Minor burns

Integumentary system benefits

• physical protections

• immunity

• wound healing

• body temp regulation

• fluid maintenance

• synthesis of vitamin D

• detection of stimuli

Superficial skin injuries

epidermis only with no loss of any skin

Symptoms: red, blanched when pressure is applies, unbroken skin, non-blistering, painful to touch

Heals within 3-6 days

ex) sunburn, abrasions

Superficial partial-thickness skin injuries

all epidermis and superficial dermis

symptoms: pain, edema, drainage, blanching, blistering

Heals within 7 - 20 days

Ex) lacerations

• acute: heals within 30 days (use OTC)

• chronic: takes longer than 30 days (refer)

Deep partial thickness skin injuries

all epidermis, superficial dermis, and extends deeper into dermis

Symptoms: edema, less blanching, possible blistering, pain

refer needs immediate medical attention heals in about 3 weeks with a scar

Full-thickness skin injuries

extends beyond dermis into subcutaneous fat, tendons, muscle or bone

refer

Thermal burns

contact with flames, scalding liquids, or hot object

• otc treatment avaiable

Chemical burns

exposure to corrosive or reactive chemicals

• refer

Electrical burns

flow of electricity and heat of electric current

• refer

First degree burns

superficial only

• epidermis damaged

• red, warm, painful, no blisters

• heals 3 -7 days

• OTC

Second degree burns

superficial partial or deep partial thickness

• epidermis and part of dermis is damaged

• red, painful, swollen, blistering

• increases risk of infection

• heals 10 - 14 days (superficial partial)

• heals 2 - 4 weeks (deep partial)

• may use otc depending on case

Third/fourth degree burns

full thickness

• down to subdermal muscle, bone, or interstital tissue

• refer

Inflammatory phase

hemostasis: release of thromboplastin from injured cell to form a clot to stop bleeding

inflammation: debris and bacteria are removed from wound, collagen is formed to stimulate healing

• lasts 3-4 days

Proliferative phase

starts day 3 - 4 and continues for 3 weeks

• wound gets filled with new connective tissue and covered in new epithelial tissue

Maturation (remodeling) phase

longest phase (60 days after injury)

• starts week 3 once wound is closed by connective tissue and new epithelium

• continual collagen synthesis and breakdown, replacing weak collagen

Factors that slow healing

• not enough oxygenation

• inadequate moisture

• foreign body

• > 60 years old

• stress

• inadequate nutrition

• diabetes, obesity, cancer, alcoholism, smoke

• anticoagulants

• corticosteroids

• immunosuppressants

Exclusions to minor wounds

• cuts longer than ½ in

• a cut still bleeding after applying pressure for over 10 minutes

• chemical, electrical burns

• deep partial thickness, full thickness

• signs of infection

• diabetes, obesity, cancer, alcoholism, smoking

• on face, hands, feet, major joints, genitalia

• injury is worsening

Rule of nine

estimates TBSA by dividing the body into multiples of 9%

• patient’s hand size = 1% TBSA

uncontaminated wounds cleaning

cleansing wound through irrigation gently

contaminated wound cleaning

more aggressive irrigation, remove debris or foreign body

• if can’t be removed refer

Wound dressings

Leaving wound open to air or covering it with non-occlusive dressing

• increases risk of dehydration, delaying healing, and increases risk of bacterial entry

• want a moist environemtn

Gauze dressings

non-occlusive fiber dressing with loose, open weave

Advantages:

• highly absorbent for wounds

• non-occlusive

Disadvantages:

• not a moist healing environment, unless with skin protectant

• needs secondary dressing (surgical tape, wrap to adhere to skin)

• frequent changes are required

Ex) sterilux builky gauze bandage, kerilx rolls and sponges

Non-adherent dressing

lightly coated porous dressings

Advantages:

• less adherent than plain gauze

Disadvantages:

• many do not provide a moist healing environment

• need secondary dressing

• frequent change

Ex) adaptic curad non-stick pads, Nexcare non-stick pads, vaseline gauze

Adhesive bandages

adhesive bandage with nonadherent pad in the cneter

Advantages:

• cost effective

• special charcateristics (clear bandages, waterproof, antibacterial fabric, highly durable adhesion)

Disadvantages:

• many do not provide a moist environment

• frequent dressing changes

Ex)bandaids

Hydrocolloid dressings

composed of hydrophilic particles in an adhesive form covered by a water resistant film or foam

Advantages:

• provides moist healing environment

• reduces pain

Disadvantage:

• assessment of the wound is difficult

• impermeable to gases

• less cost effective

Ex) DuoDerm, healing strips, CGF dressing, exuderm

Transparent adhesive films

semi occlusive, translucent dressing with continuous adhesive composed of polyurethan or copolyester thin film

Advantages:

• provides moist healing environment

• easy inspection of wound

• reduces pain

Disadvantage:

• expensive

Systemic analgesics

first step of treating pain for minor skin injuries

• Non-steroidal anti- inflammatory drugs:

  • ibuprofen (motrin)

  • Naproxen (aleve)

  • acetaminophen (tylenol)

Skin protectants for minor burns

protects the injured area from irritation caused by friction, rubbing, by promoting moist healing and increases overall comfort

• lotion: spreads easily to apply to large burns or wounds (do not use on wound bed)

• Creams: water based emulsions allows some fluids to pass through film good for broken skin

• Ointments: oil based preparations provide a protective film to impede the evaporation of water from the wound area (no appropriate for broken skin)

Topical antibiotics for minor wounds/burns

products containing:

• bacitracin

• neomycin - can cause contact dermatitis

• polymyxin B

Used to prevent infection

Topical anesthetics

only used on intact skin

• temporarily relieves pain

Ex) benzocaine, lidocaine, pramoxine

Aerosol and pump spray

• doesn’t need to physically touch injured area

• hold 6 in from skin and spray wound for 1-3 sec

• not protective

Antiseptics

Works: destroys or inhibits the growth of microorganisms in tissue

(not recommended for open skin injuries will slow healing)

minimizing scarring

silicone scar sheets