DAN Medical Frequently Asked Questions

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Burn Injuries

Prevention, Diagnosis and Treatment of BurnsDescription
Thermal burns from a heat source can range from life-threatening to minor emergencies. Both can affect boating operations significantly. The degree and severity of burns is highly dependent on the source and time of exposure as well as the location. Treatment of burns is therefore equally variable depending on the location and severity

Symptoms/Diagnosis
Burns have been traditionally classified based on extent of injury to the skin ranging from First-degree (minor) to Fourth-degree (major). Causes of thermal burns include fire, hot liquids, steam, hot objects, and UV-sunlight. A more updated classification describes wounds as either superficial, partial-thickness or full-thickness burns, but for simplification of this guide we will use the tradition description of 1st, 2nd and 3rd degree. First-degree burns are minor burns leading to redness, minor swelling and pain. Sunburns are typical 1st-degree burns. Second-degree burns are burns that penetrate the outer (epidermal) layer of the skin and affect the next inner layer (dermis) of skin, typically causing either red, pale or white discoloration of the skin as well as significant swelling, weeping and blister formation. The pain of a 2nd-degree burn is significant and the skin may scar once healed. Third-degree burns are burns that penetrate the deeper layers of the outer skin and affect the fatty layers of skin. These types of burns are often blackened/charred or white with a waxy or leathery appearance. Due to damage of the underlying structures that include fat and nerve tissues these burns are often painless except at the peripheral margins of the wound. This burns require emergency care by a professional care provider.

Treatment
Treatment depends on the type, location and severity of the burn. First, remove body from source of heat/injury. Secondly, wash hands thoroughly before handling a burn. Most burns (1st and 2nd degree) can be easily treated with simple measures such as cool water irrigation for 15-30 minutes, removal of any potentially constricting materials (rings, bracelets, clothing) that could potentially swell. Do NOT break any blisters that are smaller than a 1-2cm in diameter. Clean area with soap and water using gentle pressure. Pat dry with a clean cloth or gauze if available. Over-the-counter burn ointments are adequate for topical application prior to bandaging. Topical Bacitracin or Polysporin ointments are also suitable. Unbroken blisters may be left alone but if there is risk of further contamination or injury applying a dry loose bandage is recommended to protect the burn wound. Use of non-stick gauze pads is ideal for burn wounds.

For wounds to the hands, arms or legs where swelling of the extremity presents a significant risk factor avoid any taping or constrictive bandages that are circumferential to the extremity as this could lead to worsening swelling and pain. Keep burned extremities elevated as much as possible to reduce inflammation and swelling.

A mild non-prescription pain reliever such as ibuprofen (Motrin), naproxen (Aleve) or acetaminophen (Tylenol) is suitable for pain control and with the former two medications, anti-inflammatory relief.

Prevention
Prevention of burns requires vigilance while boating with products that are potential sources of thermal injury. Precautionary measures such as the following: use of cooking products and hot liquids should be handled with protective handles or gloves; never leave hot stove or cooking utensils unattended; turn hot pot handles toward rear of the stove; avoid loose fitting clothing while cooking; unplug all appliances while not using them; avoid touching hot metal surfaces on outside of boat during hottest times of the day. Sunscreen protection applied liberally and often to ALL sun-exposed surfaces. Current recommendations for sunscreen protection include the use of Broad-spectrum lotions that protect against both UVA and UVB rays, SPF 30 or higher and water-resistance. Apply lotions to dry skin 15 minutes prior to exposure and reapply approximately every TWO (2) hours or after swimming or significant sweating.

Impact on Boating
Minor burns (1st degree and some 2nd degree) can be safely and adequately treated while boating without significant impact to safety. However, if a burn involves the hands, feet, face or airways it could significantly impact the ability to operate while at sea. Most burns are not initially infected but vigilance must be maintained to keep wounds clean and free from contamination. Medical help must be sought for any burns that involve a significant portion of the body (approximately >10%); a circumferential on an extremity and have developed significant swelling and edema; burns that are suspected of being 3rd degree or greater require immediate medical attention. Dehydration is a significant problem with large wounds and therefore vigilance towards maintaining adequate hydration is essential.
Description
Sunlight contains three forms of ultraviolet rays (UVA, UVB and UVC) of which only UVA and UVB rays can lead to damage after prolonged exposure. Both forms of UV light can penetrate the primary layers of the outer skin (epidermis) and in extreme exposure circumstances reach the second layer, the dermis. Sun exposure cause both visible and unseen damage. Sunburn is the primary effect that is seen immediately after exposure. Long-term exposure contributes to the increased risk of developing skin cancer, especially melanoma.

Symptoms/Diagnosis
The majority of sunburns are superficial and classified as 1st degree burns which typically involves redness, mild inflammation and pain. Some people will experience viral-like symptoms such as fever, chills, nausea, headache and fatigue.

Treatment
A mild non-prescription pain reliever such as ibuprofen (Motrin), naproxen (Aleve) or acetaminophen (Tylenol) is suitable for pain control and with the former two medications, anti-inflammatory relief.

Prevention
Sunscreen protection applied liberally and often to ALL sun-exposed surfaces. Current recommendations for sunscreen protection include the use of Broad-spectrum lotions that protect against both UVA and UVB rays, SPF 30 or higher and water-resistance. Apply lotions to dry skin 15 minutes prior to exposure and reapply approximately every TWO (2) hours or after swimming or significant sweating.

Impact on Boating
Minor burns (1st degree and some 2nd degree) can be safely and adequately treated while boating without significant impact to safety. However, if a burn involves the hands, feet, face or airways it could significantly impact the ability to operate while at sea. Most burns are not initially infected but vigilance must be maintained to keep wounds clean and free from contamination. Medical help must be sought for any burns that involve a significant portion of the body (approximately >10%); a circumferential on an extremity and have developed significant swelling and edema; burns that are suspected of being 3rd degree or greater require immediate medical attention. Dehydration is a significant problem with large wounds and therefore vigilance towards maintaining adequate hydration is essential.


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