Transcript Treatment of Burns and scalds

Management of Minor
Burns and Sunburn;
Pharmacist Role
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Learning outcomes
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Learn about different type of skin burn
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Learn how to provide a quick pharmaceutical advice
when patient seeking your advice in such situation
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Learn about the cases you should refer for medical
attention
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Learn about the products available in the pharmacy
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Ambulatory management of burns is divided
into:
Acute treatment
Follow-up care.
Acute management includes:
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Measures to minimize further damage to patients
Identifying patients requiring hospitalization
Implementing measures to promote healing
Prevent infection and relieve pain.
• Follow-up care
◦ The focus shifts to limiting disfigurement from
scarring and dysfunction from contractures.
◦Although most patients with burns can be managed
by family physicians, some require surgical referral
for skin grafting and scar rehabilitation.
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First aid advice for burn:

Immediately get the person away from the
heat source to stop the burning.
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Cool the burn with cool water for 10-30
minutes. Do not use ice, iced water or any
creams or greasy substances, such as butter.

Remove any clothing or jewellery that is near
the burnt area of skin, but do not move
anything that is stuck to the skin.
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Make sure the person keeps warm – for
example by using a blanket – but take
care not to rub it against the burnt area.

Cover the burn by placing a layer of cling
film over it.
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Use painkillers, such as paracetamol or
ibuprofen, to treat any pain.
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When to get medical attention
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Depending on how serious a burn is, it may be
possible to treat it at home. For minor burns, keep
the burn clean and do not burst any blisters that
form.

More serious burns will require professional medical
attention.
Tell patient to get to a hospital A&E department for:
 All chemical and electrical burns
 Large or deep burns – any burn bigger than your
hand
 Full thickness burns of all sizes – these burns cause
white or charred skin
 Partial thickness burns on the face, hands, arms,
feet, legs or genitals – these are burns that cause
blisters
The skin

Skin is the largest organ. It has many functions, including
acting as a barrier between you and the environment and
regulating your temperature.
The skin is made up of three layers:
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The epidermis (the outer layer of your skin) is 0.5-1.5mm
thick. It has five layers of cells that work their way up to
the surface of your skin, where dead cells are shed
approximately every two weeks.
The dermis (the underlying layer of fibrous tissue) is 0.33mm thick and is made up of a mix of three types of tissue.
The dermis contains your hair follicles and sweat glands, as
well as small blood vessels and nerves.
The subcutaneous fat or subcutis (the final layer of fat
and tissue) varies in thickness from person to person. It
contains your larger blood vessels and nerves, and
regulates the temperature of your skin and body.
DEPTH OF A BURN
The traditional classification of burns as
first, second or third degree is being
replaced
by
the
designations
of
superficial,
superficial
partial
thickness, deep partial thickness and
full thickness.
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Superficial epidermal burns
Superficial epidermal burns are where the epidermis is
damaged. Skin will be red, slightly swollen and painful but
not blistered.
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Superficial dermal burns
Superficial dermal burns are where the epidermis and part of
the dermis are damaged. Skin will be pale pink, painful and
there may be small blisters.
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Deep dermal or partial thickness burns
Deep dermal or partial thickness burns are where the
epidermis and the dermis are damaged. This type of burn
makes skin turn red and blotchy. Skin may also be dry or
moist, become swollen and blistered, and it may be very
painful or painless.

Full thickness burns
Full thickness burns are where all three layers of skin (the
epidermis, dermis and subcutis) are damaged. In this type of
burn, the skin is often burnt away and the tissue underneath
may appear pale or blackened. The remaining skin will be dry
and white, brown or black with no blisters. The texture of the
skin may also be leathery or waxy.
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Superficial burns on the trunk and right arm of a young child.
Typically, these are red burns that blanch with pressure.
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Superficial partial-thickness burn on a man's right knee. Blistering
wounds that blanch with pressure are characteristic of
superficial partial-thickness burns. These wounds are also
typically moist and weeping.
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Deep partial-thickness burns on the trunk and extremities of a
young child. These burns are typified by easily unroofed blisters
that have a waxy appearance and do not blanch with
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pressure.
Full-thickness burn on a woman's left flank. Burn areas of this type
are characteristically insensate and waxy white or leathery
gray in color.
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Classification of Burns Based on Depth
Classification Cause
Ultraviolet light,
Superficial
Characteristics
Appearance
Sensation
Healing time
Scarring
Dry and red;
Painful
3 to 6 days
None
Painful to air and
7 to 20 days
Unusual;
burn
very short flash
blanches with
(flame exposure)
pressure
Superficial
Scald (spill or
Blisters; moist,
partial-
splash), short
red and weeping; temperature
potential
flash
blanches with
pigmentary
pressure
changes
thickness
burn
Deep partial- Scald (spill),
thickness
Blisters (easily
Perceptive of
flame, oil, grease unroofed); wet or pressure only
burn
More than 21
Severe
days
(hypertrophic)
waxy dry;
risk of
variable color
contracture
(patchy to cheesy
white to red);
does not blanch
with pressure
Full-thickness Scald
burn
(immersion),
Waxy white to
Deep pressure
Never (if the burn Very severe risk
leathery gray to
only
affects more than of contracture
flame, steam, oil, charred and
2 percent of the
grease, chemical, black; dry and
total surface area
high-voltage
inelastic; does
of the body)
electricity
not blanch with
pressure
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When to refer
All chemical and electrical burns large or deep burns – any burn
bigger than the affected person’s hand
 Full thickness burns of all sizes – these burns cause white or
charred skin
 Partial thickness burns on the face, hands, arms, feet, legs or
genitals – these are burns that cause blisters
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Also get medical help straight away if the person with the burn:
Has other injuries that need treating or is going into shock (signs
include cold, clammy skin, sweating, rapid, shallow breathing and
weakness or dizziness)
If pregnant
If over 60 years of age
If under five years of age
Has A medical condition such as heart, lung or liver disease,
or diabetes (A long-term condition caused by too much glucose in
the blood)
Has A weakened immune system (the body’s defence system), for
example because of HIV or AIDS or because they're having
chemotherapy for cancer
Chemical burns
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Chemical burns can be very damaging and require
immediate medical attention at an A&E department.

