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Scars and Burns

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Lecture 7: Other Topics (Scars, Complex Cases, Documentation, Collaboration, Resources)

Burns, Wounds and Scars

1. Hyperemesis Gravidarum/ Pernicious Vomiting Definition: Excessive nausea and vomiting during pregnancy, extending beyond week 12 or causing dehydration, ketonuria, and significant weight loss within the first 12 weeks. Incidence: 1 in 200-300 women Cause: Unknown, but may be associated with increased thyroid function and Helicobacter pylori infection. Signs and Symptoms: • Decreased urine output • Weight loss • Ketonuria • Dry mucous membranes • Poor skin turgor • Elevated hematocrit • Decreased sodium, potassium, and chloride levels • Polyneuritis (in some cases) Assessment: • Hemoglobin: Elevated hematocrit concentration (hemoconcentration) due to inability to retain fluids. • Electrolytes: Decreased sodium, potassium, and chloride levels due to low intake. • Acid-base Balance: Hypokalemic alkalosis (severe vomiting, prolonged period). • Neurological Examination: Polyneuritis due to B vitamin deficiency. Effects (if left untreated): • Intrauterine Growth Restriction (IUGR): Dehydration and inability to provide nutrients for fetal growth. • Preterm birth: Due to complications caused by the condition. • Prolonged hospitalization/home care: Resulting in social isolation. Therapeutic Management: • Fluid and Electrolyte Management: Monitor input and output, blood chemistry to prevent dehydration. • Nutritional Support: Withhold oral food and fluids (usually) and administer total parenteral nutrition (TPN). • Intravenous Fluid Replacement: 3000 ml Ringer's lactate with added vitamin B to increase hydration. • Antiemetic Medication: Metoclopramide (Reglan) to control vomiting. 2. Ectopic Pregnancy Definition: Implantation of a fertilized egg outside the uterine cavity (ovary, cervix, fallopian tube - most common). Incidence: Second most frequent cause of bleeding during the first trimester. Causes: • Obstruction of the fallopian tube: ◦ Adhesions (from previous infection like chronic salpingitis or pelvic inflammatory disease). ◦ Congenital malformations. ◦ Scars from tubal surgery. ◦ Uterine tumor pressing on the proximal end of the tube. ◦ Current use of an intrauterine device (IUD). Signs and Symptoms: • Missed period/amenorrhea. • Positive hCG test. • Sharp, stabbing pain in the lower abdominal quadrants and pelvic pain (at time of rupture). • Scant vaginal spotting/bleeding. • Rigid abdomen (from peritoneal irritation). • Leukocytosis (increased WBC count due to trauma). • Decreased blood pressure and increased pulse rate (signs of shock). • Cullen's sign (bluish tinge around the umbilicus). • Tender mass palpable in the cul-de-sac of Douglas (vaginal exam). • Falling hCG or serum progesterone level (suggesting the pregnancy has ended). • No gestational sac on ultrasound. Therapeutic Management: • Non-ruptured Ectopic Pregnancy: Oral administration of methotrexate followed by leucovorin. • Ruptured Ectopic Pregnancy (emergency): Laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube. 3. Hydatidiform Mole (H-mole)/ Gestational Trophoblastic Disease/ Molar Pregnancy Definition: A gestational anomaly of the placenta consisting of a bunch of clear vesicles resembling grapes. This neoplasm is formed from the swelling of the chorionic villi, resulting from a fertilized egg whose nucleus is lost, and the sperm nucleus duplicates, producing a diploid number 46XX. Incidence: Approximately 1 in every 1500 pregnancies. Risk Factors: • Low socioeconomic group (decreased protein intake). • Women under 18 or over 35 years old. • Women of Asian heritage. • Receiving clomiphene citrate (Clomid) for induced ovulation. Types of Molar Growth: • Complete/Classic H-mole: All trophoblastic villi swell and become cystic. No embryonic or fetal tissue present. High risk for malignancy. • Partial/Incomplete H-mole: Some of the villi form normally. Presence of fetal or embryonic tissue. Low risk for malignancy. Signs and Symptoms: • Uterus expands faster than normal. • No fetal heart sounds heard. • Serum or urine test for hCG strongly positive. • Early signs of preeclampsia. • Vaginal bleeding (dark-brown spotting or profuse fresh flow). • Discharge of fluid-filled vesicles. Diagnosis: • Ultrasound. • Chest x-ray (lung metastasis). • Amniocentesis (no fluid). • Hysteroscopy (via cervix). Management: • Evacuation of the mole: Dilation and curettage (D&C). • Blood transfusion. • Hysterectomy (in some cases). • Monitoring hCG levels: Every 2 weeks until normal. • Contraception: Reliable method for 12 months to prevent confusion with a new pregnancy. 4. Premature Cervical Dilatation/ Incompetent Cervix Definition: Premature dilation of the cervix, usually occurring around week 20, when the fetus is too immature to survive. Incidence: About 1% of pregnancies. Causes: • Increased maternal age. • Congenital structural defects. • Trauma to the cervix (cone biopsy, repeated D&C). Signs and Symptoms: • Painless dilation of the cervix. • Pink-stained vaginal discharge. • Increased pelvic pressure. • Rupture of membranes and discharge of amniotic fluid. Therapeutic Management: • Cervical cerclage: Surgical procedure to prevent loss of the child due to premature dilation. • Bed rest: After cerclage surgery, to decrease pressure on the sutures. 