Nadia burns her hand

Nadia burns her hand

1. The Skin

   • Largest organ
   • high proliferative ability
   • Epidermis
     • Stratified squamous epithelium
     • No blood supply
     • Consists of 5 layers:
     • Cells
       • Keratinocytes
       • Melanocytes
       • Tactile cells
       • Dendritic cells
     • First degree burn
       • Red , dry , no blisters
       • minor: less than 10% of TBSA
   • Dermis
     • Connective tissue
     • Layers:
       • Papillary
         • Areolar loose connective tissue
         • House pain receptors
         • Fingerprints
       • Reticular
         • Deepest layer
         • Dense irregular
         • Blood vessels
         • Hair follicles
         • Sebaceous gland
           • Produces sebum
           • Lubricates the skin and hair
         • Sweat gland
           • Apocrine
           • Eccrine
     • Second degree burn
       • red , swollen , blistered
       • minor: less than 10%
       • moderate: 10-20%
   • Hypodermis
     • Subcutaneous tissue
     • adipose tissue
       • energy reservoir
       • thermal insulation
     • Production of leptin
     • Third degree pain
       • white and charred-looking
       • no pain
       • severe: >20%
   • Innate immunity
     • protections from infection , cancer , autoimmunity , toxins
     • epidermis
       • keratinocytes
         • antigen presenting cells
         • antimicrobial peptides
       • langerhans cell
     • dermis
       • dermal dendritic cell
       • melanocytes
       • dermal macrophages

2. Burns

   • Skin damage
     • heat
     • chemicals
     • electricity
     • Radiation
   • Signs and symptoms
     • Redness
     • Pain
     • Swelling
     • Blisters
       • fluid filled sac between the layers of the skin
       • vesicle: < 0.5 cm diameter
       • bullae: >0.5 cm diameter
     • Peeling skin
   • Complications
     • Bacterial infection
     • Hypovolemia
     • Hypothermia
     • Scars
       • scar formation
         • incapable of regeneration
         • severe damage to tissue
         • angiogenesis
         • formation of granular tissue
         • remodelling
     • Psychological problems
       • anxiety towards recovery and appearance
       • depression
       • sleep disturbance
       • distress
   • Management and treatment
     • minor and major
       • hold under cold water
       • bandage up
       • make a cold compress
       • consult a doctor
     • severe
       • IV fluids
       • Antibiotics
       • nutritional supplements and a high protein diet
     • skin grafting
   • the don'ts
     • don't apply ice
     • don't apply toothpaste
     • don't apply home remedies
     • don't burst blisters

3. Investigations of infected wound

4. Physiology of healing

   • mechanisms of tissue repair
     • regeneration
       • damaged cells are replaced
       • cell proliferation
         • labile tissue
         • stable tissue
         • permanent tissue
       • replacement by stem cells
     • scar formation
   • wounds closure
     • first intention
       • small wounds
       • regeneration>fibrosis
       • fast healing
       • minimal scarring
     • second intension
       • larger wounds
       • fibrosis > regenerations
       • slow healing
       • scarring
   • excessive scarring
     • hypertrophic scar
     • keloids
   • factors that affect tissue repair
     • infection
     • nutrition
     • mechanical variables
     • glucocorticoids
     • poor perfusion

5. Cell death

   • apoptosis
     • physiological and pathological
     • intact membrane
     • no inflammation
     • programmed
   • necrosis
     • pathological
     • membrane not intact
     • leakage of cellular content
     • damage and inflammation
     • types of necrosis
       • coagulative
         • infarction
       • liquifactive
         • brain
         • abscess
       • gangrene
       • caseous
         • tuberculosis
       • fat necrosis

6. Infection

   • signs and symptoms
     • signs
       • skin spots
       • abnormal heart rate
       • rapid breathing
       • sweating
       • cough
     • symptoms
       • fever
         • abnormally high body temperature
         • systemic response to invading microorganisms
         • pyrogens
           • macrophages
           • leukocytes
           • pathogen
         • sequester
           • liver + spleen
         • increase the metabolic rate
       • fatigue
       • headache
       • nausea
   • source of infection
     • staphylococcus aureus
       • found in the nose and skin
       • facultative anaerobic
       • cutaneous disease
         • folliculitis
         • furuncle or boil
         • carbuncle
         • impetigo
       • toxin-mediated diseases
         • scalded skin syndrome
         • toxic shock syndrome
         • food poisoning
       • invasive diseases
         • osteomyelitis
         • endocarditis
         • bacteraemia

7. antibiotics

   • cell wall synthesis inhibitors
     • beta lactam antibiotics
       • penicillin
     • others
   • protein synthesis inhibitors
   • DNA synthesis inhibitors
   • RNA synthesis inhibitors
   • metabolites inhibitors