Injuries that result from direct contact with or exposure to a thermal, chemical, electrical or radiant source
The severity of the burn injury is related to... (3 things)
Source of the energy
Temperature of the source
Duration of exposure
Any burn injury causes an _________ _________ _______ and a release of ___________ ____________ resulting in a major fluid fluid shift, edema & decreased blood volume.
acute inflammatory response
4 Types of Thermal Burns
3 Types of Chemical Burns
3 Types of Electrical Burns
Electric shock from faulty wires
High Voltage Wires
2 Types of Radiation Burns
Exposure to Radioactive Source
Where do the majority of burns (which are accidental) happenen?
Which age groups are at highest risk for burns?
Young Children under 3
Senior Adults over 70
What education would be involved with helping parents reduce the risk of burns at home?
Decrease water temperature
Easy to handle handles at sinks/tubs
Adequate supervision near heating sources
Reduced clutter near heat sources
Smoke and fire detectors in place
Superficial Partial-Thickness Burn
-Skin layers involved
-also called which type
-how does it heal
1st Degree Burn
Involves the epidermis & part of the dermis
Little, if any blister formation
Usually heals well w/o scar tissue
Sunburn or other minor burns (examples)
Deep Partial-Thickness Burn
-also called which type of burn
-which skin layers involved
-how does it look & feel
-what is necessary w/ large areas?
2nd Degree Burn
Involved the epidermis & part of the dermis
Painful & swollen
Large areas require grafting
May result in scarring
High risk of infection
-also called which types of burns
-which body structures are involved
3rd & 4th Degree Burns
Destruction of all skin layers & often underlying tissues
Appears hard & dry at the surface (eschar)
Usually requires significant surgical repairs including skin grafts (may be completed in stages)
Many burns are at mixed levels of injury
2 Methods of Determining the Size of a Burn
Rule of Nines
What is the purpose of determining the percentage of a burn?
--which method of burn size is used to do this initially?
For treatment purposes-- to know amount of fluid loss and which burn center the patient should be transferred to--Rule of Nines
What is the Rule of Nines and describe how it works
Easy & Quick method for calculating the size & extent of burn injuries
The body is divided by sections. Each section is considered to be 9% of the body surface area.
Used easily by emergency personnel
Lund-Browder Method (LBM)
Modifies the percentage of the Rule of Nines for more specific calculation (gender, size, age)
6 Effects of Burn Injury (both local & systemic)
Dehydration & Edema
Increased Metabolic Needs for healing
-what sets this apart from other burn injury complications & why?
-what does this result from?
-which organ is effected?
-how are patients treated?
Most serious of the systemic effects
Results from massive fluid & protein shifts
Electrolyte imbalances may lead to kidney dysfunction
Patients require fluid and electrolyte replacement as well as plasma infusions
Multiple organ system response may result in failure or death
Respiratory Concerns of Burn Injuries (4 bullets)
Inhalation of toxic or irritating fumes may interfere with the transport of hemoglobin
Damage to the lining or the trachea
supplemental O2 for a period of time for healing
Lung infections are a significant risk
What is a pharmacological method used to help patients deal with the tremendous pain of burns?
Medically induced coma (high doses of narcotics to keep patients in a stupor to deal with pain)
increased metabolic needs
How do burns effect metabolic needs?
hypermetabolism to maintain body temperature
May need hyperalimentation by infusion
Being fed through a feeding tube
Used for people who require 10-15,000 calories a day
Treatment for Burn Injuries (systemic & life threatening effects)
Respiratory and airway challenges (breathing machine)--remember how Cargon Monoxide poisening happens
Hemodynamics (blood volume)
Treatment for Burn Injuries: Surgical procedures involved with the healing of large/deep wounds
Removal of non-viable tissue by debridement
Covering of wounds by grafting (TransCyte, Integra)
Treatment for Burn Injuries
-What do we worry about concerning the joints due to burns?
-What is a concern for burn patients even after their wound has improved?
Prevention of hypertrophic (thick) scaring and contractures is a critical component of burn recovery and rehabilitation (compression helps tissue grow in a flat manner & exercise to improve ROM)
Basal Cell Carcinoma
Skin tumor originating in the epidermis
Non-invasive and does not metastisize
Very common Especially w/ high sun exposure
Most lesions are small & easily excised
May recurr locally (not spreading)
Mohs' Surgery common to improve appearance & resolve carcinoma
Most common treatment approach for Basal Cell Carcinoma
Results in the best cosmetic appearance along w/ resolution of the carcinoma
Squamous Cell Carcinoma
Slightly less common than Basal
May in insitu (local) or invasive (grow large)
Usually seen in the high risk exposure population
May have slightly worse cosmetic outcomes due to local invasive process
Squamous Cell Carcinoma
-what is it
-where is it found
Painless, malignant tumor of the epidermis
Lesions most commonly found on exposed areas of the skin, but also in oral cavity. (Face, neck, base of tongue)
Excellent prognosis when lesion is removed w/in resonable time
Arises from the melanocytes (melanin in skin--skin color)
Arise from nevi (multi-colored, ireegular border)
~5% of cancers (rate increasing)
Spreads quickly &insiduously to underlying tissue & adjacent lymphatic
More serious than other skin cancer, because it may result in DISTANT METASTASIS)
ABCD of Melanoma
Change in APPEARANCE
Change in BORDER
Change in COLOR
Increase in DIAMETER
Risk Factors of Malignant Melanoma
-What increases the risk (2 things)
-How can prognosis be improved
-What are 2 methods of treatment
Genetic links to Celtic/Scandinavian ancestry
Artificial exposure to UVA
Early diagnosis results in improved surgical outcome (may require chemo/radiation depending on lesion depth)
What is the function of the cardiovascular system?
