Wounds & Minor Burns

Thermal burns

Skin coming into contact with heat, flames, scalding liquids, etc.

Electrical burns

Electric current flowing through body and damaging skin

Chemical burns

Tissue damage from exposure to reactive or corrosive chemicals

Wounds

Injury causing break in the skin

Abrasions

Minor wounds caused by rubbing or friction

Lacerations

Minor wounds caused by cuts or punctures

What should be taken into consideration when treating a wound or burn?

- Cause

- Acute vs chronic

- Depth

- Size

- Area

How much of the body surface area is the groin?

1%

What areas of the body take up 9% of the body surface area (separately)?

- Entire head and neck

- Entire right arm

- Entire left arm

What areas of the body take up 18% of the body surface area (separately)?

- Anterior trunk

- Posterior trunk

- Entire right leg

- Entire left leg

What are the exclusion criteria for burns (in addition to certain areas)?

- Electrical or chemical burns

- Self-harm induced

- Deep partial thickness and beyond

- Signs/symptoms of infection

- Certain underlying medical conditions (DM, immunocompromised)

What are the areas that are self-care exclusions for wounds and burns?

- Face

- Hands/feet

- Major joints

- Perineum

- Genitals

What are the exclusion criteria for wounds (in addition to certain areas)?

- Wound secondary to bite

- Deep partial thickness and beyond

- Self-harm induced

- No signs of healing within 7 days

- Signs/symptoms of infection

- Certain underlying medical conditions (DM, immunocompromised)

What is the nonpharmacologic treatment for minor burns?

Cool tap water for 20 minutes

How does cool water help burns?

- Decreases histamine release

- Decreases edema

Why is ice not used for burns?

Vasoconstriction

What are the nonpharmacologic treatments for minor wounds?

- Clean tap water

- Tdap vaccine

- Moisture-retentive dressings

What are the pharmacologic options for minor wounds and burns?

- Systemic analgesics

- Skin protectants

- First-aid antibiotics

- Topical anesthetics

- First-aid antiseptics

What are the systemic analgesics used for minor wounds and burns?

- Ibuprofen (Advil)

- Naproxen (Aleve)

- Acetaminophen (Tylenol)

- Aspirin (Ecotrin)

How do NSAIDs work for minor wounds and burns?

- Reversible inhibition of COX-1 and 2

- Prostaglandin inhibition

What are the side effects of NSAIDs?

- Swelling

- Acute renal failure

- GI bleeding

How does acetaminophen work for minor wounds and burns?

- Weak prostaglandin inhibition

- Peripherally blocks pain impulse generation

What is the side effect of acetaminophen?

Hepatotoxicity

How does aspirin work for minor wounds and burns?

- Irreversible inhibition of COX-1 and 2

- Prostaglandin inhibition

What are the side effects of aspirin?

- Platelet inhibition

- GI bleeding

What are the skin protectants used for minor wounds and burns?

- Emollients and moisturizers

- Aquaphor

- Vaseline

How do skin protectants work for minor wounds and burns?

- Prevents further irritation

- Prevents drying and promotes moist healing

- Decreases pain

What are the first-aid antibiotics used for minor wounds and burns?

- Neosporin

- Polysporin

What are the key points of first-aid antibiotics for minor wounds and burns?

- Indicated for infection prevention

- Helps maintain moist environment

- May be less effective than skin protectants

- Data is conflicting and limited

What are the key points of topical anesthetics for minor wounds and burns?

- Temporary relief of pain

- Interrupts transmission of neuronal electrical impulses

- Systemic absorption of benzocaine may occur

What is systemic absorption of benzocaine associated with?

- Methemoglobinemia

- Seizures

- Dyspnea

- Coma

What are the important points of first-aid antiseptics for minor wounds and burns?

- Hibiclens

- Inhibits growth of microorganisms in tissues

- Can be cytotoxic to cells essential for wound healing

- Data is limited and unclear

What are the important points of topical hydrocortisone with relation to minor wounds and burns?

- Topical preparation can be absorbed systemically

- May lead to HPA axis suppression

- Concentrations are increased when used with aloe vera

What is the clinical presentation of mild sunburns?

- Erythema

- Edema

- Pain

- Tenderness

What is the clinical presentation of severe sunburns?

- Blisters

- Bullae

- Fever/chills

- Weakness

- Shock

What are the risk factors for sunburns?

- Light skin, eyes, hair

- Family history of melanoma

- Autoimmune conditions or immunosuppressants

- History of severe sunburn

- Photosensitizing drug use

What drugs can cause photosensitivity?

- Tetracyclines

- Fluoroquinolones

- Sulfonylureas

What are the nonpharmacologic options for sunburns?

- Hydration

- Use moisturizers after shower

- Protective clothing

- Sunglasses

- Sunscreen and SPF chapstick

What are the side effects of topical aloe vera?

- Redness

- Stinging

- Burning

What are the exclusion criteria for sunburns?

- Large areas of blistering

- Severe edema or pain

- Signs of infection

- Headache or confusion

- Lightheadedness or vision changes

How many Americans are expected to develop a type of skin cancer?

1 in 5

What are the products recognized as GRASE by the FDA?

- Zinc oxide

- Titanium dioxide

After how long do water-resistant sunscreens need to be reapplied?

40-80 minutes

Who should be referred for sunscreen?

Children < 6 months

What are the key points of sunscreen application?

- Apply liberally to exposed areas

- Apply 15-30 minutes prior to sun exposure

- Reapply every 2 hours at minimum

When should we start to see an improvement in a wound being treated over the counter?

7 days

It is appropriate to treat superficial wounds over the counter.

True

Which is roughly 9% of the body?

Left arm

Which patient should be referred?

A patient with a dog bite

Which of the following areas is appropriate to treat over the counter?

Forearm

Which of the following is recommended for a thermal burn?

Cool tap water x 10 minutes

What is the preferred method for irrigation?

Clean tap water

How often does a patient require a Tdap vaccine?

Every 10 years

What are the benefits of moisture-retentive dressing?

- Promotes wound healing

- Prevents infection

- Prevents skin maceration

- Provides autolytic debridement

A patient should consume extra water after a sunburn.

True

Aloe vera can increase systemic absorption of which topical medication?

Hydrocortisone

Single-spectrum sunscreen provides protection against skin cancer.

False

Chemical sunscreen is recommended over physical sunscreen.

False

What is the cutoff age for over-the-counter sunscreen use in infants?

6 months

A patient with fair skin should be recommended at least which SPF?

30

Why should a patient avoid ice on a thermal burn?

vasoconstriction

Which vaccine should you make sure a patient is up to date on if he/she comes in with a puncture wound?

Tetanus

What are the benefits of using a moisture retentive dressing?

• promotes wound healing

• prevents skin maceration

• prevents infection

• provides autolytic debridement

Which of the following is NOT a risk factor for a severe sunburn?

HTN

What is a potential risk of consuming too much ibuprofen?

Nephrotoxicity

What is a potential risk of consuming too much APAP?

Hepatotoxicity

What are some common adverse effects of topical hydrocortisone cream?

Stinging/burning and Dry skin

At what frequency should a patient reapply a water resistant sunscreen?

40 to 80 minutes

At what frequency should a patient reapply sunscreen? (not water resistant)

2 hours