Nadia Burns Her Hand (skin burns)

Types
1. radiation
2. contact burns
3. chemical
4. electrical
  1. true high tension
    1. current flows through individual
  2. flash
    1. heat from a high voltage current arc
      1. current doesn't flow
5. fire
  1. flame burns
    1. usually inhalation
6. scalds
  1. liquid
    1. spill
    2. immersion
  2. steam
  3. grease
demography
1. name: Nadia
  1. incident
    1. burned her hand with hot oil
2. age: 55
3. occupation: chef
4. marital status: married
skin
1. 3 layers
  1. epidermis
    1. consists of 5 layers
      1. from bottom to top
        basale
        spinosum
        granulosum
        lucidum
        corneum
  2. dermis
    1. consists of 2 layers
      1. reticular
      2. papillary
  3. subcutaneous layer
    1. adipose tissue
Effects
1. Local
  1. model of Jackson
    1. outermost: zone of hyperemia
    2. Inner region: zone of coagulation
    3. 2nd layer: zone of stasis
2. Systemic
  1. metabolism
    1. increased basal metabolic rate
  2. immunity
    1. down regulation
  3. respiratory
    1. ARDS
    2. bronchoconstriction
  4. cardiovascular
    1. hypovolemia
    2. hypotension
    3. hypoperfusion
Severity
1. 1st degree
  1. only epidermis involved
    1. pain - redness - dry & peeling skin
2. 2nd degree
  1. epidermis and part of dermis involved
    1. pain - redness - blisters
3. 3rd degree
  1. all skin layers involved
    1. charred skin - leathery texture - no pain
4. 4th degree
  1. subcutaneous layer lost
Coagulative necrosis
1. cell death
  1. apoptosis
    1. no inflammation
    2. shrunken nucleus
    3. physiological or pathological
    4. intact nucleus
  2. necrosis
    1. inflammation
      1. leads to
        systemic fever
        decrease availability of zinc and iron
        bacteria cannot tolerate heat
        caused by PGE2 bradykinins
        stimulate hypothalamus
      2. importance
        fights infection
        kills pathogens
        by
        by immune cells and reactions
        mediates healing
        by scar
        permanent
        ex: neurons
        by normal tissue
        stable
        ex: liver
        labile
        ex: skin
        repair
        scar formation
        VEGF & FGF-2
        angiogenesis
        FGF-2 / PDGF / TGF
        granulation tissue formation
        PDGF & TGF-B
        deposition of connective tissue
        MMPs & TIMPs
        Remodeling
      3. cardinal signs
        redness & heat
        due to increased vascular permeability (vasodilation)
        swelling
        due to accumulation of exudate in the interstitial spaces
        exerts pressure on
        pain receptors
        pain
        due to stimulation of
        loss of function
        caused by all other factors
      4. causes
        injury
        autoimmune diseases
        infections
        entry & multiplication of a microorganism in the body
        parasites
        fungi
        viruses
        bacteria
        ivading
        normal flora
        risks
        opportunistic infections
        nosocomial infections
        indigenous infections
        a swab is taken for investigation and to decide which antibiotic to use
        investigations: lab tests
        gram staining
        +
        catalase test
        +
        staph
        coagulase test
        +
        aureus
        -
        epidermidis / saprophyticus / etc...
        -
        strept
        hemolysis
        alpha
        pneumoniae viridans
        Beta
        pyogenes agalactiae
        gamma
        enterococcus
        -
        antibiotics
        Mechanisms
        cell membrane inhibitors
        cell wall inhibitors
        nucleic acid synthesis inhibitors
        viral replication inhibitors
        metabolites
        protein synthesis inhibitors
        favored characteristics
        selective toxicity
        microbicidal
        stable
        active in the presence of organic compounds
        extensive distribution
        can be taken orally or IV
        functions
        seal body space
        mitigate pathogens
        fermentation of fiber
        tissue homeostasis
        microorganisms present in the body
        pathogenic
        symbionts
        commensals
    2. swelled nucleus
    3. pathological
    4. disrupted group nucleus
complications

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Nadia Burns Her Hand (skin burns)

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	Created by Abdelrahman Nouh almost 6 years ago