burns and acute inflammation

burns and acute inflammation

1. burns and burn management

   • a burn is sever skin damage that cause the affected skin cells to die
     • causes
       • intense heat
       • electricity
       • UV radiation
       • chemicals
     • types
       • range from 1st degree to 4th degree burns
         • 1st
           • damage to the epidermis
         • 2nd
           • damage to the epidermis and part of the dermis
             • partial-thickness
         • 3rd
           • full-thickness burn
         • 4th
           • hypodermis also damages, burn reaches muscle tissue
   • management of burns
     • pre hospital
       • stop the burning
         • stop, drop, roll
       • cool the burned wound
       • give fluids
     • at the hospital
       • early fluid replacement
       • ensure the environment is sterile
       • find the degree of the burn
       • rule of nines
       • ABCDE assessment
         • airway
         • breathing
         • circulation
         • disability
         • exposure

2. skin layers and function

   • skin layers
     • epidermis
       • stratum corneum
       • stratum lucidum
       • stratum granulosum
       • stratum spinosum
       • stratum basale
     • dermis
       • papillary layer
       • reticular layer
     • hypodermis /subcutaneous adipose tissue
   • skin functions
     • covers the entire body an protects the internal organs
     • protection against pathogens
     • prevents dehydration and reserves water
     • temperature regulation
     • excretes waste
     • produces vitamin D via sun exposure
     • act as route of drug administration
     • aids in diagnosis of systemic diseases

3. acute inflammation

   • a response against a pathogen that aims to protect the body against the invader and eliminate it
   • main players
     • blood vessels
       • dilate to increase permeability and help the protective cells escape to the site of injury
         • leads to exudate formation
     • cells and proteins
       • predominant cells in acute inflammation are neutrophils
         • eliminate pathogens by phagocytosis
       • proteins and mediators like chemokines and cytokines work as signals that guide leukocytes to injury site
   • exudate formation
   • signs and symptoms
     • inflammation cardinal signs
       • redness
       • swelling
       • heat
       • pain
       • limited joint movement
     • systemic symptoms
       • fever
       • loss of appetite
       • headaches
       • generalized fatigue
       • an effect of pyrogens and leukotrienes released from mediator cells of inflammation

4. apoptosis vs necrosis

   • necrosis
     • pathological
     • happens as a result of injury
     • also called a host cell reaction
     • reversible
   • apoptosis
     • self programmed degradation of cells
       • physiological
     • happens because of the body's own decision
       • elimination of unwanted cells
     • the cell is degraded by its own enzymes
     • irreversible
   • cellular level changes

5. signs of wound infection

   • expanding redness around the wound
   • yellow to green pus formation/cloudy wound drainage
   • red streaking of the edges of the wound
   • unpleasant odor
   • increased inflammation of the wound
     • pain, tenderness, swelling, heat
     • loss of function and movement of the infected area

6. skin normal microbiota

   • commensal bacteria that live and thrive on the skin feeding on substances the skin produces
   • prevent colonization by pathogens by competing for attachment sites or for essential nutrients
   • factors contributing to variation
   • types of skin flora
     • staphylococcus epidermidis
     • staphylococcus aureus
     • corynebacteria
     • propionibacteria
       • cutibacterium acnes
     • B-proteobacteria
     • flavobacteria
     • streptococcus mitis

7. innate immunity

   • physical and chemicals barriers that prevent pathogens from entering the body
     • eliminate pathogen before the engagement of the third line of defense
   • cells of the innate immunity
     • neutrophils
       • phagocytes
     • eosinophils
     • mast cells
     • basophils
     • monocytes
       • macrophages
       • dendritic cells
   • mechanism of immune response against infection

8. antibiotics

   • any substance that inhibits the growth and replication of a bacterium or kills it outright
   • classification according to mechanism of action
     • cell wall synthesis inhibitors
     • increase cell membrane permeability
     • protein synthesis inhibitors
     • interfere with RNA and DNA synthesis
     • antimetabolites
   • penicillins
     • kill susceptible bacterial by inhibiting the synthesis of the bacterial peptidoglycan cell wall
     • types
       • natural penicillins
       • extended spectrum penicillins
       • antistaphylococcal penicillins
     • pharmacokinetics
       • low plasma binding protein affinity
       • bioavailability depends on type
       • short half life
       • kidney excretion
     • adverse reactions to penicillins
       • urticaria
       • fever
       • joint swelling
       • angioneurotic edema
       • pruritus
       • skin rashes

9. bacterial resistance

   • is the resistance of bacteria against antibiotics, the bacteria develops tolerance to the antibiotic that used to affect it previously
     • how bacterial resistance happens
   • mechanisms of resistance
   • prevention
     • immunization
     • using antibiotics only when necessary and only to the targeted bacteria
   • resistance gene transfer

10. antibiotic susceptibility test

    • susceptibility is the inability of a pathogen to grow in the presence of an antimicrobial drug
    • testing is done to determine if a bacteria is resistant or susceptible to a certain antibiotic as well as the effectiveness of this drug on the bacteria
      • done by culturing a specimen of bacteria taken from a subject and exposing it to the drug
    • results
      • susceptible
        • likely to inhibit bacterial growth
          • right choice for treatment
      • intermediate
        • can be effective at a higher or more frequent dosage
        • may only be effective in some body parts
      • resistant
        • not effective at inhibiting bacterial growth
          • most likely not the appropriate choice for treatment
    • methods
      • dilution
      • disk
      • E-test
      • automated antimicrobial susceptibility testing systems

11. process of wound healing

    • homeostasis
      • blood escapes the broken capillaries
        • blood dries on the exposed surface of the wound and dries forming a scab
      • platelets migrate to the ijnury site
        • start the clotting process
    • inflammation
      • macrophages and neutrophils fill the injury site and eliminate pathogens
        • with the help of increased permeability of blood vessels and the release of mediators
    • proliferation
      • fibroblasts and myofibroblasts replace damaged tissue with collagen fibers
      • formation of granulation because of proliferative skin cells and revascularization of the area
    • remodeling
      • happens lastly when the damaged cells are replaced with new ones as well as collagen fibers and intact blood vessels are present yet again

12. complications of burns and healing

    • inadequate scar formation
      • the wound may split or reopen again
    • excessive scar formation
      • keloid scar
        • regions of extreme overgrowth beyond the confines of the original wound area
      • hypertrophic scar
        • occur when the remodelling stage exists for a longer period of time and they are more cellular and more vascular than mature scars
    • contracture formation
      • develop when normally elastic tissues such as muscles or tendons are replaced by inelastic tissues (fibrosis)
    • burn patients are at risk of several physical and mental disturbances
      • physical
        • infections
        • sever fluid loss
        • reduced bone or muscle density
        • hypermetabolism leading to malnutrition
        • scarring
        • metabolic acidosis
      • mental
        • anxiety
        • stress
        • insecurity

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