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”
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
Rule of 9’s
Legs = 9% Each
Back = 18%
Arms & Head = half of 9 = 4.5%
Superficial Burn
Classification of Burn
Epidermis
- *Local Pain**
- no blisters or scars*
Superficial Partial Thickness
Classification of Burn
Epidermis
& the most superficial portion of dermis
SEE MD
local pain / red
ELEVATED VESICLES
Deep Partial Thickness
Classification of Burn
Entire Depth of Dermis & Epidermis
SEE MD
Extensive damage
Leathery Appearance
Infections / Scarring
Full Thickness
Classification of Burn
SEE MD
ALL LAYERS OF SKIN + MUSCLE
Charred / Dry
Infections / Skin Grafting
Thermal Burns
From Flame / heat / Sun / Scald
COOL TAP WATER
to prevent blister fromation
decreases EDEMA
OTC analgesic PRN
Electrical Burns
Visible at Point of ENTRY & EXIT
Underlying tissue damage
SEE MD
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
When to use Antibiotics for Burns?
Infections
Use ABx PROPHYLAXIS for:
Moderate –> Severe Burns
Use Systemic ABx in Rare Instances
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
Ideal Dressing
REMOVE excess exudate
Maintain a moist environment
permeable to Oxygen
Thermally insulate & Protect the wound
free of particulate & easily removalble
Antimicrobial
Types of Wound Dressings
When wounds are Colonized / Infected
SILVER & IODINE
Acticoat / Actisorb / Iodoflex
Nonadherent
Types of Wound Dressings
DO NOT stick to the wound bed
Affordable / Widely Available
Effective on FLAT wounds
Adaptic
Nexcare Pads
Release Dressings
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**