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