Derm FINAL Exam: Yamaki Burns

_____-degree

• Superficial-thickness burn

• Injury to the superficial cells of the epidermis; does not form blisters, but it does become erythematous and mildly painful.

• Heal within 3 to 7 days without scarring.

• Example: Sunburn

1st

_____-Degree

• Superficial partial-thickness, depending on the depth of dermal involvement.

• Superficial second-degree burns involve the _____ and the _____.

  • Erythematous, blistered, weeping, painful and very sensitive to stimuli.

• Heal spontaneously within 3 weeks with little scarring.

• Deep second-degree burns

  • Involves the deeper elements of the dermis and may be difficult to distinguish from third-degree burns

  • Burn area is pale, feels indurated or boggy , and dose not blanch with pressure.

  • Less painful

  • Healing occurs slowly over the course of about 35 days with possible severe scarring and permanent loss of hair follicles and sweat and sebaceous gland

2nd, epidermis, upper layer of the dermis

_____-degree

• Full thickness deep burn

• Entail complete destruction of the _____ of the skin including all skin elements.

• Appear pearly white, gray, or brown and is dry and inelastic.

• Pain is only sensed when _____ is applied.

• Healing over the course of several months and are repaired most often by _____ and _____ of the wound to prevent contractures of the skin.

3rd, full thickness, deep pressure, excision, grafting

_____-degree

• Similar to third degree burns except that devitalized tissue extends into the subcutaneous tissue, fascia, and bone (full-thickness).

• Appears blackened, dry, _____ because of destruction of nerve endings

• Great risk of _____

4th, painless, infection

KNOW IMAGE

Superficial Epidermal Burn Characteristics

• _____ appearance

• Blanches with pressure

• Sensation of pain

• Healing time: 3-7 days

• Superficial → was first degree

dry and red

Superficial Partial Thickness Burn Characteristics

• _____, _____, _____

• _____

• _____ to temperature and air

moist, red, weeping, blanches with pressure, painful

Deep Partial Thickness Burn Characteristics

• _____ or _____

• _____

wet, waxy, does not blank with pressure

Full Thickness Burn Characteristics

• _____

• _____, _____, _____, _____

blisters, waxy white, leather gray, charred, black

_____ Injury

• Blisters

• Extends through fascia and/or muscle. Sometimes.

• Bone even.

• Deep pressure

• Healing: never, unless surgical treated

Deep Burn

Pharm Rec → _____

Superficial Burns

Cooling of Burns

• _____ or still water applied for no longer than _____ to avoid wound maceration

• Wound may be covered with wet gauze or towels at room temperature for up to _____

• Do NOT apply _____ or _____ directly on wound due to risk of increasing burn depth

cool running water, 5 mins, 30 mins, ice, iced water

Xeroform Dressing

• _____, sterile, wound dressing

• _____ properties

Non-adherent, occlusive

Adaptic Dressing

• _____ dressing

• Knitted cellulose acetate fabric

• Impregnated with petrolatum emulsion

• _____ properties

Non-adherent, occlusive

Mepitel Dressing

• _____ and can be removed without harming new epithelial cells

does not adhere to moist wounds

Treatment of Superficial Burn Wounds

• Maintain a _____ environment

• _____ that assist with the healing process and promote re-epithelialization

• Topical antimicrobial agents to consider _____ is present:

  • Combo antimicrobial agent: polysporin (Bacitracin and Polymyxin B)

• _____: Xeroform, Adaptic, Mepitel

moist, covered with dressings, only if infection, non-adhesive dressings

Antibiotics for Burns

• Microbial colonization _____ mean infection

• Prophylaxis of infection _____

• _____ antibiotic use for clinically _____ wounds

  • Cellulitis, malodor, gangrenous, purulence (pus)

  • Fever, chills, hypotension, leukocytosis, confusion

does not, not necessary, Reserve, infected

Antimicrobial Ointments

• Polysporin® (OTC)

  • Bacitracin and polymyxin B

• Mupirocin (Rx)

