HTHS 1120 Module 1 Burn

3 layers of skin

epidermis, dermis, subcutaneous layer

5 layers of epidermis

Basale, Spinsosum, Granulosum, Lucidum, Corneum

Basale

Base layer. Stem cells divide moving new cells up through the other layers of skin

Spinosum

Cells look spiny, 8-10 layers

Granulosum

Keratinocytes undergo apoptosis, 3-5 layers

Lucidum

Only present in thick skin (fingertips, palms, soles of feet), 3-5 layers

Corneum

Continuously shed and replaced, lamellar granulles for waterproofing, 3-5 layers

Acronym to remember layers of epidermis

Boys seek good looking chicks

Functions of the skin - Regulate body temperature

-sweat
-vasodilate (when too hot)
-vasoconstrict (when too cold)

Functions of the skin - Stores blood

-epidermis has no blood supply
-dermis does

Functions of the skin - protects body from external environment

-protein keratin protects from microbes, abrasions, heat, and chemicals
-lipids keep body waterproof

Functions of the skin - detects sensations

-nerve receptors detect touch, pressure, vibration, tickling, and pain.

Functions of the skin - excretes and absorbs substances

-water evaporates from skin
-absorb fat soluble vitamins DEAK, gas, toxins like acetone, carbon tetrachloride, poison ivy, poison oak, heavy metals like lead, mercury, & arsenic

Functions of the skin - synthesizes vitamin D

-UV rays become calcitriol to activate vitamin D. Calcitriol also assists in absorption of calcium in GI tract

Hypovolemic shock

caused by low blood volume or loss of fluid

Cardiogenic shock

failure of heart due to heart attack, heart valve defects, or arrhythmias

Neurogenic shock

vasoconstriction or vasodilation is controlled by nerves. Nerve damage results in constant vasodilation causing decrease pressure in vessels

Sepsis or anaphylactic shock

-sepsis (spread of infection) causing vasodilation and capillary permeability
-anaphylaxis is caused by allergic reaction. Causes inflammation, vasodilation, and capillary permeability

Shock

Cardiovascular system cannot deliver enough oxygen to tissues

1st degree burn

Mild pain and redness but no blisters

2nd degree burn

destroys epidermis and part of dermis, redness, blister, edema, and pain

3rd degree burn

Destroys epidermis, dermis and subcutaneous layer. Can be white or charred dry wounds. Numb and marked edema

Rule of nines
% for perineum

1%

Rule of nines
% For front of head & neck

4.5%

Rule of nines
% for front and back thighs, legs, & feet

36%

Rule of nines
% for front & back of one arm

9%

Rule of nines
% for front and back of trunk

36%

Inflammatory Response

leak fluid and proteins, swelling, hypotension, oliguria, shock, tachycardia, tachyphea

symphatic nervous response

fight or flight mode, heart rate + respirations increase, saliva dries, releases glycogen stores from liver, elevated blood glucose

basal metabolic rate

increases, core temperature turns up, body consumes glucose + oxygen at a high rate, increased nutritional demands

suppression of nervous system

cortisol is released, suppressed defense mechanisms

Burn effects on Kidneys

filter our large amounts of myoglobin and hemoglobin, can lead to acute renal failure

Burn effects on the respiratory system

carbon monoxide poisoning, inhalation of toxins from smoke, edema, diminished oxygen

Burn effects on the cardiovascular system

low blood pressure, hypovolemic shock, myocardial infarction, abnormal heart rhythms, life threatening

stem cells

undifferentiated that can differentiate into one or more cell type

pluripotent stem cells

can differentiate into any cell

multipotent stem cells

limited number of cell types

unipotent stem cells

one cell type

bone marrow stem cells

harvested from iliac crest, differentiates into keratinocytes and fibroblast, aids in growth of blood vessels, anti-inflammatory properties, painful procedure, low yield, declining number

adipose stem cells

plentiful, easily harvested, anti-inflammatory cytokines, hard to isolate

hair follicle stem cells

bulb contains epithelia and melanocyte stem cells, readily available but harvesting yield is low

subcutaneous layer

innermost layer of the skin, containing fat tissue, insulates and stores energy

dermis layer

oxygen + nutrients, collagen, elastin
papillary: superficial 1/5, blood vessels, nerve receptors for touch, temp, pain
reticular: deep 4/5, hair follicles, nerves, sebaceous + sudoriferous glands

epidermis layer

5 layers of stratified squamous

CBC lab test results

WBCs and Hct are higher, RBC lower

Chemistry panel lab results

glucose, creatine kinase, BUN levels are increased, protein levels low

Carboxyhemoglobin

Carbon monoxide bound with hemoglobin, no room for oxygen

Lactated Ringer's Solution

solution used to replace fluids and electrolytes in those with low blood volume/pressure

physiological causes of shock

heart failing to pump, blood vessels dilating

symptoms of compensated shock

increased heart rate + respiration, constriction of peripheral circulation, pale cool skin

symptoms of decompensated shock

low blood volume, lack of profusion, falling blood pressure

When is shock irreversible?

perfusion to organs cannot be restored, cell damage in liver + kidneys, irreparably damaged organs

What percentage of the body is burned when there is a significant mortality risk?

50%

Burns on face, nose, mouth, neck...

cause swelling and obstruction of airway

why do patients need extra protein when recovering from a burn?

rebuilds lost muscle due to burn wounds and breaking down of muscle tissue for energy

why do burn patients need extra carbohydrates?

burns only use glucose (provided by carbohydrates), allows protein to be used to rebuild muscle instead of energy

mechanical ventilation and endotracheal intubation

aids respiration, gives oxygen

Foley catheter

monitors urinary output

chest x-ray

assesses damage to respiratory tract

debridgement

Removal of skin that is dead or contaminated

skin grafting

transfer of skin from one body site to another to replace skin that has been lost through a burn or injury

transfusion of RBCs

restore blood loss, red blood cells are essential to provide oxygen

tachyphea

respirations increase

Tachycardia

increased heart rate

stridor

Harsh or high-pitched respiratory sound, caused by an obstruction of the air passages

edema

puffy swelling of tissue from the accumulation of fluid

sepsis

presence of infectious organisms in blood stream

nasogastric tube

tube inserted through the nose into the stomach, removes/places substances

contractures

permanent shortening of a muscle or joint

hypotension

low blood pressure

oliguria

Decreased urine output

EMT and paramedics role

stabilize, treat wounds, monitor vitals, recognize + treat shock

Nurses

insert nasogastric tube, monitor patient

physician

diagnoses and treats patient

respiratory therapist

intubates and monitors mechanical ventilation

physical therapist

increases mobility during healing

occupational therapist

helps patient adjust to day to day life

psychiatrist

helps patient heal emotionally

plastic surgeon

uses surgery to release contractures due to fluid loss from burn

dietician

assesses nutritional content and metabolic rate to maximize healing process