation with tap water (more aggressive cleaning if contaminants)
Wound Cleansing
- Gentle irrigation with tap water, consider more aggressive cleaning if contaminants present
- Goal of preventing infection and promoting healing
- Avoid removing blisters or damaged skin
Wound Dressing
- Avoid drying wounds (which increases scab formation)
- Use newer dressings to create a moist environment (benefits: stimulate cell proliferation, encourage migration of epithelial cells for healing, and provide barrier to microbial contamination, absorb excess fluid)
- Combine dressings with skin protectants
- Use hydrocolloid dressings for moderate exudate or partial-thickness wounds to protect intact skin
- Use appropriate dressing for various wound types
Hydrocolloid Dressing
- Inner colloidal layer with gel-forming agents
- Outer water-impermeable layer
- Moist environment, minimal-moderate exudate
- Absorbs exudate from the wound (protects intact skin with minor burns or blisters)
Transparent Adhesive Film
- Thin, elastic, waterproof polyurethane films
- Impermeable to bacteria, permeable to gas
- Not highly absorbent
- Only for superficial or superficial partial-thickness wounds
Liquid Adhesive Bandage
- Tissue adhesives (spray or brush-on)
- Clear polymer layer, flexible coating
- Slight burning with application
- Waterproof
- May last 5-10 days
- Avoid over sutures, near eyes or mucous membranes
- May have antibacterial and antiseptic effect
- Cosmetic benefit, flexibility
- Some have topical analgesic
Scar Prevention
- Avoid sun exposure (UV radiation increases pigmentation)
- Use sunscreen
- Silicone therapy (preferred), occlusions and hydration, relief of itching and discomfort, appropriate application
- Sheets-soft, semi-occlusive, medical grade silicone with membrane backing
- Gel-thin layer, dries and forms a transparent, gas permeable, water-impermeable coating
- Other options: Mederma® (allantoin, onion extract), Mitomycin C, green tea, aloe vera, Vitamin D or E, laser, injections
Systemic Analgesics
- Symptomatic relief, no healing benefit (Ibuprofen, Naproxen, Aspirin, Acetaminophen)
Skin Protectant
- Protect from irritation/drying
- Prevent drying of stratum corneum, promote moist healing, reduce pain, scar prevention
- Emollients and moisturizers (Petrolatum, Aquaphor, CeraVe, White Petrolatum, Desitin, Vaseline, Glycerin, Neutrogena Norwegian Formula Hand Cream, Cocoa butter, Palmer's, Colloidal oatmeal, Aveeno)
Antibiotic Ointment
- Variety of mechanisms against different bacteria
- Prevent infection (not treatment of active infection)
- Concern for antibiotic resistance (benefits are not clearly proven)
- OTC: Polymyxin/bacitracin/neomycin (Neosporin) Bacitracin and polymyxin (Polysporin)
- Rx: Mupirocin (Bactroban), Bacitracin/neomycin/polymyxin B/hydrocortisone (Cortisporin)
Topical Anesthetics
- Temporary pain relief (Benzocaine, Lidocaine, Pramoxine)
- Inactivate sodium channels in sensory neurons
- Interrupts transmission of electrical impulses
- Gel, solution, spray, cream, ointment, patch
- Limited to topical use (systemic absorption can cause methemoglobinemia)
Antiseptic
- Destroy or inhibit microorganism growth, may damage human cells
- Promotes healing (Chlorhexidine, Hydrogen peroxide, Povidone-iodine)
- Strong evidence supports using clean tap water for wound irrigation.
Product Types (Wound care)
- Ointment(oleaginous), protective film, prevent water evaporation, recommended for minor burns and wounds (when skin is intact).
- Cream(water-based emulsion), allows some fluid to pass through (preferred if skin is broken) with glove/gauze for application
- Lotion, spread easily, easier for larger wounds
- Spray, benefits from no touch application (less contamination and pain; 6 inches away, 1-3 seconds; do not provide a protective layer; alcohol-based can irritate and dehydrate)
Special Considerations
- Age: Decreased surface contact between dermis and epidermis; reduced dermal lymphatic drainage
- Diabetes: Reduced wound healing, increased incidence of foot ulcers, hyperglycemia alters white blood cell function
- Obesity: Impaired wound healing, increased risk of skin infection, pressure wounds and skin fold wounds
- Medications: Possible delay of wound healing (Anticoagulant, Antimicrobial, Antineoplastic, Anti-rheumatoid, NSAIDS, Colchicine, Nicotine, Steroids, Vasoconstrictors)
Support for Wound and Burn Healing
- Nutrition -Hydration
- Smoking hinders wound healing
- Honey: moist environments, absorbs exudates, inhibits bacterial proliferation
- Aloe vera gel
- Calendula: anti-inflammatory and antibacterial
Chronic and Serious Wounds
- Pressure sores: prevent with repositioning (5 minutes every 2 hours). Seat repositioned every 15-60 minutes
- Arterial ulcers: secondary to peripheral vascular disease, very painful, lower extremities
- Venous ulcers: dysfunction of venous valves, pooling of blood and high venous pressure in legs; abnormally high pressure causes skin damage.
Treatment of Chronic Wounds
- Debridement(irrigation, hyperbaric oxygen, surgical, enzymatic, biologic(medical maggots))
- Cleaning with normal saline, sterile water
- Topical antibiotics: silver sulfadiazine (caution with sulfa allergy & G6PD deficiency), triple antibiotic
- Enzymatic debridement: collagenase(Santyl)
Patient Follow-Up for Minor Injuries
- Burns may get worse initially, so follow-up within 24-48 hours is needed.
- Minor injuries should show significant improvement within 7 days and should be completely healed within 14 days
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Description
This quiz is based on the chapter about minor burns, wounds, and sunburn from 'The Handbook of Nonprescription Drugs'. It covers the types of burns, identification of injuries, and management steps, including self-care recommendations and the use of dressings and pharmacologic products. Test your knowledge on how to appropriately respond to minor skin injuries.