  • Bactroban®

  • _____ areas or suspicion of _____

MRSA infected, resistant infection

Silver containing agents: Silver Sulfadiazine

• Development of _____ can occur and requires debridement

pseudoeschar

Chlorhexadine

• _____ prevent _____ of wound

Does not, re-epithelialization

Povidone-Iodine

• Efficacious but not first-line d/t _____ and _____ in re-epithelialization at wound site

• Must be applied 4X/day and therefore requires several wound dressings (increased _____, decreased _____)

cytotoxicity, delay, pain, adhearence

Dakin’s Solution

• Efficacy has been shown _____ for resistant bacterial infections such as MRSA and Vancomycin resistant Enterococcus. Consider only for resistant organisms

anecdotally

Honey

• _____ relatively safe and inexpensive

Manuka honey

Management of Superficial Partial Thickness Burns

• Maintain _____ environment

• Appropriate _____

• Consider antimicrobial agent if infection is suspected (difficult to fully assess extent of injury)

• _____ if _____ organisms suspected

• _____ if MRSA or suspicion of resistance or colonization with _____ organism

moist, dressings, Polysporin, no resistant, Mupirocin, resistant

Management of Full Thickness & Deep Burns

• _____ of wound _____

  • Assists in healing process, removal of damaged tissue, assists in preventing infection

Debridement, necessary

Early Excision of Deep Burns

• _____ prevents _____ of medication

• Must _____ and _____ wound initially to get medication to _____

• RCT and meta-analyses have demonstrated improved _____ and _____ with early eschar removal and debridement

Eschar, penetration, remove, debride, site of action, healing, decreased length of hospital stay

Management of Itching with Burns

• 1st-Line → _____ (1st Gen and 2nd Gen Agents)

• _____ (If AHs fail)

  • Should only be used _____ occurs NOT on unhealed wounds

AHs, Topical Low Potency Glucocorticoids, after re-epithelialization

Non-pharmacological therapy for Pruritus Associated with Burns

• _____

• _____

• AVOID products containing _____

• This is for _____ healing has occurred or burns with skin intact

Aloe Vera, AHs, Lanolin, after

Case Vignette 1

• KL is a 28-year old male who suffered a burn to his forearm after exposure to a heated oven at 450 degrees Fahrenheit. It has been several hours since the burn occurred, and he is in significant pain (7/10) which he describes as a deep sense of pressure. KL used ice cubes to cool the wound and following this he noticed immediate blister formation and swelling of the site of injury. How should his wound be managed?

  • Wound dressing? → YES

  • How to properly cool wounds? Pt used ice = worsens, rec → cool water for no more than 5 mins

  • Antibiotics? → NO, they just got the wound

  • Need for referral? → Only on forearm and only blistered when ice was added → NO

KNOW

Case Vignette 2

• DR is a 54-year old female with a history of hypertension, diabetes, and plaque psoriasis that flares around her forearms, elbows, and hands. She currently uses hydrocortisone 2.5% cream on her elbows and hands every other day to control her psoriasis and also uses methotrexate to prevent severe flare ups.

• While fixing a fuse in her home an electrical spark injured her hand and over the last 72 hours, she has noticed her hand has a white, red and patchy appearance. The injury appears waxy, is painful if any pressure is applied and seems to be of variable depth. She also noticed that a thick scab has developed that is warm to the touch, erythematous, and is raised with a purulent core.

• She has been applying polysporin to the injury site to prevent infection as well as her hydrocortisone cream to alleviate pruritis. She has been wrapping it with dry gauze to keep it clean and covered.

• Please develop a treatment plan while considering her current medical history, current medications and recent injury.

  • How would we classify her burn? → In between superficial partial and deep partial

  • How should her burn be initially managed?

    • Dressings? → Dressings is dry gauze (sticks to wound) and not wet/occlusive 

    • Antibiotics? → YES bc it’s red, she has a fever, and wound has pus

  • How do her other medical conditions contribute to the management of her burn? → Methotrexate and hydrocortisone (immunosuppressants) → NEED REFERRAL (remove scab)

KNOW