Coordinate w/ the pulmonary system to circulate oxygenated blood through the arterial system to all cells & also collect deoxygenated blood through the venous system and return it to the lungs for oxygenation.
Where is the heart located?
Mediastinum b/t the lungs in pericardial sac (double-layered w/ small amt. of fluid b/t layers)
--Fluid subjective to infection & inflammation
What is the actual muscle of the heart called & what are it's 2 important characteristics?
Myocardium (striated & involuntary)
What divides the atria of the heart
Separate the atria from the ventricles
Right: Tricuspic Valve
Left: Mitral/Bicuspid Valve
Located at the entry to the large arteries from the ventricles
Aortic Valve (systemic)
Pulmonary Valve (lungs)
-what is responsible for cardiac contractions
-what is the rate of contraction & how is it altered?
Cardiac contractions are initiated & controlled by the sinoatrial node (SA node) located in the wall of the R. Atrium
SA node generates impulses for contraction at ~70 beats/min.
--altered by presence of hormones or ANS
Pathway of Conduction
SA node--> atria contract-->AV node-->AV bundle/bundle of His-->Terminal Purkinje fibers--> ventricles contract
How do we monitor the pattern of conduction?
Electrocardiogram (EKG or ECG)
What is the control center of the heart?
Medulla Oblongata (brain stem in the back of the head)
In early Stages, Hypertension is ___________. (has to do with symptoms)
Initial signs vague and non-specific (fatigue, malaise, sometimes morning occipital headache)
Steps of Treating Essential Hypertension (5)
Reduction of Sodium intake
Reduction of Stress
Drugs (diuretics, ACE inhibitors, drug combinations)
What is the Function of the Respiratory Tract?
Provide the mechanisms necessary for transporting oxygen and for removing carbon dioxide from the blood
The function of the Respiratory System Requires what 2 things?
Ventilation: The ability to move air in and out of the lungs on a pressure gradient
Respiration: The gas exchange that supplies oxygen and removes CO2
Name the structures of the UPPER respiratory Tract (5)
Name the Structures of the Lower Respiratory Tract (4)
Bronchi & Bronchioles
What is the function of the UPPER AIRWAY? (6 bullets)
-what does it do to the incoming air
-what part removes irritants from the air
-what provides additional protection
-Function of the larynx & trachea
Warm & Moisten incoming air
Cilia remove foreign irritants from air
Tonsils and other lymphoid tissues provide additional protection
Epiglottis protects the respiratory structures from aspiration of food
Larynx: Vocal Cords that vibrate with the expiration of air producing the sound of voice
Trachea: Windpipe that is composed of smooth muscle and elastic tissue that is supported by C-Shaped rings of cartilage
Lower Respiratory Tract Infections
-what is it caused by? (which pathogen)
-where does this pathogen thrive
-what is required to diagnos this
-complications if left untreated (4 things)
Caused by Leionella Pneumonophilia ( thrives in warm, moist environments... often nosocomial infection)
dificult to Identify, requires special culture medium
Untreated Infections cause severe congestion and consolidation, necrosis in the lung, possibly fatal
Lower Respiratory Tract Infections
--Sever Acute Respiratory Syndrome--
-what is the causative agent
-which type of transmission
-what are the first signs
-what are the later signs
Acute Respirator Infection
Causative microbe SARS- associated coronavirus
Transmission by respiratory droplets--close contact
First Signs: Fever, headache, myalgia, chills, anorexia, possibly diarrea
Later Signs: Effect on lungs evident: dry cough, marked dyspnea; areas of interstitial congestion, hypoxia, mechanical ventilation may be required
How is SARS Treated? (2 things)
High fatality rate
Prevention of SARS and how it's spread (4 bullets)
Risk Factors (monitored to prevent outbreaks)
Travel to areas where endemic or epidemic or Contact w/ such traveler
Presence of a cluster of undiagnosed atypical pneumonia cases
Employment involving close contact with the virus (active cases quratines until clear of infection)
Lower Respiratory Tract Infections
-what are the 3 types?
Secondary or Re-Infection
Active TB (either primary or secondary)
Tuberculosis: PRIMARY Infection
-what happens when the organism first enters the lungs?
-what happens if cell-mediated immunity is inadequate?
When organism first enters the lungs
Engulfed by macrophages=local inflammation
If cell-mediated immunity is inadequate: Mycobactyeria reproduce and begin to destroy lung tissue
This form of disease is CONTAGIOUS!
Tuberculosis: If Cell Mediated Immunity IS adequate in PRIMARY Infection
Some bacilli migrate to lymph nodes-granuloma-formation of tubercle (contains live bacilli)-walled off and calcifying
Tubercle may be visible on chest rediograph
Bacilli may remain viable in a dormant stage for years
Individual's resistance and immune resposes high-bacilli remain walled off
Primary or latent infection: Individual has been exposed, infected, but does not have disease and is asymptomatic
Individual cannot transmit disease
Tuberculosis: SECONDARY or Re-Infection
-when does it occur
-what impairs immunity
Occurs when client's cell-mediated immunity is imapired due to stress, malnutrition, HIV infection, Age
Mycobacteria begin to reproduce and infect lung
Active TB, which can be spread to others
Active TB (primary or secondary)-4 bullets
Organisms multiply, forming large areas of necrosis: causes large open areas in lung (cavitation)
Cavitation promotes spreading into other parts of the lung: Infection may spread into pleural cavity