5. Abortion Definition: Termination of pregnancy before the fetus is viable (400-500 grams or 20-24 weeks gestation). Types of Abortion: • Spontaneous Abortion: Pregnancy interruption due to natural causes. ◦ Threatened: Mild cramping, vaginal spotting. ◦ Inevitable/Imminent: Profuse bleeding, uterine contractions, cervical dilation. ◦ Complete: All products of conception expelled spontaneously. ◦ Incomplete: Part of the conceptus expelled, some retained in the uterus. ◦ Missed: Fetus dies in utero but is not expelled. ◦ Habitual: 3 or more consecutive spontaneous abortions. • Induced Abortion: Deliberate termination of pregnancy in a controlled setting. Complications of Abortion: • Hemorrhage. • Infection (endometritis, parametritis, peritonitis, thrombophlebitis, septicemia). Management: • Bed rest. • Emotional support. • Sedation. • D&C: Surgical removal of retained products of conception. • Antibiotics. • Blood transfusion. 6. Placenta Previa Definition: The placenta is implanted in the lower uterine segment, covering the cervical os, obstructing the birth canal. Incidence: 5 per 1000 pregnancies. Signs and Symptoms: • Abrupt, painless vaginal bleeding (bright red). • Bleeding may stop or slow after the initial hemorrhage, but continue as spotting. Types: • Total: Placenta completely obstructs the cervical os. • Partial: Placenta partially obstructs the cervical os. • Marginal: Placenta edge approaches the cervical os. • Low-lying: Placenta implanted in the lower rather than the upper portion of the uterus. Therapeutic Management: • Immediate Care: Bed rest in a side-lying position. • Assessment: Monitor vital signs, bleeding, and fetal heart sounds. • Intravenous Therapy: Fluid replacement with large gauge catheter. • Delivery: Vaginal birth (safe for infant if previa is less than 30%). Cesarean section (safest for both mother and infant if previa is over 30%). 7. Abruptio Placenta/ Premature Separation of Placenta/ Accidental Hemorrhage/ Placental Abruption Definition: Separation of a normally implanted placenta after the 20th week of pregnancy, before birth of the fetus. Incidence: Most frequent cause of perinatal death. Causes: • Unknown. • Predisposing Factors: ◦ High parity. ◦ Advanced maternal age. ◦ Short umbilical cord. ◦ Chronic hypertensive disease. ◦ PIH. ◦ Trauma (automobile accident, intimate partner abuse). ◦ Cocaine or cigarette use. ◦ Thrombophilitic conditions (autoimmune antibodies). Classification: • Total/Complete: Concealed hemorrhage. • Partial: Concealed or apparent hemorrhage. Signs and Symptoms: • Sharp, stabbing pain in the uterine fundus. • Contractions accompanied by pain. • Uterine tenderness on palpation. • Heavy vaginal bleeding (may be concealed). • Signs of shock. • Tense, rigid uterus. • Disseminated Intravascular Coagulation (DIC). Therapeutic Management: • Fluid Replacement: IV fluids. • Oxygen: Limit fetal hypoxia. • Fetal Monitoring: External fetal heart rate monitoring. • Fibrinogen Determination: IV fibrinogen or cryoprecipitate. • Lateral Position: Prevent pressure on the vena cava. • Delivery: CS is the method of choice if birth is not imminent. 8. Premature Rupture of Membranes Definition: Rupture of the fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks. Incidence: 5%-10% of pregnancies. Causes: • Unknown. • Associated with: Infection of the membranes (chorioamnionitis), vaginal infections (gonorrhea, streptococcus B, Chlamydia). Signs and Symptoms: • Sudden gush of clear fluid from the vagina with continued minimal leakage. • Nitrazine paper test: Amniotic fluid turns the paper blue (alkaline), urine remains yellow (acidic). • Microscopic examination: Amniotic fluid shows ferning, urine does not. • Ultrasound: Assess amniotic fluid index. • Signs of infection (increased WBC count, C-reactive protein, temperature, tenderness, odorous vaginal discharge). Therapeutic Management: • Bed Rest: To prevent further leakage and risk of infection. • Corticosteroids: To hasten fetal lung maturity. • Prophylactic Antibiotics: To reduce risk of infection. • Intravenous Penicillin/Ampicillin: If (+) for streptococcus B. • Induction of Labor: If fetus is mature and labor does not begin within 24 hours. 9. Pregnancy-Induced Hypertension (PIH)/ Toxemia Definition: Vasospasm occurring in both small and large arteries during pregnancy, causing elevated blood pressure, proteinuria, and edema. Incidence: Rarely occurs before 20 weeks of pregnancy. Risk Factors: • Multiple pregnancy. • Primiparas younger than 20 or older than 40. • Low socioeconomic background. • Five or more pregnancies. • Hydramnios. • Underlying diseases (heart disease, diabetes). • Rh incompatibility. • History of H-mole. Categories: • Gestational Hypertension: Blood pressure 140/90 or greater, without proteinuria or edema. • Preeclampsia: Blood pressure 140/90 or greater, with proteinuria and edema. • Eclampsia: Seizures or coma accompanied by preeclampsia. Therapeutic Management: • Preeclampsia: Bed rest, balanced diet, left lateral position. • Severe Preeclampsia: Hospitalization, diazepam, hydralazine, magnesium sulfate. • Eclampsia: Magnesium sulfate, diazepam, oxygen therapy, left lateral position

