Integumentary Conditions Flashcards
4 Functions of the skin?
1) Protects from outside exposure
2) Temperature regulation —> prevents heat loss
3) Watertight seal —> prevents excessive loss of water
4) Sensory —> keeps brain informed about external environment
Above what temperature do thermal burns occur?
Above 44 degrees
What happens during burn shock? What are the types of injury?
Fluid loss across damaged skin and volume shifts within body: capillary leakage leads to intravascular volume comes out of circulation and into the extra vascular spaces.
When does burn shock set in?
6-8 hours after initial burn, (it is not normally seen in the prehospital field)
What is important to be aware of in a hypotensive patient with burns.
Burn shock is delayed, search for other sources of injury causing shock.
What is burn shock the result of?
Massive fluid shifts and electrolyte disturbances within the body
What limitations to the body does burn shock cause?
Limits the effective distribution of oxygen to the tissues and hampers the circulations ability to remove waste products
What do you look for when trying to assess airway burns? When should immediate intubation be considered?
Inhalation burns —> serious airway compromise
Soot in nares, oral cavity, throat, coughing, wheezing, stridor = swelling of upper airway potentially
Laryngeal edema/ swelling = aggressive airway intervention
Features to look for in smoke inhalation?
Be aware it can cause burns in airway from breathing in super heated gases
Hypoxia from lack of O2
Tissue damage and toxic effects by chemicals in smoke
Carbon Monoxide Intoxication Features
Consider it when a group of people in same place complain of the same symptoms, specifically H/A, N/V, dizziness
SpO2 will read 100% ( co displaces o2 from alveoli and hemoglobin and binds to hemoglobin 250x more easy then O2)
Hyperbaric therapy may be indicated based on level of exposure
Rules of Chemical Burns?
Burns continues as long as irritant remains in contact with body —> move ASAP
Patient must be decontaminated —> follow handbook
2 most common deaths from electricity burns are?
Asphyxiation and Cardiac arrest due to conduction abnormalities or arrhythmias
Neuro complications from electrical burns?
Seizures, delirium, coma, temporary paralysis, confusion
Other injuries to keep in mind in the setting of electrical burns?
Kidney damage ( can resemble crush injury), fxs or dislocations and spinal precautions
What is a general rule in regards to vomiting in patients that have been exposed to radiation?
Pts unconscious or vomiting ten mins post exposure don’t survive, how soon the patient vomits usually correlates with the severity of the exposure.
Initial assessment of Burns?
1) evaluate airway -> stridor, swelling, sob, burns, soot, consider early tube
2) Evaluate mental status
3) Breathing?
4) Circulation?
5) Burn severity?
6) disability
Zone of Coagulation?
central area of skin, suffers most damage, no blood flow in this area to tissues.
Zone of Stasis?
peripheral area around zone of coagulation, decreased blood flow and inflammation
Zone of Hyperemia
least effected by thermal injury, cells recover in 7-10 days.
Superficial burns?
Epidermis only, thermal burns
Partial Thickness burns?
2nd degree, involves epidermis and varying degrees of the dermis. Sub divides into superficial partial and deep partial thickness
Superficial partial thickness features?
skin red when touched
blisters or moisture present
extreme pain
Deep partial thickness features?
extends into dermis
damages hair follicles, and sweat glands
hot liquids or steam or grease caused burns
Full thickness burns?
third degree, destruction of both layers of skin including basement membrane of dermis (which produces new skin cells)
Features of 3rd degree burns?
skin white, pale, leathery, brown or charred, no cap refill, no pain due to nerve destruction.
Fourth degree burns?
Burns extending through the skin to underlying tissues or fascia or muscle.
Major burns definition?
greater than 20% partial and or full thickness, any age
greater than 10% TBSA partial and or full thickness ages 10-50
greater than 5% full thickness of any age
burns to face, hands, genitalia, or joints
electrical burns
chemical burns
inhalation injury
any burns associated with major trauma
What is critical to prevent in burn patients?
Heat loss
What is important parts of the history and physical in burns?
Assess for circumferential burns –> can obstruct airway due to edema and restrict breathing in the chest
monitor distal pulses in burned extremities
Management and TX in burn patients?
ABC’s, RBS, cooling, keep warm, airway management (if indicated), aggressive fluid resus (due to fluid shift), pain management with fentanyl and or ketamine
Treatments in Electrical or Lightning afflicted patients?
Consider C- Spine immobilization
Large bore iv w NS wide open –> flush out the kidneys
surface burns –> dry sterile dressings
Definition of allergic reaction?
Abnormal immune response the body develops when re-exposed to a substance or allergen can be local or systemic
Anaphylaxis definition
Systemic reaction to an an exposure of an allergen involving 2 or more.
Define cellular immunity?
Body produces special white blood cells (T cells) that attack and destroy invaders
Define humoural immunity?
Antibodies dissolved in the blood plasma and lymph attack invading organisms
What is a mast cell?
Cell involved in the immune system response of the body
Define hypersensitivity to an allergen?
Abnormal reaction to allergen results in the immune system becoming hypersensitive to substances, it identifies harmless substances as threatening and overreacts to it resulting in an allergic reaction.
What are the chemical mediators mast cells release when they recognize a substance as harmful?
Histamine - localized dilation and capillary leakage
Leukotrienes - increased dilation and leakage
WBC - engulf and destroy the substance they indentify as invader.
How does histamine release clinically present as?
Vasodilation, flushed skin, hypotension
What is the dosage of Benadryl in adults for an allergic reaction.
50mg IM/IV or 1mg/kg to max of 50mg
MOA of Benadryl?
Anti-Histamine with anti cholinergic and sedating effects
Adverse Effects of Benadryl
Mucosal membrane dryness, nervousness, irritability, fatigue, adverse effects are dose dependent.
Peds dose of Benadryl?
1mg/kg to max dose of 50 mg
Contraindications of Benadryl?
Hypersensitivity, neonates, premature infants.
