week 2: integumentary Flashcards
vit d production
- UV rays absorbed as vit D3/from diet–> Vit D3 circulates the blood—> liver(converts vit d3 into another form—> kidney—> either : ca2+ reabsorption, differentiation, immunity or: proliferation, inflammation, angiogenesis
layers of skin:
epidermis: most superficial ( chemo control, protection)
dermis: houses sensory receptors, follicles glands, papillary/reticular dermis)
subcutaneous layer: adipose tissue, muscle, & bone
ezcema:
- common in kids
- looks red/patchy/itchy skin ( can have flare ups)
Psoriasis:
raised lesions that look like white patches, chronic autoimmune disorder
Contact dermatitis:
irritation from contact w an irritant, red itchy, raised bumps
Scabies:
caused by mites under the skin, red and contagious.
heat rash:
caused by blocked sweat ducts, red raised bumps/rash
what systemic diseases have skin signs:
liver, diabetes, internal cancers, Obstructive cardiomyopathy, cardiac dysrhythmias
Sarcoidosis
inflammation of the skin tissues of the body.
life-threatening skin conditions:
- pemphigus Vulgaris (PV), Toxic Epidermal Nercrolysis (TEN), AKA Stevens Johnsons syndrome
-DRESS- drug rash w eosinophillia systemic symptoms syndrome - Toxic Shock Syndrome
-meningoccocemia - rocky mountain spotted fever
- Necrotizing Fasciitis: bacteria enters through breaks in the skin.S/s: fever, redness, swelling, hypotension, severe pain (POOP/POEM)-spreads fast
osteomies:
surgery of opening the abdo wall from the bowels or urinary tract, ex: cancer
what is the leading cause in death with burns?
smoke inhalation(50-80% of fire related deaths)
CO poisoning
Co= greater affinity than O2 for hemoglobin–> severe hypoxia
-s/s: throbbing headache starting in the temples, alt mental status, N/V, tachycardia/pnea, coma/seizures,
tx: Hyper oxygenate for >30mins, vent access prn, hyperbaric chamber prn ( if exposure>30mins)
Hx: how long exposed, what was burning, was the space enclosed, any LOC?
hyperbaric chamber:
uses pressure to displace CO off hemaglobin so O2 can bind
- daltons law: +pressure=+amount of dissolved O2
- machine uses + atmospheric pressure to 2.5x that of normal
functions of skin:
retaining moisture, temp control, protection, pain/sensory receptors
Epidermis:
- outermost layer, no blood supply, strata granuolum= basal layer
dermis
-middle layer, vascularized and has collagen, ct, sweat glands, hair follicles, pain receptors, etc.
Subcutaneous layer
adipose tissuem loose CT between underlying organs & muscles
burns patho:
rupture cell membranes, blood cagulates, proteins denature, histamine= relasedsed–> cappillary D–> leaks blood plasma–> interstitialspace –> hypovolemia, edema, ,mass fluid shift.
Jackson’s theory of Thermal burns:
outer zone= red, zone of hyperremia
Middle zone= less red/orange= zone of stasis
inner most= yellow/white, Zone of coagulation
3 stages of burns:
1.emergent:
- immediate pain response, catecholamine release, tachy/cardia/pnea, mild anxiety
2. fluid shift
- 18-24hrs after, inflmmatory response initiated(+bf to the site, intravascular fluid—> extravascular space, leaky capillaries, massive edema)
3.resolution
- days to weeks after, general rehab/progression back to normal function
Eschar?
dead tissue that is leather like & black. can lead to compartment syndrome! results from full thickness burns. Skin denatures/dies over the wound, edema limits BF to area–>die
(code 4/CTAS1/LOAD & GO)
what are the first steps of Tx for burn pt….
- stop the burning process: w sterile water/NS
2 reasses damage–> remove clothing/jewerly - cover w a sterile burn sheet
- Irrigate the area (10-30 mins dependent on thickness and SA)
- dress area w dry dressings if : greater than 15% of BSA, 2nd degree or full thickness ( full thickness always gets dry!)
- give fluids ( extreacellular space will fill uo w K+–> affects heart/hypovolemia)fluids ++ osmotic pressure
what are some systemic affects of burns?
Infection, organ fialure ex: kidneys, could be due to abuse, or special factors
burning wood/nylon releases….
cyanide in the air
burning appliances releases
Freon in the air
management of chemical burns?
scene safety: HAZMAT, fire etc
proper ppe, remove clothing/brush off dry chemicals
-irrigate chemicals w NS and sterile water
–acid-10 mins, Base=20mins
-tx: hydrofluoric acid with Ca2+ gluconate gel/injection
how long should you irrigate the eyes if they have sustained a burn?
20 mins
superficial thickness burns…(1st degree)
only involves the epidermis, site will be red w mild pain, heals in 5-7 days.
superficial -Partial thickness burns (2nd degree)
through the dermis, pink/wet/blisters, 2-4 wks to heal
Full thickness:(3rd degree)
through the subcutaneous layer, nerve receptors= burnt= no pain at the actual site, cherry red/pale/pearly white, slow/no cap refill, can produce keloid scarring/eschar ++ major risks for compartment syndrome.
4th degree burns….
muscle + bone ( not used currently)
deep partial thickness burns:
-less wet/red, +/- blisters, slow/no cap refill, +/- pain, 3-8 wks healing, severe scarring, requires skin grafts
what are some indications for a/w burns?
soot in a/w, a/w edema, singed hair/facial hoarse, black tongue, carbonaceous sputum, hoarse voice, stridor, resp distress
indications for early intubation?
resp distress, stridor, acessory muscle use, blisteres/edema of orpharynx, deep burns on face+ neck
rule of 9’s (adult)
head (f+b)= 9%
Trunk=18%
Back=18%
genitalia=1%
each leg (f)=18%
each leg (b)=18%
arm= 9% each
rule of 9”s for children:
head+neck(f+b)=18%
arms=9% each (4.5%=1 front/Back)
Torso= 18%
Back =18%
each leg(f/back only)=7%
major burn %’s in adults…
> 25=BSA 2nd degree
10% BSA 3rd degree
any a/w burns
major burns in children…
> 20% BSA 2nd degree, any 3rd degree, any a/w
what are some risks of abuse …
premature baby, chronic illness, misbehaving child, toung parents, parents with mental health/drug/alc abuse, parent changing stories/lies, abnorm behaviour
signs of abuse with burns
- consistent burn patterns, depth, instruments around
what is dangerous about cement burns?
cement= 64% Ca oxide ( lime), 21% silicon oxide, had a very alkaline ph of 12.5 ( very basic)
do burn pt get O2 right away?
yes, it is best to get them on hi flow NRB at 15L/min immediately, humidified O2=better
when to use sterile dressings..
partial thickess>15% BSA, full thickness >5%BSA, burn surfaces coming in contact w eachother ex: fingers
how to prevent hypothermia in a burn pt?
blankets, foil blanket, ambient warming, fluid resus( IV, RL/NS)
parkland formula?
- recommended for >15% BSA in kids and >20% bsa in adults
= vol of RL= 4mLx%BSAxweight(kg)/ 2
1/2= 1st 8 hrs
1/2= next 16 hrs
why is it important to manage pain asap?
to reduce psycho trauma for the pt, +immune function/wound healing
(multi modal analgesics= recommended)
When to transfer to a burn facility?
- full thicknes in any age
- partial thickness >10% BSA
- any burn involving critical areas ex: hans/feet./face/genitals etc
- significant chemicl injury, electric, lightning, coexisting majortrauma/preexsisting medical conditions
- inhalation burns