Battle Scars Video Questions

BAttle Scars

Type of scars

5.01 : Metals in the earths crust The composition of the Earth’s crust we get some metals from the sea but most from earths crust.The Crust is the outer llayer of the Earth. It is huge mixture of many different compunds. It also contains elements such as sulphur,copper,silver,platinum and gold. These occur uncombined, or native, because they are unreactive. if you could dig up the earths crust and break down all the comnpunds, you would find it is almost half oxygen! its composition is oxygen 45% ( nearly one-fourth ) silicon 27% ( over one foruth) all other metals and non-metals 2% pottasium 1.5% sodium 2.5% magnesium 3% calcium 5% iron 6% aluminium 8% Nearly three-quarters of the earth’s crust is made up of just two non-metals, oxygen and silicon. These are found combined in compunds such as aluminium oxide,iron oxide,and calcium carbonate. the rest of the crust consists mainly of just six metals.Aluminium is the most abundant of these, and iron is next.None of the six is found uncombined, because they all are reactive metals,and reactice metals like to form compounds. Some metals are scarce : look again at the pie chart above. it shows that there are just 6 plentiful metals. all the other metals together make up less than one-fifth of the earths crust,so they are not plentiful. copper zinc mercury silver lead gold tin platinum the scarce metals are expensive. Even so, we are using them up quicly, and many people are worried that they will soon run out. Metal ores: The rocks in the Earths’s crust are a mixture of many different compounds. But some contain a large amount of single metal compound ,or a single metal,and it may be worth digging up these extracted metals.Rocks which metals are obtained are called ores.Below are some examples: Mine or not to mine? Before starting to mine an ore,the mining company must decide whether it is economical.It must find questions like these: 1.How much ore is there? 2.How much metal will we get from it? 3.Are there any special problems about getting the ore out? 4.How much will it cost? 5.how much will be able to sell the metal for? 6.so will me make a profit if we go ahead? the answers to these questions will change from year to year.if the costs of fuel drops,and the selling price of a metal rises,even a low quality or low-grade ore may be worth mining. The mining company must also think about local community,who may worry that the landscape will be ruined by dust,pits,scars, and that the extraction plant will cause pollution.on the other hand,they may welcome the new jobs tthe mining will bring.

APUSH Scars Quiz Chp 4-6

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Chapter 11: Forensic Identity