If possible, find out what chemical caused the burn and tell
the healthcare professionals the emergency department.
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If you are helping someone else, wear appropriate
protective clothing, then:

Remove any clothing that has the chemical on it from the
person who has been burnt
If the chemical is dry, brush it off their skin
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Use running water to remove any traces of the chemical
from the burnt area
Sunburns
 In cases of sunburn, advice the patient:
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If you notice any signs of sunburn, such as hot, red and painful
skin, move into the shade or preferably inside.
Take a cool bath or shower to cool down the burnt area of skin.
Apply after-sun lotion to the affected area to moisturise, cool and
soothe it.
 Do not use greasy or oily products.
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If you have any pain, paracetamol or ibuprofen should help relieve
it. Always read the manufacturer’s instructions and do not give
aspirin to children under 16 years of age.
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Stay hydrated by drinking plenty of water.
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Watch out for signs of heat exhaustion or heatstroke, when the
temperature inside your body rises to 37–40°C (98.6–104°F) or
above. Symptoms include dizziness, a rapid pulse or vomiting.
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If the eye is involved, the eyelid should be
pulled back and the eye irrigated with tap
water for at least 15-30 min from the
nasal side to the outside corner.
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No attempts should be made to neutralise
any chemical burns; this might cause
further damage.
Treatment of minor burns and
sunburns
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Most patients with superficial burns complain of
pain. Therapeutic options include topical cold
compresses, skin protectant, external
anaesthetics, topical corticosteroids and OTC
analgesics.
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The inflammatory response to burns evolves over
the first 24 to 48 hours.
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Moisturisers that contain aloe vera will also help
soothe skin. Calamine lotion can relieve any
itching or soreness.
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Cleanse the burn before applying the dressing.
Don’t use alcohol containg products
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Non-adherant hypo-allergic dressing should be
used
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New dressing would include the option of
exudate absorption and conclusiveness; if remain
dry and intact could be left 10 days
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Skin protectant
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They can make the burn area less painful
Protect from mechanical irritation
Re-hydrating helps healing
They only provide symptomatic relief
◦ Bismuth subnitrate and boric acid are not
considered safe for burned skin (FDA)
◦ Live Yeast cell derivative has not accepted by FDA
to be safe and effective in accelerating healing
◦ Skin protectant can be applied as often needed, if
not improved within 7 days (refer)
Pharmacological therapy
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Systematic analgesics
◦ Recommend short term analgesics preferably
with anti inflammatory effect (NSAID)
◦ NSAID are of benefit to mild sunburn, esp. with
the first 24 hours (reduce inflammation caused
by UV radiation)
◦ For who can tolerate NSAID; use acetaminophen
(no prostaglandin effect though)
Pharmacological therapy
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Topical anaesthetics
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Can inhibit pain signals transmission
Short relief 15-45 min
Benzocaine (5-20%), lidocaine (.5-4%)
The higher concentration are recommended for
intact skin while lower when skin is not intact.
◦ Should be applied to small area to avoid
systematic toxicity
◦ No more than 3-4 times daily
Pharmacological therapy
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Topical Hydrocortisones
◦ Not FDA approved in minor burn
◦ However, often used 1% in first aid products
◦ Should be used with caution in broken skin
(allow infection to develop)
◦ High potency corticosteroids might may delay
reepithelialisation
Pharmacological therapy
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Antimicrobials
◦ Silver Sulfadiazine have been the gold standard
agent
◦ Recent studies showed lack of superiority
comparing to honey and membrane like
dressing
◦ However, in minor burns antibiotics and
antiseptics are limited value, esp for intact skin
Pharmacological therapy
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Vitamins
◦ The benefit is not well known
◦ Deficiency of Vit C and A will impair healing
◦ No scientific evidence that vit dosage above
RDA would accelerate healing
◦ However, Vit C play a role in collagen
synthesis, because it is not stored in the body
it is reasonable to recommend up to 2 grams
daily from the injury until healing is complete.
Pharmacological therapy
◦ Vit A is shown to improve healing and deficiency
may be associated with increase infection
◦ However, Vit A stored in the liver and long term
supplements are not recommended.
◦ In minor burn, oral supplement might not of
benefit but topical product might be advised
◦ Deficiency of Vit B may retard healing and
should be supplemented if nutritional status is
poor.
◦ Vit E might delay wound healing and not
recommended for burns
◦ In summary, burned patient with good
nutritional status not benefit from Vit
supplements and assuring of adequate vit C
intake is recommend.
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Counterirritants
◦ Such as camphore, menthol
◦ FDA still evaluating this but generally should
not be used
◦ They increase blood flow and might cause
further edema
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Product selection (Tip for the pharmacist)
◦ Ointment helps with a protective layer that
prevent evaporation and skin drying but might
promote bacterial growth
◦ Ointment are more appropriate in intact skin
minor burn
◦ Lotions that produce powder layer are not
recommended
◦ Generally, minor burn treatment is empirical
A sterile, non-adherent, fine-mesh gauz
impregnated with hydrophilic petrolatum
should be placed over wound (non-intact
skin)
 A second layer of absorbent gauze should
be used as a protective layer
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◦ Should not be constricting and replaced every
48 hours (inspect for sign of infection)
Dressing