Week 2 - Lecture 3 - Clinical Models Flashcards
burn injuries
caused by a trauma injury
burn injuries cause an inflammatory response
- in the skin
- in other integumentary structures
6 functions of the skin
protection : 1st line of defence -physical barrier
body temperature regulation
cutaneous sensation
metabolic functions (vitamin D activation)
blood reservoir
excretion
Burn pathophysiology
burns are caused through
direct contact with excessive heat, radiation, caustic chemicals or electricity
- heat will denature proteins causing irreversible cellular damage
all burns result in acute inflammatory response
burn severity is correlated with exposure type and time of the affected surface area
Burn pathophysiology classification
superficial partial thickness (first degree)
epidermal damage only
vasodilation of dermal blood vessels
increased capillary permeability
- localised redness, warmth, oedema (swelling) pain
do not result in cell necrosis or scarring
extracellular matrix remains intact
healing is rapid
Deep partial thickness( second degree) burns
epidermal and upper dermal damage epidermal and dermal layers separate - fluid accumulates, blisters appear loss of function: 1st line of defence Tissue necrosis are common, tissue fibrosis, scarring healing occurs within 2-4weeks
Full thickness (3rd degree) burns
entire thickness of skin involved
-epidermis, dermis, subcutaneous
skin gray- white, cherry red, or blackened
not painful (nerve ending destroyed)
healing is difficult due to extensive tissue loss
skin grafting usually necessary
regeneration of epithelial cells impaired
scarring is extensive
loss of elasticity leads to contractors
loss of skin function: multiple complications (in severe burns)
microorganism invasion -infection body fluids shifts - impaired blood circulation, oedema (swelling) dehydration and electrolyte imbalance - leads to renal shutdown and circulatory shock overwhelming metabolic demand - increased risk of malnutrition temperature regulation problems
Burn pathophysiology cont’
significant hemodynamic changes - changes in the flow of blood in tissues and organs
poor perfusion
- problematic for vital organs
- constant flow of oxygen required
inadequate blood in circulation can lead to hypovolemic shock
fluid volume replacement required
Access for microorganisms in burns means
significant risk for sepsis development
- bacterial infection of the blood
significant risk for septic shock
- massive inflammatory response due to bacterial toxins in blood
in full thickness burns : dead tissue and exudate convert into an eschar
- thick coagulated crust made from dead skin
- requires surgical removal to prevent further microorganism growth within the dead tissue
extensive demand on metabolic and reparative processes
- increased energy, oxygen, protein needs
- not sufficient nutrients available will lead to tissue wasting, hypoxia and infection
burn diagnosis
wound depths are classified according to the affected tissue layers
brun clinical manifestations
depend on depth of burn injury
superficial- partial thickness burns show the 5 signs of inflammation
deep partial thickness burns
- blistering occurs, erythema, pain, oedema, serous exudate
full thickness burns
- erythema, eschar, oedema, exudate
- destroyed nerve endings inhibit pain response from burn penetration area
- not pain free : nearby tissue suffer from partial thickness burn
- pain perception according to bull’s eye
surface area of 9
slide 15
critical burn if
> 25% of body has second degree burns or
10% of body has third degree OR
if the face, hands, feet or respiratory passages bear third degree burns
burn treatment
increased survival rates
minor and moderate burns
- remove source of injury
- stop burning process
- chemical burns flushed with plenty of water
- wound can be cleared with water
- antimicrobial ointment applied
- dressing
changing dressing frequently helps debridement
what is debridement
the mechanical removal of debris and necrotic tissue
burn treatment for moderate and major burns
emergency medical admission
includes any third degree burns to the face, hands, feet or respiratory system
respiratory passageway burns may lead to suffocation
-specialised intervention
initial focus
-stabilise airways, breathing and circulation
- fluids : replace water and sodium, restore circulation
nutrition: increased metabolic demand
antibiotics : infection
analgesics : pain management
wound management for major burns
removing necrotic tissue
closing wounds
preventing infection
hydrotherapy to cleanse the wound, remove dead tissue and exudate
skin grafting for full thickness burns
- full thickness burns use the replacement healing process
- unable to undergo re-epithelialisation
-transplanted tissue supports cellular regeneration
-decrease infection
-minimise scarring
long term rehab (tertiary prevention)
severe scarring contractures (shortening and hardening of tissues) deformity and immobility chronic pain depression, psychological issues
What is arthritis
inflammatory disorders that involves damage to articular cartilages of synovial joints
acute forms of arthritis : caused by bacteria via traumatic joint wound - treated with antibiotics
arthritis caused by chronic inflammation
- RA
-Gouty arthritis
OA is not caused by inflammation
function of synovial joints
articulation : site where two or more bones meet
function of joints
-give skeleton mobility
-hold skeleton together
synovial joints
- highly vascular
- two layer synovial membrane
- connective tissue layer
- synovial cell layer : fluid production
- bone separated by fluid filled joint cavity
- freely movable
- include limb joints; most joints of body
common target for inflammation
RA pathophysiology
RA is systemic autoimmune disease
chronic inflammation of synovial membranes and synovial hyperplasia
-increased synovial fluid production
-swelling and thickening of synovial membrane
-joint erosion
-pain
onset between 36-50 years
RA affect 0.8% of adults worldwide
F= 3x more
autoimmune =
the immune system attacking healthy tissue
